Knee Replacement

A knee replacement is a very successful operation for people having a difficult time with a worn-out knee. It is an option for a patient with bone-on-bone arthritis, who has failed to get satisfactory relief from other treatments. People often talk about it as a last resort operation, which is a reasonable way to think about it. The idea of the operation is to decrease pain and improve function.

People typically stay 1-2 days in hospital for the surgery. As techniques and recovery from the surgery improve this has been getting less. You can stay longer if you need to though! For appropriate patients who would find a very short stay in hospital convenient, Dr Martin can offer a 24 hour stay for the surgery. Dr Martin frequently performs bilateral knee replacement surgery, and these patients are often in hospital only two days too. Dr Martin uses dissolvable stitches but you still need to keep the wound covered with a dressing for about 2 weeks. Dr Martin routinely uses the subvastus approach for knee replacement surgery.

Most people feel that they are on the mend and are back to doing what they were before the surgery by 4-6 weeks, from which point on most people will just get better and better. This is different for everyone: sometimes people recover more quickly and sometimes more slowly.

You can think about the surgery itself a bit like resurfacing a tyre. The worn-out knee is cut out to a depth of about a centimetre and this is then resurfaced with metal and plastic. You keep most of your own ligaments and tendons around the knee. A routine knee replacement doesn’t usually involve stems up or down the bones, but they can be useful in complex or redo cases.

It is important to have accurate expectations about what it is like to have an artificial knee. Some people have an idea that an artificial joint will be a “super knee” which isn’t the case, but an artificial knee is usually much better than a worn-out painful one.

If you are thinking about having major knee surgery it is important to have a good discussion with the doctor about whether the operation is right for you, or not. This mainly comes down to clearly understanding both the risks associated with the surgery and the benefits expected. For more information please read the frequently asked questions section.

FAQ

What is arthritis?

Osteoarthritis (OA) is wear to, or failure of, a joint lining down to bare bone-on-bone. Many people use the term osteoarthritis to dismiss vague aches and pains that they resign themselves to put up with, but osteoarthritis is something specific and usually treatable. Osteoarthritis can cause pain, stiffness, bony lumps, bow or knock kneed legs and swelling.

Hip and knee replacements are examples of major operations for osteoarthritis, but for other areas in the body smaller operations may be appropriate too. Surgery for osteoarthritis is generally the last resort and there are many non-operative treatments that can also be discussed with the doctor.

Other types of arthritis, like rheumatoid or psoriatic arthritis, are often treated by a rheumatologist. An orthopaedic surgical opinion may be useful in these cases too if a lot of damage has been done to the joints.

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What is osteoporosis?

Osteoporosis is a condition often associated with ageing in which bones become weaker and break more easily. It is something to ask your general practitioner about as it is known to be associated with other medical conditions or medications.

If you are middle-aged or older and have broken a bone it is also something to have checked out. There are tests to rule out important causes and there are effective treatments. If someone has osteoporosis it doesn’t mean they can’t have a knee replacement.

Osteoporosis is sometimes confused with osteoarthritis as both can be shortened to osteo.

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Can my worn-out knee get too bad for an operation?

Normally it isn’t possible to let your worn-out knee get too bad for surgery. Actually it is usually in the best interests of your health to put joint replacement surgery off for as long as possible.

Your own worn-knee is normally tough and won’t disintegrate or grind away to nothing. People also worry about the worn joint throwing other joints out and causing damage to something else, but that wouldn’t typically be a reason to proceed with surgery. If a joint near or opposite the first one wears out then realistically it was probably going to do so eventually anyway.

In general, the decision to proceed with knee replacement surgery is made when the problem with the knee or knees, in terms of pain and disability, is bad enough in its own right that it makes sense to proceed. The surgery is to alleviate current trouble rather than protect against problems in the future.

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Am I too old for a knee replacement? If I put it off will I be too old?

No one is really too old for a joint replacement. It is important to make a careful and considered decision about proceeding with major surgery in all age groups, and this is especially the case in the very elderly.

A joint replacement is never out of the question, as long as your medical fitness allows it. Dr Martin takes time with elderly patients to really get to the bottom of their issues and to help the patient decide whether an operation is right for them or not.

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Am I too young?

Joint replacements don’t last forever and younger people wear them out more quickly. However, the results of surgery in young people are improving and so there probably isn’t a need for a hard and fast cut off like there used to be.

Despite this there are still good reasons to avoid a knee replacement in a younger person if at all possible. As a rough guide, Dr Martin would try to avoid doing knee replacements under the age of 50.

If you are young and having a lot of trouble from bad knee arthritis, then it isn’t a straightforward situation. That is a good reason to see an orthopaedic surgeon to talk through the different options and associated decision making.

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