Knee replacement surgery in Greenwich

Knee replacement surgery is an operation to remove damaged parts of your knee joint and replace them with artificial elements, known as an implant or prosthesis.

It’s a major surgery that is recommended as a treatment for very intense knee pain and discomfort.

If knee replacement surgery is the right option for you, there’s a good chance it will cure your knee pain, because it removes the source of the pain.

People often visit the consultant orthopaedic surgeons at our specialist knee clinic to ask about private knee replacement surgery in Greenwich, London. They could be suffering with pain or discomfort at any age, and they may have been struggling with their symptoms for some time.

Symptoms can include:

• Pain in the knee
• Discomfort in and around the knee
• Loss of function of the knee.

The first impression our surgeon gets when assessing the patient’s knee and knee pain is largely based on their age and general fitness. For example, the younger and fitter the patient, the more likely their pain is to be related to a sporting injury.

However, there is a group of patients in their 30s or 40s upwards, who aren’t particularly sporty and haven’t developed a particular injury as such, that nonetheless develop pain in their knees. The pain can be intermittent to start with; they can notice it during certain activities, such as when they go on prolonged walks or go up and down stairs. Commonly, this is when people will notice a change in the function of their knee(s).

The patient tends to start accommodating the knee pain or lack of function by reducing their activity levels. Sometimes, they check on the Internet to see what they should be doing to help themselves, or they may take some painkillers or apply ice packs to the affected area.

Some patients will even venture out and get some physiotherapy, which is all very sensible. When it becomes a more significant issue, and one which is more persistent, they will come to us for further advice.

When assessing knee pain, we never start with a set idea of treatment – for example, we don’t go looking to give a knee replacement. Instead, we focus on the patient’s symptoms and make assessments clinically.

We examine the patient, too. There are lots of structures within the knee – both soft tissues and bone – and we can tell quite a lot by examining a patient, as to what is the likely source of their problem.

Most people that present with relatively mild symptoms are far from being considered for knee replacement. They usually have some sort of tendon irritation or a slow-developing problem, which they can manage themselves.

Those patients tend to need an X-ray or a special scan – and this will then give our consultants more information as to whether they have arthritis, which is essentially the main reason for performing a knee replacement.

Our focus in the initial consultation is to gauge the patient’s symptoms and offer treatment accordingly.

Diagnosing Arthritis

When patients go through the process of the clinical assessment – examination and investigation, X-rays, or scanning – we may then start picking up the people with arthritis. It’s a matter, then, of gauging what degree of arthritis they have but, more importantly, how much the arthritis is affecting them symptomatically.

Some patients have mild arthritis but have very severe pain. Conversely, we see X-rays showing very severe arthritis, yet the patient has very little pain at all.

At The Blackheath Hospital, we will always look to try non-surgical treatments first, before recommending any kind of knee surgery. Some of the most common include:

Activity Modification for Knee Pain

If, for example, the patient has very mild symptoms with good alignment and good function, we would generally go down the route of activity modification to start with.

If they are a runner and find that pain is present after a run (and we find that they have significant arthritis), the first thing we’d suggest is perhaps that they shouldn’t be running.

Physiotherapy for Knee Pain

For patients who are in the realms of relatively mild pain, physiotherapy might be an option. These patients can often last for years without progressing to a knee replacement.

For those patients who have unrelenting pain – especially at nighttime – and those who are finding the pain is ruining their life, we may begin to consider knee replacement.

Painkillers for Knee Pain

In terms of pain relief, there are a huge range of painkillers. However, as the arthritic process is a progressive disease – it never resolves, and it slowly gets worse – patients must be realistic regarding how strong a painkiller they are going to take to dumb down their symptoms.

If these less invasive treatments do not help to reduce your knee pain, and your quality of life is really being affected by the pain and discomfort you’re experiencing, then we’ll start to consider whether knee replacement is the best option for you.

Your knee joint comprises two main surfaces that can begin to wear out. The first is the weight-bearing surface where you’re standing, between your thigh-bone, called the femur, and your lower leg bone, called the tibia.

This surface is covered in cartilage, which is a soft tissue, and this wears down in time. It doesn’t last forever, so if you’re very heavy, if you do a lot of activity, or have done in your younger years (or had injuries in your younger years), you may have damaged and ‘scuffed’ the cartilage.

Once that happens, it starts wearing out and thins down. There will come a point when the cartilage gets so worn down that bone is exposed and the nerve endings in the bone get stimulated, which then causes the pain.

The other area that can be affected is behind your kneecap. Your kneecap sits at the front of your knee, and that comes into play when you’re going up and down stairs or bending your knee. It’s required for good function of your thigh muscles. On inclines and descents, you will find that the kneecap really starts working. If that cartilage starts wearing down, those patients will have pain at the front of their knee.

Once the bone loses its protective layer of cartilage, it's essentially arthritis, and that is painful.

