Knee replacement surgery
At Parkside Orthopaedics and Sports Medicine Centre, we have a team of leading knee surgeons. If your knee has been damaged by arthritis, an injury or other medical conditions, our experts can perform knee replacement surgery. This can significantly reduce your pain and improve your movement.
What is knee replacement surgery?
Knee replacement surgery is a common operation to replace a damaged knee joint with an artificial joint called an implant. There are two main types of knee replacement operations:
• Total knee replacement: This is where both sides of your knee joint are replaced. You can be considered for this surgery at any age. It is most often performed on people between the ages of 60 and 80.
• Partial (or unicompartmental) knee replacement: This is a smaller operation, where only one side of your knee joint is replaced. It is most often performed on younger people between the ages of 55 and 64, who have less serious knee damage.
Our experts may recommend a robotic-assisted procedure to perform a knee replacement (please see below for more details).
Your knee is made up of the thighbone (the femur), the shinbone (the tibia) and the kneecap (the patella). The ends of these bones and the back of your kneecap are covered with a layer called cartilage. This layer cushions the bones and allows smooth movement. If the cartilage is worn away, the ends of the bones and the back of the kneecap get damaged.
During a knee replacement operation, your surgeon replaces the damaged parts of your knee joint with new metal and plastic parts. A total knee replacement is designed to last for at least 15 to 20 years. A partial knee replacement is designed to last for at least 15 years.
Why might I need knee replacement surgery?
Your orthopaedic consultant may recommend knee replacement surgery if your knee joint is worn or damaged and this affects your quality of life. You may have severe pain, swelling and stiffness in your knee joint. These symptoms may make it hard to walk, sleep, work or carry out everyday tasks, such as climbing the stairs or doing your shopping. The chronic (long-term) pain may make you feel depressed or prevent you from enjoying social activities.
The most common causes of damage to the knee joint are:
• Osteoarthritis: This is where the protective cartilage in the knee joint slowly wears away over time. The bones in the knee then start rubbing and you may get painful growths called bone spurs. Osteoarthritis is most common in older people and anyone who is overweight, has a family history of the condition or previously suffered a knee injury.
• Rheumatoid arthritis: This is an autoimmune disease, where the immune system attacks the knee joint lining by mistake. The joint becomes swollen and the cartilage and nearby bone can get damaged over time. Rheumatoid arthritis commonly affects both knees.
• Post-traumatic arthritis: You can get this type of arthritis after a serious knee injury, such as a fracture or tear of the ligaments (connective tissue). Over time, the cartilage in the knee may become damaged. You may have knee pain and restricted movement.
• Other medical conditions: Various medical conditions can damage the knee joint. They include gout (a type of arthritis), haemophilia (a rare blood-clotting disorder), osteonecrosis (death of bone cells in the knee) and conditions that cause unusual bone growth.
Are there any alternatives to knee replacement surgery?
If your knee joint is damaged, your orthopaedic consultant usually suggests non-surgical treatments first. These may include:
• painkillers or anti-inflammatory medicines
• physiotherapy and exercise
• weight loss to reduce the strain on your knee
• walking aids, such as a stick, or an elastic support for your knee
• steroid and/or hyaluronic acid injections into the knee joint to reduce pain, inflammation (swelling) and stiffness
If these treatments do not manage your symptoms, your consultant may recommend surgery.
In some cases, your consultant may suggest an alternative operation to a knee replacement. The long-term results may not be so good. Possible alternatives include:
• Knee arthroscopy: A thin metal tube called an arthroscope is put in your knee joint. This tube has a light and camera at one end. Your surgeon can see inside the joint and wash out loose pieces of bone or cartilage.
• Microfracture: Your surgeon makes small holes in the knee bone. This encourages new protective cartilage to grow.
• Mosaicplasty: This is a type of keyhole surgery. Your surgeon uses healthy cartilage and bone from another part of your knee to repair the damaged area.
• Osteotomy: Your surgeon cuts and reshapes the shinbone. This relieves the pressure on your knee joint and reduces the weight carried by the damaged area.
How do I know whether knee replacement surgery is suitable for me?
If you get knee pain, you can have a full assessment at Parkside Orthopaedics and Sports Medicine Centre. A specialist orthopaedic consultant asks you about your symptoms and how they affect you. They also find out your medical history.
Your consultant then examines your knee and assesses its strength and range of movement. To make an accurate diagnosis, your consultant arranges digital X-rays. Sometimes you may also need an MRI or CT scan. Our Diagnostic Imaging Suite performs high quality scans in a relaxed environment.
Using the information collected, your consultant discusses the best method of treating your knee problem. They consider your general health, age and lifestyle and prepare an individual treatment plan. Your consultant explains the benefits and risks of knee replacement surgery.
How can I prepare for having knee replacement surgery?
If you decide to have knee replacement surgery, your consultant will give you detailed information about how to prepare. It is important to keep as active as you can before your operation. This may be challenging when you are in pain, but our physiotherapy team can teach you gentle exercises to strengthen your knee muscles.
