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Knee replacement surgery

Private knee replacement operations for people in the City of London, Woodford, Essex and beyond

A total knee replacement is an operation where a consultant orthopaedic knee surgeon replaces arthritic bone and cartilage in the joint with an artificial knee, also known as a prosthesis.

The artificial knee is made of metal alloy components and attaches to the end of the thigh-bone (femur) and to the top of the shin-bone (the tibia).

A plastic polyethene spacer sits in between to act as an area articulating with the metal.

Osteoarthritis of the knee is a common and painful condition, which causes damage to the smooth, articular cartilage that lines the joints, resulting in pain and stiffness.

The causes of osteoarthritis can vary and include a genetic predisposition, trauma to the knee in the past, such as a bad fracture, and rare medical conditions. In severe cases of osteoarthritis, a knee replacement can provide significant pain relief and improve function.

When the cartilage has worn away, and bone starts to rub on bone, a knee operation might be the right option for you. Your private consultant orthopaedic surgeon at the hospital can discuss the most suitable treatment for you.

While a knee replacement is an excellent treatment option for an arthritic knee, in principle, it’s best to keep your natural knee for as long as possible because an artificial knee (prosthesis) doesn’t function like a normal knee.

Data shows that satisfaction rates and outcomes are lower when surgeons replace an artificial joint in people who do not yet have bone-on-bone disease. Your surgeon may decline surgery if you have mild arthritis, as a knee replacement may not be the best option for you.

Other reasons a surgeon may decline or delay surgery include severe obesity, which usually means a BMI of over 40 or 45, or other medical problems such as severe heart disease. If you have significant medical issues or severe obesity, it is best to address these problems before a knee replacement. Age is not a factor if you are in good health.

Patients presenting at The London Independent Hospital with knee replacement symptoms often feel extreme pain that has not improved with conservative treatment such as physiotherapy, a knee brace, steroid injections or simple painkillers.

Good indicators that you might do well with a knee replacement are if your quality of life is affected, you struggle to sleep because of pain at night, and your ability to walk a certain distance has reduced.

It’s also not uncommon for knee pain to cause hip joint problems. If hip and knee arthritis are on the same side, your consultant may recommend operating on the hip first. When you arrive at The London Independent Hospital for your private consultation, your consultant will assess whether you are a candidate for total knee replacement or not.

Once the consultant is satisfied that you are, they’ll discuss the surgery and what total knee replacement treatment entails. You may also have an X-ray, which the consultant will use to divide the knee into three parts – the inside, outside and behind the kneecap (patella).

A typical pattern is for patients to get arthritis just inside the knee. If the rest of the joint is OK, the surgeon may recommend a partial replacement of the inside, leaving the rest intact.

Although a partial knee replacement takes the same time in theatre as a total knee replacement, recovery is a lot quicker. In addition, it’s less painful and has fewer risks of medical complications, even for a high-risk patient with medical problems.

Finally, you could have treatment on a day-case basis instead of a two-night stay.

Before surgery, the consultant may suggest you lose weight if you are overweight because obesity can cause a higher risk of some complications. You should try weight loss even if you decide not to have a total knee replacement.

The consultant may also recommend physiotherapy treatment to strengthen your muscles, so you are as strong as possible before surgery to improve your outcome. The hospital will invite you to a pre-assessment at The London Independent Hospital to check your general health and ensure you have no other medical problems that need addressing before surgery.

The tests, which are done by a nurse, generally include blood pressure, an ECG (electrocardiogram) to detect heart issues, blood tests and an overview of your history.

If all the tests at the pre-assessment clinic are OK, total knee replacement surgery can go ahead at the hospital in London as planned.

When you come to hospital, before you have your operation, you will need to be anaesthetised. At The London Independent Hospital, we most commonly use a spinal anaesthetic (spinal nerve block) with sedation. Although the spinal anaesthetic does not put you fully to sleep, you are sedated and are unlikely to remember any of the operation.

A general anaesthetic is possible, but as most patients having this type of treatment are older, and many have other medical complications, so a spinal is a better and safer option.

Once the anaesthetic has taken effect, you’ll be wheeled into theatre, where the team consists of the consultant surgeon and anaesthetist, a scrub nurse, an assistant to both the surgeon, and the anaesthetist, a second nurse, and a runner to fetch any equipment.

