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
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.
There are three different compartments in the knee joint. These are:
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).
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.
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:
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.
Typically, patients are offered a knee replacement when:
“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”.
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.
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:
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.
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.
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.
If you have any concerns about any of the risks associated with knee replacement surgery, speak to your surgeon at your consultation appointment.
“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.
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.
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.
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.
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.
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.
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.
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