Knee surgery

Diagnosis and treatment for your knee problems

Our Orthopeadic Surgeons have a special interest in lower limb joint replacement and reconstruction, with knee replacements and any soft tissue surgery of the knee – including ligament reconstructions and arthroscopy – available at the hospital.

Patients who visit us at Albyn present with a host of knee-related symptoms, including pain, discomfort and reduced function.

Knee replacements are one of the most common surgeries, with demand increasing year on year, due to an increase in the elderly population, whose joints tend to wear out.

Younger patients will visit us too, as many of them are unwilling to suffer with the pain and restrictions of their day to day activities.

There are two strands within knee replacement – one of them focuses on robotics. This involves putting a standard knee replacement in using a robot to help the surgeon.

Many knee surgeries are now performed with the assistance of robotic equipment says our Orthopeadic Consultant who fits robotic knees regularly here at Albyn Hospital.

Robotic arm surgery is transforming the way knee surgery is done. The benefits for the patient of joint replacement using the robotic arm (over conventional joint replacement) include:

Reduced length of stay
Less pain
Improved early functional outcome.

There are two types of knee surgery available here:

Conformist knee surgery
Robotic knee surgery.

A CT scan is carried out before a robotic-assisted knee replacement – and the scan that is performed pre-operatively will be sent to the company which provides the robot. The robot itself is called the Stryker Mako robot. During the procedure, trackers are placed on the patient. This allows the robotic arm to know exactly where the patient’s bony landmarks are, which allows for more accurate positioning of the components – to within a millimetre of the desired position.

In 2020, Albyn Hospital completed its 100^th surgery using the robotic arm – and there have been many more life-changing surgeries since.

The Conformis iTotal knee replacement is another option, which involves getting the exact position and size right before surgery. Our surgeon will then implant the knee at the time of the operation.

In fact, most total knee replacements performed here in the UK are non-robotic (a safe and well-established technique) and only around 10% of patients opt for the newer robot assisted techniques.

The cost of the robotic assisted knee and the custom fit knee are roughly equivalent, at being 15% more than a standard total knee replacement. At Albyn Hospital, four surgeons carry out robot-assisted total knee replacements and three carry out Conformis Custom-fit total knee replacements. All these surgeons also carry out traditional total knee replacements, too, which is often a better option for some patients.

The total knee replacements (TKR) used today are predominantly based on technology first introduced in the 1980s. Despite this long history, the reality is that, although knee implants survive well and can last a long time, up to 20% of patients report they are not satisfied with their outcome.

Customised knee replacements, however, are designed to improve patient outcomes and satisfaction. They also offer improved longevity of the implant.

A bespoke implant is about 15% more expensive than a tradition implant, but all major insurers now approve Conformis procedures and at Albyn Hospital we have of the most competitive pricing for this technology.

With regards to out-patient treatments that we do here, we’re looking at joint conservation prior to surgery.

If you and your consultant decide that a customised knee replacement is the right option for you, this is what happens:

You will be booked in for a CT scan of your knee
Images will be transferred to Conformis – the manufacturer, in the USA.
Your surgeon will then order your implants directly with Conformis
From this point, the process takes around six weeks and you can then be booked in for surgery.

During the surgery, special 3D printed instruments made from your CT scan will be used to make accurate cuts on your bones. This will ensure that your customised implant fits perfectly. Following surgery, you will undertake physiotherapy to strengthen the muscles in your leg and make sure the best result possible is achieved.

Patients can be treated with injection therapies – including PRP (platelet-rich plasma) injections – as out-patients.

There is also the option of hyaluronic acid injections, and unloader osteoarthritis braces, along with physiotherapy and rehabilitation.

Our Consultants say they ‘are not all about surgery’ and if there is a less invasive option, it will always be explored first.

Usually, the patient’s GP will have gone through all the options before the initial consultation –simple things like painkillers, modifying your activity, reducing weight, physiotherapy, and using walking aids. Normally, the GP has tried a lot of these things before the patient arrives at Albyn.

If they haven’t tried any of these modalities, then of course, they will be tried, before the patient reaches the stage where a joint replacement is the only option remaining – and it's necessary.

Often, patients will have had knee x-rays before they come to Albyn. If not, that will be done on the day and this will confirm the diagnosis. Only in a rare case, would an MRI scan be required. So, in the vast majority of cases, a simple x-ray will confirm the diagnosis, which they have either already had, or can be done on the day.

At Albyn, we try everything possible to prevent an operation or delay the time before the operation is required, but it’s a balance between quality of life and risks of the operation.

If a patient can no longer deal with their problem, they are fed up, or their restrictions on day to day life are significantly affected, it may be time to have a joint replacement.

Depending on what time of the day a knee surgery operation is performed at Albyn, patients can be up and about and begin walking.

In years gone by, the standard was for patients to stay in bed for two days, and only after that would they get up. However, today the surgeon and anaesthetist do lots of things slightly differently in the operation to try and improve the pain relief afterwards, to allow patients to get up quicker.

Patients tend to feel better once they are up and can get going. This also reduces the risk of the operation, to minimise the development of a blood clot in the leg. So, getting up and going is essential, as soon as possible, as long as they are comfortable to do that.

Patients are on average in hospital for about three days – they’re in and out.

Albyn has access to all the latest equipment and technology that we need to operate in theatre, in addition to the diagnostic scanners. We are also looking at new techniques for custom-fit total joint replacements, particularly total knee replacements, which would enable our Consultants to make the knee replacement to exactly fit the patient and thereby get the best function and quickest recovery.

Here are some at-a-glance reasons to choose Albyn Hospital:

Shorter waiting times – Patients who visit Albyn Hospital can make the most of shorter waiting times, meaning you can get back on your feet much quicker following a knee injury or complaint. Albyn also offers innovative robotically-assisted surgery.
Flexible appointments – You can choose an appointment time to suit you and your schedule; in some cases, remote consultations will be offered too.
Consultant-led appointments – Your appointment will be consultant-led, and you will see the same person each time – from your consultation, right through to any treatment needed.
Patient satisfaction and personalised care – In an independent survey* in 2020, 98.9% of our patients said they would recommend the hospital. *Results were compiled by independent healthcare agency, Quality Health.