Once everything is ready, your specialist knee surgeon will cut through the skin and capsule surrounding the knee and expose the knee joint. Next, they will cut away the arthritic bone, using jigs or cutting guides to shape it, so the artificial knee fits perfectly.

Each prosthetic is shaped differently and comes in six or seven different sizes because humans come in all shapes and sizes. A few days before the operation, your surgeon will have used templating software to calculate the size of the prosthesis you need.

Once the surgical team is ready, the surgeon cements the prosthesis using bone cement. The nurse will mix the cement powder with liquid until it has become a dough-like consistency, about the size of the palm of a hand. Then, the surgeon applies it to the knee.

The cement squeezes out at the edges like tile grout when the surgeon puts it in the prosthesis. So, they will remove the excess and wait for about eight or nine minutes for the cement to become rock-hard. As well as deep stitches in the knee capsule, which the patient won’t see, the surgeon will close the wound, mostly like with dissolvable stitches.

However, some consultants favour staples and clips, especially in larger patients. Then they put a bandage on the knee. The total knee replacement procedure takes about an hour and a half.

Recovery while still in hospital

After knee replacement surgery, you’ll go to a recovery area for monitoring. If you had a spinal anaesthetic, the wait is short. If you had a general anaesthetic, you might be in recovery for half an hour until you are fully awake.

Then you’ll go to your private room. Total knee replacement patients' average length of stay at The London Independent Hospital is two days. The stay is usually less for partial knee treatments. Your consultant surgeon will have warned you that a knee replacement is a painful procedure, especially in the first few days.

The rest of your hospital stay will include blood tests and a ‘check’ X-ray. In addition, you’ll receive painkillers and nursing care because you’ll be in pain. A physiotherapist will also help you walk safely. Physiotherapy treatments aim to get you up and mobile.

Bed rest is actively discouraged. If you have had an operation in the morning, the physiotherapist will generally come and see you on the same day. They will get you walking on crutches in the afternoon and ensure you can get to the bathroom and go up and down steps if you live in a house with stairs. Once you have achieved that, you’re ready to go home.

Recovering at home

For the first week or two after surgery, you’ll be on opiate painkillers provided by the hospital. Then, after a couple of weeks, you’ll be able to wind them down and take over-the-counter painkillers and anti-inflammatories.

Patients usually come off these altogether after six weeks. The first month will be painful and challenging. Then, at six weeks, the pain will be more manageable, and you will feel you’re turning a corner, and things are getting better, and you can stop using crutches.

Some people are off their crutches sooner. Recovery is not a passive process – you will need to work at it. For example, if you do not comply with physiotherapy treatment or exercise, the knee will stiffen – and you will be less satisfied with the procedure. Typically, you can drive after six weeks.

This depends on whether you can do an emergency stop without having significant pain and on whether you had surgery on the left or right knee. If you have an automatic car and your left knee is replaced, you might be able to drive sooner.

The general advice is to avoid heavy impact sports. Swimming, walking, and skiing are fine. But if you go back to tennis, badminton, squash, running, and other high-impact sports, you need to be cautious.

Knee replacement surgery fails because of loosened cement around the prosthesis, which will happen faster if you continually place a high load on your knee. For this one reason, active patients under 65 have a higher revision rate than older people.

In other words, with continued high-impact sports, you are setting yourself up for potentially having a second operation or even a third in your lifetime. That’s why, in an ideal world, it’s better to delay surgery until you are over 65. In younger people, the satisfaction rate is low, and complications are higher.

However, data shows that 90% of knee replacements are still OK after 10 years and many last 15-20 years or even longer.

Self-pay packages for a knee replacement at The London Independent Hospital start from a fixed price of £13,958, covering pre-assessment, surgery, one follow-up appointment, and physiotherapy. This is just a guide price for patients paying for themselves.

The price of knee replacement surgery will differ from person to person, depending on factors including the type of prosthesis you have, and whether you need total or partial knee replacement surgery.

You can choose to spread the cost in instalments over a convenient timeframe. We offer flexible payment options, so you can spread the cost over anywhere from 12 months to five years, and the first year is often interest free.

If you have private medical insurance, knee replacement surgery is often covered by your policy. We work with all major providers.

