Knee replacement surgery in Bath

Knee replacement surgery (also called knee arthroplasty) is a surgical procedure that involves replacing your damaged, worn or diseased knee with an artificial joint.

Knee replacements can improve the quality of life for many people with severe knee pain, stiffness and mobility issues.

Adults of any age can be considered for a knee replacement. However, most knee replacements are carried out on people between the ages of 60 and 80.

The internationally-trained orthopaedic surgeons at Bath Clinic use robotic-assisted knee surgery to improve the precision and accuracy of the procedure. Robotic-assisted surgery also reduces the risk of complications.

The technology used at Bath Clinic is called Mako®robotic-arm, and it is a valuable addition to the clinic’s Centre of Excellence in Joint replacement.

This centre is available to patients living in Bath, Bristol, and Wiltshire.

Using robotic-assisted surgery: The Mako® robotic-arm

Dr. Clark explains how the Mako® robotic-arm works in knee replacement surgery. “The Mako is involved in two ways: firstly, it does a CT scan of the leg — that’s a very, very precise and accurate scan of the bones.”

“Then the scan is uploaded into the Mako’s ‘brain,’ if you like, in its computer, and then it puts some ‘pins’ in the legs of the Mako. So, the Mako can ‘see’ where the leg is at all times.”

The surgery is then planned on the computer, Dr. Clark explains. The robotic device also adds an international, collaborative dimension to the surgery. “The scan is sent off to the States, and the initial plan is made there.”

Increased knee replacement accuracy and precision

“In the surgery, you deliver that plan, and you can make your bone cuts within 0.1–0.2 millimetres of accuracy [...] That’s one-fifth of a millimetre, so it’s very accurate.”    

“Even better than that, it then enables you to assess the tension in the knee, the tightness, and to balance that in different parts of the knee,” Dr. Clark explained.” By adjusting the planned implant position very precisely, the knee can be balanced with greater accuracy than previously possible,” he adds.

This initial plan is done by the surgeon in collaboration with the U.S.-based Mako team, and then the final “tweaks” of fine-tuning the tightness of the knee are done in the surgery.

Better knee replacement outcomes

"The main takeaway", Dr. Clark explains, is that the Mako is very accurate, and “the recovery is thought to be faster when you use the Mako knee replacement than with normal knee replacements.”

Dr. Steve Pope, another consultant orthopaedic surgeon at Bath Clinic, agrees that the Mako robotic arm can be beneficial.

He says, “Although we're still waiting for hard evidence that it provides better outcomes in the long run, it probably will be shown to be beneficial because of improved accuracy of placement of the prosthesis.”

To understand what happens during a knee replacement surgery, we must first look at how the knee joint works.

A joint is an area where two or more bones meet and are held together by several muscles, ligaments, and tendons. Your knee joint is made of two long leg bones — the femur and the tibia. In the knee joint, the surface of the two main bones is covered by cartilage, which absorbs shock, stops the bones from rubbing against each other, and protects the knee.

The cartilage in those who need a knee replacement is most commonly damaged by osteoarthritis or other forms of arthritis.

During a knee replacement operation, your surgeon will remove the damaged cartilage. After doing this, they will attach artificial parts made of metal and plastic to the end of the bones, which gives your knee a new surface. For this reason, knee replacement is also called ‘knee resurfacing’.

There are a few different reasons and health conditions that may lead to you needing knee replacement surgery.

The most common causes of knee replacement are three types of arthritis:

• Osteoarthritis (OA): this is the most common form of arthritis in the world and the most common reason why people get knee replacements. People with advanced OA may have severe joint pain and stiffness that interferes with their daily activities. They may not be able to walk, climb, kneel, or run because of the pain. People with severe OA may also have bony swelling and joint deformities, such as a bent knee. They may find it hard to keep their balance and have a ‘giving way’ or ‘buckling’ sensation in their joints.

• Rheumatoid arthritis (RA): this is an autoimmune disorder that leads to inflammation of the synovial membrane — the tissue that encapsulates the joint. Synovial membranes normally secrete synovial fluid, which helps to lubricate the joint. But in RA, the inflamed synovial membranes lead to an excess of synovial fluid, which in turn causes swelling, pain, soreness, and stiffness. Over time, RA damages the knee by eroding the cartilage and bone.

• Post-traumatic arthritis (PTA): this condition results from acute direct trauma to the knee. Symptoms include swelling, excessive synovial fluid, pain, and sometimes bleeding within the joint. PTA often resolves on its own, but chronic PTA may also damage the knee joint over time.

Fractures, torn cartilage, or torn ligaments may also cause damage to the knee joint that may require knee replacement.

You may want to consider knee replacement when non-surgical, medical treatments have not helped or have not helped enough.

Such non-surgical treatments for knee OA include:

• Physiotherapy
• Non-steroidal anti-inflammatory drugs (NSAIDs) or other over-the-counter painkillers and anti-inflammatory medication
• Corticosteroid injections into the knee joint
• Avoiding activities that cause pain
• Assistive devices that may help redistribute the body weight more evenly, such as canes or more advanced technologies such as a biomechanical shoe
• Weight loss (for overweight or obese people)

“A knee replacement is essentially one of the treatments that you can [try] and certainly, if what you have is not working, then you should definitely try it,” says Dr. Damian Clark.

