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Knee replacement surgery

Knee replacements are a common surgery that helps patients regain movement and flexibility in their knee joint

As a weight-bearing joint, the knee is put under a great deal of strain each day. Over time, prolonged wear and tear, as well as degenerative joint conditions such as osteoarthritis, can lead to significant pain and loss of mobility.

The best way to overcome this issue is to have surgery to replace the knee joint.

According to the National Rheumatoid Arthritis Society, more than 100,000 knee replacements are carried out in the UK every year. Despite the complexity of this joint, modern knee replacements are extremely safe, successful and long-lasting, restoring the quality of life of patients who receive them.

“Getting a knee replacement will enable patients to rediscover lost movement and flexibility in their knee joint, as well as helping to eliminate the pain and discomfort they’ve been experiencing. The value of this surgery to improving patient lives shouldn’t be underestimated.”

Mr Tom Pollard, Consultant Orthopaedic Surgeon, Circle Reading Hospital

Also known as knee arthroscopy, knee replacement is a surgical procedure designed to replace either parts of the knee or the entire joint with an artificial joint. Replacing just part of the knee tends to be referred to as a partial knee replacement.

The goal of knee replacement surgery is to relieve knee pain that can’t be controlled using other treatments, and to restore movement and strength to the joint.

Partial vs. total knee replacement

There are three different compartments in the knee joint. These are:

  • The patellofemoral compartment, where the kneecap and femur meet
  • The medial femorotibial compartment, or the inside of the knee
  • The lateral femorotibial compartment, or the outside of the knee

A partial knee replacement replaces only one part of the knee. This could be the inside (medial) part, the outside (lateral) part or the kneecap part (patellofemoral compartment).

What happens if another part of my knee requires surgery after I have already had a partial knee replacement?

It’s not uncommon for someone to have a partial knee replacement, only to need further surgery down the line.

In this instance, you will almost certainly be given a total knee replacement, rather than simply having another small area of the knee restored.

Your surgeon will discuss with you what to expect and make you aware of any additional risks that may be involved.

I need both knee joints replaced. Will I be able to have knee replacement surgery on both knees at the same time?

A double knee replacement is usually referred to as a bilateral knee replacement and is very rare.

The main reason for this is because the recovery period for even a single knee replacement is extensive, and this more than doubles when both knees are replaced at the same time.

Instead, most patients are offered to have the surgery on one knee at a time, which enables them to go through a much more manageable recovery period.

In the past, joint replacement surgery was largely thought of as being something only carried out on older patients, whose joints had been severely affected by wear and tear. However, knee replacement surgery is today carried out on patients of all ages and lifestyles. 

By far the most common reason for knee replacement surgery is osteoarthritis. “Damage to the knee joint caused by osteoarthritis is the cause of between 80% and 90% of knee replacements at our Reading hospital”, states Mr Pollard.

Osteoarthritis is a condition characterised by degeneration of the joints, and while it is more common in older patients, it can affect anyone of any age.

Other causes of knee replacement surgery include:

  • Secondary arthritis, such as rheumatoid arthritis
  • Traumatic injuries to the joint, such as those sustained in a crush or fall
  • Infections, such as those seen in septic arthritis
  • Gout
  • Disorders that cause unusual bone growth

Circle Health Group hospitals understand the importance of treating each patient as an individual. As such, exactly how quickly you will be offered knee replacement surgery will depend on various factors affecting your individual circumstances.

In the early stages of a condition like osteoarthritis, patients often manage their knee pain and stiffness using a combination of pain relief and anti-inflammatory medications and physiotherapy.

These can be effective for some time, before the patient decides that they are no longer providing enough relief from the pain and stiffness in their knee, at which time, further treatment in the form of surgery may be discussed.

However, there are also circumstances in which patients may be offered knee replacement surgery right away — for example, if you have been involved in an accident and the knee bone has been damaged.

When will a knee replacement be offered?