It’s six months since Gillian Norman Bruce had a total knee replacement at The London Independent Hospital, and she couldn’t be happier with the successful outcome. Gillian’s problems with an arthritic knee began in 2011.

She was initially treated with steroid injections and physiotherapy in 2020. Although X-rays showed she needed a knee replacement, circumstances delayed her treatment. So, Gillian decided to see a consultant privately.

She chose The London Independent Hospital because it’s close to her home, and she appreciated the expertise and excellent reviews of orthopaedic knee consultant Mr Deepu Sethi.

“The pain had become unbearable”

So, what was it like before the total knee operation? Gillian says: “The pain had become unbearable. I wasn’t sleeping. I felt like someone had a hot screwdriver going into my knee all the time. I was on a lot of painkillers, and my mobility was starting to suffer. I didn’t think I could take another year of it.”

Once on the patient pathway at the London Hospital, everything was straightforward – from payment to operation and recovery.

Spreading the cost of treatment

Gillian explains: “I am a self-pay patient, and Chrysalis, a partner service Circle Health Group provides, managed that side of it very well. It was helpful to spread the cost. It was like buying a sofa – you paid it off every month for a year without paying interest.”

The hospital scheduled a date with the consultant quickly. “Mr Sethi was warm and engaging – I felt confident in him as a person and his technical expertise as a surgeon,” says Gillian. “He was very calming.” Mr Sethi quickly organised the operation, and his secretary booked Gillian a pre-assessment.

Gillian says: “From that, they understood that I have a dodgy hip on the other side and another dodgy knee, which meant they could manage the process. The continuity of care through the physiotherapy was excellent.”

The operation itself

Mr Sethi and the anaesthetist visited Gillian in the hospital before the operation and performed it in the evening under a planned epidural. In theatre, the team pulled up her leg, putting a green screen in front of her, so she couldn’t see what was happening.

As Gillian was slightly sedated, she could hear the noise of the operation, which she found fascinating. She’d been told what would happen in advance and couldn’t feel anything. She says: “I would do an epidural again because a general anaesthetic knocks out your whole system.

The operation took a couple of hours, but the time went quickly, and it was well-managed. The feeling in my legs came back fast. The operation was at 7pm. I was back in the room at 10pm. But during the night, I was taking myself off to the loo on my own on a Zimmer.”

The importance of physiotherapy

At 10am the following morning, recovery treatment began. With support from her physiotherapist, Gillian started with small stretches, and within 12 hours was walking the corridor, albeit on a Zimmer and still in much pain, which Mr Sethi had warned her to expect.

The physiotherapist assessed her during her pre-operative assessment, then just before the operation, and again after she had had surgery. So they had got to know her and they had a baseline to compare how she went upstairs before and after treatment.

“The golden rule is to do your physiotherapy exercises,” advises Gillian. “It will make all the difference. They gave me day-one and week-one exercises, then gradually harder week-two exercises. They always gave me something achievable.

So, by the time I was discharged from physiotherapy four months after the operation, there was no swelling or anything. The outpatient physiotherapy was one of the high points of the hospital’s service.” Less than 48 hours after Gillian’s surgery, the X-rays showed the knee was fine, and Mr Sethi discharged her from hospital, sending her home on crutches.

Recovering at home

“One thing that Mr Sethi recommended in his second meeting before the operation was to hire a cryo-cuff,” Gillian says. “It was a godsend. You put ice into it and wrap a kind of icepack from ankle to thigh, and it pumps cold water around.

So, you can feel the swelling going down. It made a real difference to recovery. He was also helpful in suggesting I get a commode, a stool for the shower, and a raised loo seat, so I came back to an equipped house.”

When Gillian left The London Independent Hospital, the ‘screwdriver’ pain had stopped, but she felt post-surgical pain, which was just as intense as Mr Sethi had warned. But six weeks later it had reduced.

Gillian also had a 20cm scar running from below to above her knee, which has faded over time. Now, Gillian is more mobile and can walk a reasonable distance. Even at the six-week sign-off, she could walk with a stick for 3 kilometres on holiday to Devon.

What’s her advice for anyone having a knee replacement at The London Independent Hospital? “Do your physiotherapy, take your medication and do as you’re told!” says Gillian. “Keep a diary of your exercises and meds. I saw Mr Sethi at six weeks and three months and six months, and during the first stage of recovery he phoned me personally, which I really appreciated.

