Damaged, diseased or worn knees are replaced by artificial joints in a routine operation by arthroplasty. The common reason for this surgery is arthritis. Either both sides of the joint are replaced (TKR) or a partial, one side of the joint (PKR). The replacement knee will last for 20 years.
Knees may be excessively damaged by osteoarthritis, rheumatoid arthritis, gout or haemophilia. Knee replacement surgery may also be necessary for bone dysplasias, avascular necrosis (the death of the knee bones), and other severe knee injuries or deformities.
In a total knee replacement surgery, the joint surfaces at the top of the shin bone (‘tibia’) and the thigh bone (‘femur’) are both replaced with metal parts. They are either cemented into place, or the surface of the bone-facing component is textured to encourage bone growth.
The underneath of the kneecap (‘patella’) might also be replaced with a plastic dome. This decision is sometimes taken during the operation when Mr. Samarji decides whether or not the original kneecap can be preserved. The wound is closed with stitches and tightly bandaged. The operation takes one to two hours. It is normally conducted under a spine-blocking anaesthetic.
Six weeks after the operation, you should be off crutches and back to normal activities. Knee replacements have extremely high success rates.
The most common indication for a knee replacement is painful osteoarthritis of the knee. In making the decision to undergo an operation at the consultation it is important to discuss and consider how much pain the knee is causing you and to consider the various options open to you for the treatment of arthritis. These include painkillers, physiotherapy, steroid injections, weight loss, splints and of course surgery (knee replacement, or osteotomy or partial knee replacement).
At the consultation, the various options will be discussed along with the nature of the surgery and what it involves including the chance of success and risks, in order to help you make what you feel to be the right decision. Usually, when simple measures such as painkillers and physiotherapy are no longer effective most patients elect to undergo a knee replacement operation, which is highly effective. However, this can really only be done after a consideration of the above.
Knee replacement surgery involves removing the arthritic parts of the knee joint and replacing the arthritic bone with a metal prosthesis on the femur and a metal plate on the tibia into which is clipped a hardwearing plastic tray. The operation takes between one and two hours to perform.The operation is usually carried out under a general anaesthetic or a regional technique such as an epidural or a spinal anaesthetic.
Generally, you will stay in hospital for three to four days following a knee replacement. The nurses and physiotherapists will help you mobilise following the operation.
Following knee replacement surgery patients tend to return to work approximately two months following the operation. Return to playing sports such as golf is usually at eight weeks following the procedure. You will normally be able to start driving at six to eight weeks following a knee replacement.
All patients undergoing knee replacement surgery will need physiotherapy. The physiotherapists will work to regain strength and rehabilitate the knee following knee replacement surgery. The physiotherapy usually proceeds for two to three months following the operation.
All surgery carries risks. Knee replacement surgery is subject to risks that can potentially affect all surgery that includes infection, deep vein thrombosis / pulmonary embolus, stiffness, bleeding, complex pain, loosening and requirement for further or revision surgery. The risks of severe complications are very low and the chance of getting a good result from surgery is very high. Nevertheless, it is important to weigh up the pros and cons before making any final decision.