Typically, patients are offered a knee replacement when:

  • They are suffering from severe pain, swelling and stiffness in the knee
  • Their mobility is reduced
  • Their knee pain keeps them awake at night
  • It becomes difficult to perform day to day tasks like driving, shopping and walking up and down stairs
  • Their pain and mobility issues are affecting their mental health
  • They are unable to work or socialise because of the pain and mobility issues caused by their knee

“Getting a knee replacement can significantly restore the quality of life of a patient who has been experiencing chronic pain and mobility issues” – Mr Pollard.

There is no right or wrong time to get a knee replacement, but Mr Pollard advises patients not to delay the procedure too long. “All the time you delay, the joint will get increasingly stiffer, and this can prolong your recovery, as well as affecting the overall outcome of your knee replacement surgery”. 

When you choose to have knee replacement surgery at Circle Reading Hospital, you can relax knowing that you are in the safest of hands.

Our dedicated knee surgery unit provides the very best clinical care for our patients. We combine the expertise and experience of leading orthopaedic consultants with the very latest diagnostic technology.

Preparing for knee replacement surgery

As with any surgery, knowing what to expect and undergoing the right preparations is crucial for helping to keep you calm and comfortable in the days leading up to your surgery, and for your recovery period afterwards. 

Your surgeon will talk to you about the best ways to prepare for your surgery, but this will typically involve:

  • Making arrangements for someone to help with pet/childcare, if required
  • Preparing your home for your return. This may mean setting up a sleeping area downstairs so that you don’t need to go up and down stairs until you are ready, filling your freezer with meals and arranging for someone to come in and clean for you
  • Staying as active as you can. This will help keep the muscles around your knee strong, which is vital for your recovery following surgery
  • Stopping any medications advised to you by your orthopaedic surgeon

You won’t be able to drive for a number of weeks after your knee replacement procedure, so it’s important that you factor this into your preparations and make alternative arrangements for any trips that you may need to make, including your post-operative check-up.

Your pre-operative appointment

You will also need to attend a pre-operative appointment around a week before your surgery. This is to ensure that you are physically and mentally ready for your surgery.

You’ll undergo a full health check, and a member of your care team will speak to you about what to expect at each stage of the surgery and recovery. They will also be able to answer any questions that you have.

You will be in hospital for between three and five days, so it’s important to take everything that you might need with you on the day of your surgery. This should include changes of nightwear and clothes, toiletries and other personal hygiene items, your phone, charger and headphones and anything you want to keep you entertained during your stay.

You will not need to bring any pain relief, but you should bring any other medications that you usually take.

The day of your knee replacement surgery

Knee replacement surgery is usually performed under general anaesthetic, meaning that you will be asleep before you enter the operating theatre and will wake up in recovery.

However, in some cases, it may be possible or advisable for a patient to have their knee replacement surgery under a spinal block combined with sedation to keep them calm and comfortable. Anaesthetic options can be discussed with your orthopaedic surgeon during your consultation.

Once the anaesthetic has taken effect, the anaesthesiologist will continually monitor your heart rate, blood pressure, breathing and blood oxygen levels during the surgery. The skin over the surgical site will then be cleaned, and the surgery will begin.

This will involve a vertical incision into the skin of the knee to expose the joint. The relevant parts of the knee joint will be removed and then replaced with the artificial knee prosthesis, which is secured in place with surgical cement.

After the knee has been replaced, the incision will be closed with either sutures or surgical staples. In some instances, a drain will be inserted to remove any fluids which may accumulate, and a sterile dressing will be applied. 

As with any type of surgical procedure, there will be a risk of complications occurring. These will be explained to you in detail by your orthopaedic surgeon ahead of your procedure, but include:

  • Bleeding
  • Infection
  • Blood clots in the lungs or legs
  • Loosening or wearing out of the artificial joint
  • Fracture
  • Continued pain or stiffness
  • Nerve or blood vessel damage

If you have any concerns about any of the risks associated with knee replacement surgery, speak to your surgeon at your consultation appointment.

Unsurprisingly, it will take time to get back on your feet following a knee replacement. Not literally — you should be up and moving around within 48 hours of your procedure. But the recovery period from knee replacement surgery isn’t something that should be underestimated.

Knee replacement recovery time

“It will be six weeks before you thank me,” is something that Mr Pollard tells all of his patients. “The reason for this is that the first six weeks of recovery after a knee replacement are the hardest, and patients should be prepared for this”.