He was incredibly reassuring, and I knew if there’d been a problem, he would have called me.” Six months later, the most significant outcome is not being in pain and no longer needing to constantly take painkillers. And her mobility is massively increased.

“You’re back to having a knee like you used to have. It’s a great outcome when you’ve been in pain for a while. The only thing is that, unfortunately, for the rest of your life, you will ping away at the airport! But being pulled aside is a small price to pay.”

Infection is a serious but thankfully rare risk of knee replacement surgery. It happens in less than 1% of cases. However, surgeons dread it the most, because often the only way to deal with the deep infection in an artificial joint is to remove the implants.

Then they treat the infection before inserting another prosthesis, which has a significant adverse effect on the patient and the outcome. Surgeons at The London Independent Hospital will reduce the risks by giving you antibiotics around the same time as surgery and ensuring there’s no active infection in the body. In addition, the hospital will do its utmost to minimise risks in people with underlying conditions such as diabetes, making sure it’s controlled during the pre-assessment process.

There’s a risk of blood clots in the leg or the lung, so the hospital routinely gives two weeks of blood-thinning medication after surgery to reduce that risk. That’s also why the hospital encourages people to be mobile early, because that too lowers the risk of blood clots.

Another risk is that you’ll need a revision in the future, either because of loosening around the implant or the plastic polyethene wearing away (although harder-wearing parts are much better than they were). The satisfaction rate for a total knee replacement procedure at The London Independent Hospital is 80-85%.

Most patients are pleased with the result of their knee replacement, but are not always totally pain-free. Although the surgery aims to relieve pain, some patients (about 5%) will be significantly dissatisfied. Although the hospital will investigate, sometimes it finds the replacement to be technically correct, and there’s no reason for it to be painful.

There’s also no guarantee that a revision will make it better. Weeks after a knee replacement, you may still have occasional pain and discomfort from the surgery, and if you have a busy day in the future, you might have to take a painkiller.

But, on the plus side, the severe knee pain will have gone, you will feel a lot better and be more mobile than before the operation. And your symptoms will continue to get better for up to a year – or even two.

The London Independent Hospital in East London provides services to patients in the City of London, Woodford and Essex, and is easy to reach from all locations.

Few private hospitals deal with the volume of total and partial knee replacements done at The London Independent, so you are in the hands of experienced surgeons. Knee surgery is one of our top specialities, and all our consultant surgeons are experienced specialists.

The dedicated in-patient care and the follow-up physiotherapy service at The London Independent Hospital are also excellent. Everyone at the hospital shows kindness and care, and if you have a problem, your highly skilled consultant is there to support you.

When you choose to go private with Circle Health Group, you’ll benefit from:

  • Consultant-led care from start to finish
  • Bespoke treatment plans, built around you
  • Private, en-suite rooms with TV and WiFi as standard
  • Delicious healthy meals cooked on-site to your dietary requirements
  • The reassurance of six months’ aftercare, included in your fixed price package

For more information or to book an appointment with one of our knee specialists at The London Independent Hospital, call us today or use our easy online booking portal.

Specialists offering Knee replacement surgery

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Mr Ahsan Sheeraz

Consultant Trauma & Orthopaedic Surgeon

MBBS, MRCS, PGDip, FRCS

The Saxon Clinic 1 more The London Independent Hospital

View profile Book online

Mr Kostas Tsitskaris

Trauma and Orthopaedic Surgeon (Hip and Knee)

MD, MSc, FRCS(Tr&Orth)

The London Independent Hospital

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Mr Ziali Sivardeen

Consultant Orthopaedic Surgeon

BMEDSCI, BMBS, AFRCS, FRCS (TR AND ORTH)

The London Independent Hospital

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Mr Deepu Sethi

Consultant Orthopaedic & Knee Surgeon

MBBS MRCS FRCS (T&O)

The London Independent Hospital

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Mr Vivek Gulati

Consultant Orthopaedic Hip & Knee Surgeon

BA(hons) MA MBBChir(Cantab) MRCS MRes Dip(IC) FRCS(Tr&Orth)

The London Independent Hospital

View profile Book online

Mr Steven Millington

Consultant Orthopaedic Surgeon

BMed Sci BMBS FRCS (Tr&Orth) PhD

The London Independent Hospital

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