The knee is the largest hinge joint within the body. If you suffer from pain in the knee it can be through a variety of factors such as injury, arthritis or disease. Although, there are non-surgical solutions - if your symptoms are severe you may need a knee replacement surgery.
More than 70,000 knee replacements are carried out in England and Wales each year, and the number is rising¹.
1. Why is knee replacement surgery needed?
Knee replacement surgery (also known as arthroplasty) may be offered to you when your knee joint is worn or damaged and you have some of the following symptoms:• you have severe knee pain that interferes with your quality of life and sleep
• swelling and stiffness in your knee joint that reduces your mobility and everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
• you cannot work or have a normal social life A knee replacement can relieve knee pain and allow you to be more active.
A knee replacement is major surgery, so it is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven't helped reduce pain or improved mobility.
2. What is a knee replacement?
Knee replacement surgery involves replacing damaged, worn or diseased cartilage and bone in your knee joint with an artificial joint made of metal or plastic to enable the joint to move in the same way as a natural joint.
You may have either a total or a partial knee replacement depending upon how damaged your knee is. Total knee replacements (TKR) are more common. They involve both sides of your knee joint being replaced. Partial knee replacements (PKR) involve a smaller incision and less bone being removed. Your knee surgeon will discuss the best option for your needs.
3. What does the procedure involve?
Knee replacement surgery is usually performed either under general anaesthetic (you are asleep throughout the procedure) or under spinal or epidural anaesthetic (you are awake but have no feeling from the waist down).
Your surgeon will move your knee cap to the side to access your knee joint. The worn ends of the bones in your knee joint are removed and replaced with metal and plastic parts (prosthesis) which have been precisely measured and shaped to fit. The artificial joint is held into place with special cement or the bone surface is roughened to encourage your bone to fuse onto the prosthesis.
4. What conditions require knee replacement surgery?
Osteoporosis is the number one cause of knee replacement and the principal diagnosis for 96% of TKR recipients².
Other conditions that cause knee damage that may require knee surgery include rheumatoid arthritis, haemophilia, gout and knee injury.
5. What are the benefits of knee replacement?
The main benefits of knee replacement surgery are reduced or no knee pain and being able to move around so that you can undertake normal daily activities, participate in exercise and society.
Many people who have undergone surgery state that they have a new lease of life. They are able to resume many of the activities they previously undertook and regain their independence.
The majority of people are happy with their knee replacement.
6. What are the risks?
Whilst knee replacement surgery is a common operation there are risks as with any operation. Complications are rare but can include:• stiffness of the knee
• infection of the wound
• deep infection of the joint replacement, needing further surgery
• unexpected bleeding into the knee joint
• ligament, artery or nerve damage in the area around the knee joint
• blood clots or deep vein thrombosis (DVT)
• persistent pain the in the knee
• instability in the new knee joint with further surgery needed to correct it.
• adverse reaction to anaesthesia (very rare)
Your surgeon will discuss these complications with you. The risk of them happening is small and depends upon your age and current state of health.
7. How long will a knee replacement last?
For 80–90% of people who have total knee replacement, the new joint should last for 20 years or longer³.
8. Success rates
Total knee replacement is one of the most successful procedures in all of medicine. In the vast majority of cases, it enables people to live richer, more active lives free of chronic knee pain⁴.
9. Revision knee replacement surgery
A replacement joint does not last forever. As it becomes worn it can cause your knee to become painful, swollen, stiff or unstable, making it difficult to perform your everyday activities.
Revision knee replacement surgery (replacing the replacement knee) is usually more complicated and a longer procedure than the original knee replacement surgery. It is not uncommon for people to undergo more than one revision surgery, but it is widely accepted the artificial knee joint becomes less effective each time it is replaced.
The earlier you have a knee replacement, the greater the chance you will eventually need revision knee replacement surgery. However, there is some evidence that replacing the knee joint before it becomes very stiff leads to a better outcome.
10. Getting ready for a knee replacement• Try to stay as active as you can. A physiotherapist will be able to advise you on exercises that will help strengthen the muscles around your knee to aid your recovery.
• Arrange for a friend or relative to take you to and from the hospital and to help at home for a week or two after you come out of hospital.
• Before you go for your procedure put anything you will need when you return home within easy access, such as books, TV remote control, telephone, medications.
• Ensure you have plenty of easy to prepare food, such as frozen ready meals, cans and staples like rice and pasta.
11. Things to take into hospital
You will usually be in hospital for four to seven days, depending on your progress and the type of knee replacement you have.
Here are some items you may want to bring with you:• changes of nightclothes, dressing gown and slippers • something comfortable and easy to wear
• slippers and flat, supportive shoes (with a back or heel strap) that have some room to allow for any swelling
• personal toiletries
• medication you require for your stay with the original packaging and labels
• books and magazines, iPod and other things to help pass the time during recovery
12. Are there any alternatives to knee replacement?
There are a number of non-surgical treatment options that may relieve your knee pain or improve your mobility:• painkillers can help control the pain
• a walking stick can make walking easier
• an elasticated knee support may help your knee to feel stronger
• regular moderate exercise can help to reduce stiffness in your knee
• steroid injections into your knee joint may reduce pain and stiffness
Surgical treatment alternatives include:a) Arthroscopic washout and debridement - the knee is washed out with saline and any bits of bone or cartilage are cleared away using an arthroscope. This is not recommended if you have severe arthritis.
b) Microfracture - small holes are made in the surface layer of bone to allow cells beneath that are more blood-rich to come to the surface and stimulate cartilage growth. Microfracture could be a good option if you have just a small area of damaged cartilage.
c) Osteotomy - the shin bone is cut and realigned so that weight is no longer focused on the damaged part of the knee. It is sometimes used for younger people with limited arthritis, where it may enable a knee replacement to be postponed.
d) Mosaicplasty (cartilage replacement) - Plugs of hard cartilage and some underlying bone from another part of your knee are transferred to the damaged area to repair the surface.
13. After knee replacement surgery
Your recovery is individual to you. You will be encouraged to stand within 12-24 hours after your operation and to walk with a frame or crutches initially before moving on to independent walking with sticks after about a week. It’s normal to feel discomfort at first while walking and exercising, and your legs and feet may be swollen.
You may need physiotherapy over the first few weeks. A physiotherapist will show you exercises to help strengthen your knee and advise you when to start these.
You can usually return to work 6 to 12 weeks after your operation.
Find out more about knee injuries which can occur during skiing and get more information on joint replacement surgeries via our orthopaedic posts.
About Ramsay Healthcare Knee Replacement Surgery Options
At Ramsay Health Care we are proud to work in partnership with some of the highest qualified and experienced consultant orthopaedic surgeons, neurosurgeons, pain management consultants and physiotherapists in the UK. Our holistic care offers you the best treatment for your knee pain.
At Ramsay you won’t have to wait for an appointment or for your knee replacement surgery. Your treatment may be covered by medical insurance and self-pay packages are available on request. We have first class facilities and all self-funding and most privately insured patients can enjoy our Premium Care offering exclusive benefits including superb food, a relaxing environment, priority access and appointments to suit your lifestyle. Our aim is to help you feel like a guest as well as a patient.
Please contact us for more information.