Recovery after a knee replacement starts the day after your surgery. You will experience moderate to significant discomfort depending on your own tolerance to pain, and will be prescribed pain medication to help keep this under control.

It’s important that you take this as directed. These will only be taken short-term, and within six weeks, it should be possible for you to switch prescribed medication for over-the-counter alternatives.

Movement is crucial to your recovery, and physical therapy will form part of your regular activities for at least a few months. This may begin the day after your surgery using a continuous passive motion (CPM) machine which moves your knee while you are in bed.

However, you will meet with a physical therapist, usually before you leave hospital, to discuss an exercise plan to build strength and flexibility in your new joint as you heal.

Once you are discharged from the hospital and go home, you will need to continue to take care of your knee. Your care team will give you the guidance that you need to do this before you leave. This will include how to:

  • Keep the surgical site clean and dry
  • Change your dressings
  • Reduce swelling and inflammation
  • Use crutches or other walking aids
  • Move around your home safely

Since you won’t be able to drive until your surgeon gives you permission to, you’ll need to have someone drive you home and help you get settled in. If you live alone, you may want to ask someone to stay with you for at least a few days, until you feel you can manage by yourself.

If you notice any of the following, you should speak to your care team as soon as possible:

  • You have a fever
  • There is redness, swelling, pus or bleeding from the incision site
  • You are experiencing increased pain
  • Inability to move the joint

You are likely to need to be seen by a member of your surgical team, so ensure you have someone available to drive you to hospital for this appointment.

Knee pain from arthritis disappears immediately following surgery, but this is replaced with post-surgical pain which may persist for some months.

While every patient is different, most will notice an improvement in their mobility and discomfort within six weeks of their surgery and can start driving within eight weeks.

However, full recovery after a knee replacement can take up to 12 months, during which time there may be some residual discomfort and the knee may remain warm to the touch.

It’s also normal to experience a permanently numb patch of skin on the outside of the knee, around the surgical site.

It’s important to be aware that while knee replacement surgery restores the function of the knee and reduces the pain you have been experiencing, patients will almost certainly only return to their pre-surgery range of motion and flexibility once they are fully healed.

If you were able to run and jump before your surgery, this ability should be restored and even slightly improved.

However, if these movements were impossible before your surgery, it’s highly unlikely you will be able to do them afterwards.

Your surgeon will talk to you about their expectations for the results of your surgery.

A high-quality knee replacement joint should last in the region of 25 to 30 years depending on the individual.

However, if you have had a first knee replacement at a young age, there is a chance that you will require your artificial knee joint to be replaced again.

For example, if an accident or injury meant that you needed your first knee replacement at 30 years old, you may need another by the time you reach 55–60 years of age. This is known as revision knee replacement surgery. Revision knee replacement is slightly less straightforward than the initial procedure.

This is because revision knee replacement patients have less existing bone and more scarring. There is also a slightly higher risk of developing a post-surgical infection.

However, these risks are managed and mitigated where possible by your surgeon. For this reason, it is essential that you choose an orthopaedic surgeon who has extensive experience in performing revision knee replacement surgery.

At Circle Reading Hospital, our orthopaedic surgeons are able to perform revision knee replacement surgery with the highest levels of skill and care.  Don’t hesitate to make an appointment if this is something that you would like to discuss with our team.

Getting a knee replacement needn’t be a worrying procedure with the high-quality care and support from the orthopaedic care teams at Circle Reading Hospital.

If you are concerned about the health and mobility of your knees and would like professional medical advice and treatment, please don’t hesitate to contact the orthopaedic team at Reading’s Circle Hospital today. 

Specialists offering Knee replacement surgery

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Mr Tom Pollard

Consultant Orthopaedic Surgeon

MBChB, MRCS, FRCS, MD, BSc

Circle Reading Hospital

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Mr Chinna Arvind

Consultant Orthopaedic Surgeon

MB BS, D Ortho, M S Ortho, FRCS, FRCS (Tr. & Orth)

Circle Reading Hospital

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Mr Richard Dodds

Consultant Orthopaedic Surgeon

MA, MB, BChir

Circle Reading Hospital

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