In the weeks before your operation, we also recommend that you:
• have a balanced diet
• keep to a healthy weight
• try to stop smoking
• maintain good dental hygiene
• arrange for someone to give you extra support at home after your operation
• remove anything that you could trip over at home when using walking aids after surgery
These steps can help with your recovery and reduce complications. We ask you to attend a pre-operative assessment clinic. A nurse assesses your health and decides whether you are fit to have an anaesthetic and the planned operation. You may need blood tests, urine tests and an electrocardiogram (ECG) to check that your heart is healthy.
We also invite you to a ‘joint school’. This is a group session held by video link twice a week. It covers how to prepare for the operation, what to expect and the recovery process.
What happens during knee replacement surgery?
At Parkside Orthopaedics and Sports Medicine Centre, we have four modern operating theatres. There is little or no waiting time for knee surgery.
A knee replacement can be done under a general anaesthetic. This means that you are asleep during the operation and do not feel any pain. Otherwise, you may have a spinal anaesthetic or epidural. You are then awake, but your body is made numb from the waist downwards.
The operation takes one to two hours. If you have a total knee replacement, your surgeon bends the knee and makes a cut at the front. This exposes the kneecap, which is moved aside. Your surgeon removes the damaged ends of your thighbone and shinbone. They are replaced with artificial parts, which are measured to fit:
• The end of your thighbone is replaced with a curved piece of metal.
• The end of your shinbone is replaced with a flat metal plate.
Your surgeon normally fixes these new metal parts to the bone with cement. Otherwise, they are coated with a special material that encourages the bone to grow onto it. The surgeon puts a piece of plastic between the two metal parts to prevent them from rubbing.
Sometimes, your surgeon replaces the back of your kneecap with a smooth plastic dome. Finally, the surgeon closes the wound with stitches or clips and puts a bandage on your knee.
Are there any other types of knee replacement surgery?
Two other types of knee replacement surgery are:
• Mini-incision surgery: This type of surgery is normally used to carry out a partial knee replacement. Your surgeon makes a smaller cut in the knee and uses special instruments to move around the tissue, instead of cutting through it. Only one side of your knee joint is replaced and less bone is removed. This should lead to a shorter recovery time and avoid the need for a blood transfusion (when we give you donated blood).
• Robotic knee replacement: At Parkside Orthopaedics and Sports Medicine Centre, we have invested in the latest technology. The Stryker Mako robotic arm is a piece of equipment that helps our surgeons to perform knee replacements with pinpoint accuracy. This robotic software produces an exact 3D model of your knee from a CT scan. It guides your surgeon to place the new knee joint in the best position. The precise surgery can help you to return to an active lifestyle more quickly and achieve a good long-term outcome.
What happens after knee replacement surgery?
After having your knee replacement operation, you are taken to a recovery room. You may be given oxygen, fluids and painkillers. Your body can often replace any blood lost during the operation by itself. In rare cases, you may need a blood transfusion where we give you donated blood. Another option is to return the blood that drains from the knee to your body through a tube in a vein. This is called auto-transfusion.
Your wound is covered by a large dressing, which normally stays in place for 10 to 14 days. Depending on what your consultant prefers, you may be put on a continuous passive motion machine. This machine slowly moves your knee while you are in bed to help your circulation. Our nurses monitor you closely and take you back to the ward when you are ready.
Wherever possible, we encourage you to get out of bed and start moving on the day of your operation. At first, you are likely to feel some discomfort and have swelling in the operated area. We give you painkillers and medicine to reduce the risk of blood clots after surgery. We also encourage you to take frequent deep breaths to prevent chest problems.
Our physiotherapy team visit you regularly while you are in hospital. You usually have two physiotherapy sessions a day and are set a personal exercise programme. Most people can put weight on their new knee joint within hours of the operation. Initially you use a walking frame, followed by elbow crutches or a walking stick.
Your physiotherapist teaches you how to strengthen the knee muscles. At Parkside Orthopaedic and Sports Medicine Centre, we have a rehabilitation gym and large hydrotherapy pool. We recommend that you continue having physiotherapy for six to 12 weeks after you leave hospital.
Most people need to stay in hospital for two or three days after a knee replacement. If you have a partial knee replacement, your hospital stay is often shorter. Our occupational therapist may recommend special equipment to help you manage at home. The pharmacy gives you a supply of any medicines that your consultant has prescribed. You get a ‘discharge pack’, which includes a follow-up appointment with your consultant and contact details for the ward. Our nurses are available 24 hours a day to deal with any concerns or questions.
It is important to follow our practical guidance on looking after your new knee. You need to take care to avoid any falls during the first few weeks after surgery. We explain when it is safe to return to work or other activities. You should be able to walk unaided after about six weeks. The soft tissues of the knee joint take around 12 weeks to heal fully. You may notice ongoing improvements for up to two years after the operation as your knee muscles grow stronger.
If you need knee replacement surgery, Parkside Orthopaedic and Sports Medicine Centre provides first-class independent healthcare.
We offer all-inclusive price packages for a total knee replacement. These packages start from £14,135. Terms and conditions apply. For more information about prices, please call 020 3925 1062.
To make an appointment at Parkside Orthopaedics and Sports Medicine Centre, please call 020 3944 0568 or complete this form online. Appointments are available six days a week.