Knee Replacement Procedures

Knee replacement is a common operation in which an Orthopaedic surgeon will perform to replace the worn or damaged knee surfaces with an artificial joint. Both partial and total knee replacements are common and vary based on individual considerations.

Usually your GP or Physiotherapist will consider sending you for an Orthopaedic examination if you have already exhausted other non-operative pathways such as extensive Physiotherapy, painkillers, walking aids and injections. A clinician will also consider the nature of your pain and function before making the decision to refer you to an Orthopaedic surgeon. They will make this decision in light of whether the pain affecting your quality of life, mental wellbeing and sleep.

• Osteoarthritis.

• Rheumatoid arthritis or other similar inflammatory arthritis.

• Severe trauma to the knee bones.

• Bone death due to abrupt loss of blood supply to them.

• Gout.

• Haemophilia.

• Deformed knee.

There are mainly 2 types :

• Total knee replacement – this involves replacing the end of the thigh bone (femur) and top of the shin bone (tibia). Some surgeons opt to replace the back of the patella (knee cap) with a plastic dome.

• Partial knee replacement – also known as uni compartment knee replacement. In this surgery, only one half of the knee will be replaced. Usually it will be the inside half of the knee.

Rarely, an Orthopaedic surgeon may consider doing a patella / kneecap replacement. This is advised only if the surgeon establishes it is the only area which is affected.

Your hospital will arrange a face-to-face pre-operation class to explain what to expect during and after surgery. It is also important that you stay as active as you can. A Physiotherapist can help you with prescribing strengthening exercises targeting your thigh muscles, and there is strong research evidence that the stronger you are before the surgery, the better the outcome of the surgery (Rooks et al., 2006).

It is considered as a major surgery, and national average for hospital stay is about 3-5 days. You will be under the care of a multidisciplinary team at the hospital which consists of your Surgeon, Ward Nurse (who deals with pain management side), Physiotherapist (deals with progression of your mobility and exercises) and Occupational Therapist (they help you by assessing your home environment and may help you have some assistive aids to help with daily activities).

Most people can manage without walking aids after 6 weeks but it is important that you adhere to the prescribed home exercises during this time. Most hospitals will give you an advice leaflet which contains all home exercises. You may also be referred to an outpatient department to see a Physiotherapist where they will progress your walking and exercises. You can start driving after 6-8 weeks. Full recovery can take upto 2 years, and a very small number of people have some pain even after 2 years.

Click here for useful exercises recommended by ‘Versus Arthritis’.

These are rare but can include:

• Infection to the wound or implant.

• Deep vein thrombosis.

• Ligament, artery or nerve damage.

• Persistent stiffness or pain in the knee.

• Break in the bone during or after the operation.

To avoid infection, ensure you keep the wound and dressing clean and dry, especially after a shower. Keep an eye on the wound, if it starts to swell, become red and hot, see your GP and be sure to keep an eye on your temperature as infection can raise your temperature too.

To prevent deep vein thrombosis, stick to the advice given by your nurse at the hospital, use your stockings as advised and keep active. If you develop severe pain with or without redness in your calf muscles, please contact your GP surgery.

Arthritis Research UK information booklet – click here.

NHS information – click here.

Rooks, D.S., Huang, J.I.E., Bierbaum, B.E., Bolus, S.A., Rubano, J., Connolly, C.E., Alpert, S., Iversen, M.D. and Katz, J.N., (2006). Effect of preoperative exercise on measures of functional status in men and women undergoing total hip and knee arthroplasty. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 55(5), pp.700-708.