“Every case is different", adds Dr. Clark, who is a consultant orthopaedic surgeon specialising in knee replacements at Circle Health Group’s Bath clinic.

How ‘bad’ does a knee have to be before replacement?

“When the knee starts affecting your life, reducing your enjoyment of life, or affecting your social life, then you may need to consider having some other treatments to your knee that might [include] a knee replacement,” says Dr. Clark.

“A good way to think about it is to think about mortality,” he continues. “As soon as you have a level of disability from your knee, even if it’s minor, then it would be reducing your cardiorespiratory fitness, your ability to stay mobile, and — believe it or not — it may shorten your life as well.”

The impact of knee pain on physical activity levels is also a key factor to consider. If your knee pain is “reducing activities or if there are things that you used to be able to do but you can’t do anymore because of your knee arthritis, that’s when you really need to get it sorted,” advises Dr. Clark.

Knee replacements can be partial or total.

In a partial knee replacement, your surgeon will only replace the damaged parts of your knee with a prosthesis. This procedure is less invasive.

A total knee replacement involves replacing both sides of the knee joint — that is, the ends of the bones that form the joint — and sometimes also the kneecap. These are replaced with prostheses made of metal and plastic.

These parts are usually held together with cement, although some knee replacements work without being cemented.

Over 100,000 knee replacement operations are carried out in the United Kingdom every year.

Still, knee replacement is major surgery and therefore comes with risks.

The following complications may occur:

• Blood clots
• Infection in the knee
• Infection in the chest
• Excessive bleeding
• Stiffness
• Damage to the nerves — people may sometimes develop a patch of numbness on the outside of their leg
• Damage to blood vessels
• Fracture
• Continued pain

“Eight out of 10 people are completely happy with the results of their knee replacements, but two out of 10 will still have some problems, such as pain,” explains Dr. Clark.

“Occasionally you get unexplained pain afterwards, and very severe complications such as stroke, heart attack, COVID-19, death, and amputation are thankfully very rare,” adds Dr. Clark.

There are certain things your consultant will need to check before your surgery to ensure the safety of the procedure.

They will ask about your complete medical history and may perform a complete physical evaluation to make sure you are in good health.

They will likely ask if you are on any current medication, if you have any allergies, any history of excessive bleeding or blood-thinning medication. Your consultant will also discuss with you what medication you will have to take after the surgery.

You may also be asked to avoid certain foods or fast before your surgery.

Finally, there are also things you can do before the surgery to ensure your recovery is as speedy as possible:

• Stay active with low-impact, gentle exercise before your surgery
• Avoid drinking alcohol
• Lose excess weight
• Ensure your home is comfortable and has no tripping hazards for when you return

Your consultant will guide you on the steps you can take before surgery to support your knee replacement recovery.

The actual surgery takes about one and a quarter to one and a half hours, says Dr. Clark. The recovery is, naturally, a much longer process.

“Usually the patients will find that the first night is quite difficult,” says Dr. Clark, adding that in the first two weeks, the pain can sometimes be worse than it was before the surgery.

Then, by six weeks, the pain might be back to what it was before the surgery, or already better. 

“From there onwards, the knee will continue to gradually improve,” explains Dr. Clark. “Usually, about 12 or 18 months later, you will reach your maximum. Most of the recovery comes in the first few weeks. But there is still slow recovery that happens after that.”

How long will you be in hospital after knee replacement surgery?

Patients are usually in the hospital for only two nights. “Almost all of the recovery will happen outside of the hospital,” Dr. Clarke says.

“In the hospital, we have the knee put in, it’s firmly placed and ready to go, but because the knee has just been through a big surgery it will be very swollen and sore, and then the recovery begins after that.”

“The vast majority of the recovery takes place at home.”

What you can do and what not to do after knee replacement

Many people are wondering what are some of the things that a person should avoid doing immediately after knee replacement surgery. How long before you can walk, kneel, or drive are common concerns.

“You can walk on the same day of surgery,” Dr. Clark says. There is no limit to the amount of walking or distance walked, as it varies from person to person.

“At six weeks, you can usually start driving again if you can safely control the vehicle and the doctor says it’s okay.”

However, Dr. Clark stresses the fact that patients will have to take it easy for the first 6–8 weeks. “You’re not going to do the knee any damage,” he reassures, and “there’s no restriction on the knee per se, but you really just need to do your physiotherapy and take it easy for the first six weeks.”

Regarding flying and air travel, Dr. Clark advises that patients consider the risk of blood clots when making the decision to fly. “There are no fixed restrictions, but you just need to consider [...] the risk [and make sure] you are happy to travel.”

Can you kneel after a knee replacement?

Dr. Clark explains that, while it is perfectly safe to kneel once you’ve recovered from knee replacement surgery, most people with arthritis avoid kneeling due to their underlying condition.

“There's nothing to stop you and there's no rule that says ‘you can't kneel’ [after knee replacement], but most people don't like it because it feels unpleasant.”

How long does a knee replacement last?

Total joint replacement typically lasts between 15 and 20 years.

Most current data suggests that once you have a total joint replaced, you will have a 90–95% probability that the joint will last 10 years and an 80–85% probability that it will last 20 years.

However, more recent research appearing in The Lancet has examined several national registries across the globe and concluded that over 82% of all total knee replacements last 25 years.