The process of improving the arthritis through surgery is essentially to resurface all those surfaces.

When is a knee replacement required?

When we consider knee replacement for patients, it really comes down to the level of pain they are experiencing.

If the X-rays show severe arthritis, but the patient has very little in the way of pain, we must consider if the alignment of their knee is satisfactory and not changing.

Although pain is the main reason for performing a knee replacement, we must bear in mind if the patient has a significant deformity. We must keep a close eye on this if that is the case. Sometimes, it’s better to proceed with the knee replacement to get the alignment back, because neglecting that can lead to more significant problems.

Knee replacement is essentially the culmination of progression of arthritis. Those with pain, swelling, loss of function, and loss of range of motion may need a knee replacement, but we try to avoid knee replacements in patients who are too young. The reason being is that knee replacements do not tend to last long enough. We give a rough estimate of 10 years for the life of a knee replacement, although usually they last much longer.

If they have a knee replacement in their 50s, patients should be well into their 70s before they develop a problem with the knee replacement.

If patients are younger than 50, though, we try to avoid progressing to a knee replacement, because the danger is that they would potentially wear it out quicker and have a failing knee in their working life.

Your knee replacement surgery at The Blackheath Hospital in Greenwich could be performed under spinal or general anaesthetic. If you are given a spinal anaesthetic (an injection to prevent pain from the waist down), you could be offered sedation to encourage you to sleep during your surgery. General anaesthetic will ensure that you are asleep throughout your operation. You could also be given a local anaesthetic injection during your surgery, which can provide pain relief for several hours after your operation.

During a total knee replacement operation, your surgeon will first create an incision in your knee to access your patella (kneecap). This is moved aside to provide access to your joint. Your Surgeon will then remove the damaged ends of your femur (thigh-bone) and tibia (shin-bone). The ends of these bones are measured and shaped to fit your prosthesis. But before this is fitted, your orthopaedic surgeon will test your joint with a trial prosthesis.

Once the prosthesis is ready to be fitted, your Surgeon will replace the end of your femur with a curved metal piece, while a metal plate will replace the end of your tibia. Your Consultant will position a plastic spacer between these two metal parts to minimise friction. Total knee replacement surgery could also include replacing the back of your patella (kneecap), but this will depend on your diagnosis.

If you are having partial knee replacement surgery to remove and replace a specific damaged part, surgery can be performed using a smaller incision.

After your partial or total knee replacement surgery, your incision will be closed with stitches or clips and covered with a dressing.

It should be that after surgery, when we have corrected the damage to your knee – for example exposed bone that was rubbing and causing pain – that you will now have a knee that’s pain free. It should bend and straighten smoothly, and you should be able to move freely.

Knee replacement surgery is a major operation and every patient who is offered a knee replacement must undergo a risk assessment, which helps our team ascertain if they are fit enough for the surgery.

The anaesthesia we offer is excellent, and it would be unusual for a patient to not be fit enough for a knee replacement.

As it is a big operation, unfortunately there is a risk profile and complications can happen. Some people are at higher risk of complications than others – and some complications happen randomly; you cannot predict them.

In terms of anaesthesia, we can use general anaesthetic, where the patient is completely asleep, and machines take over their breathing. However, the most common type of anaesthetic is spinal anaesthesia. It’s an injection in your back, and what that does is make your lower half numb.

People are always worried about that, as they think they will be awake and aware of what is going on. But normally the anaesthetists will give some sort of sedative, so the patient will be dozing.

One of the biggest advantages of the spinal is that it will stay in your body for several hours, therefore offering fantastic pain relief afterwards.

What people underestimate with a knee replacement, unfortunately, is it is a very painful procedure, and it takes a good couple of days to get over that initial, very severe pain. So, anything that can be done to ease that transition in the first day or two is a huge help. That’s where the spinal anaesthesia is particularly useful.

Pain management is the biggest hold-up for patients’ progression. If your pain level is manageable, you could potentially go home the same day. In real terms, you’re not going to have enough pain relief to facilitate that. People benefit from having a few days in hospital because they get more time with their physiotherapist.

The outcome of a knee replacement is largely down to how the patient works with the physio to do the exercises to get the most from the knee replacement.

If you’re a patient who neglects their exercise, unfortunately you’re likely to have a very poor result – a stiff knee that won’t move. The pain won’t settle either; the way to get over that pain issue is to get the knee moving early, which is where our physiotherapists come in.

At The Blackheath Hospital, we have physiotherapists on site – even at weekends. It’s a major part of rehabilitation after your knee replacement. We always make sure appropriate instructions are given, so that when the patient goes home, they are very clear about what they need to do in terms of their own exercises. They can then be seen as an outpatient by our physiotherapists to ensure appropriate progress.

It’s all part of the longer-term outcome; if we’re expecting a knee replacement to last a long time, a day or two in the beginning is a small price to pay.