What You Need To Know Before Having A Knee Replacement
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Firstly, how common are knee replacements in the UK?
“In the last three years, around 80,000 knee replacements were carried out each year in England and Wales. Of these, 56% were in women, with the average age being 70. However, over 3,000 knee replacements were carried out in patients under 55, and a further 5,000 in those aged 55 to 59. The age at which a knee replacement is required appears to be dropping – it’s believed this is because we have become more demanding as a population and want to stay active for longer; as well as the fact obesity rates are on the rise, with body weight a strong predisposing factor to developing knee problems.” – Mr Sam Oussedik, consultant orthopaedic and trauma surgeon at The Princess Grace Hospital
What are the key signs you could benefit from surgery?
“There are many reasons for knee pain including problems associated with ligaments, tendons, the kneecap itself, fluid on the knee, or a tear in the menisci. However, one of the most common reasons for knee pain is osteoarthritis, particularly in older people, and it is the most common reason for total knee replacement surgery. Around 90% of all knee replacements are carried out because of osteoarthritis. Most patients who require knee replacement have severe knee arthritis pain that significantly affects their ability to perform normal daily activities. Walking is painful, and it is common to walk with a significant limp and some need to use a stick or crutch. Many also have disturbed sleep due to pain. If you have tried regular physiotherapy and injections have stopped helping or have failed to help, then it could be worth chatting to a knee specialist for an assessment.” – Mr Manoj Sood, leading specialist consultant hip, knee & sports surgeon
What are the dangers in delaying knee surgery?
“There are no strict criteria and timing for a knee replacement – it is personal. X-rays and MRIs can help us identify the damage within the joint, but it isn’t the only reason for a knee replacement. Some patients have bone-on-bone arthritis on a scan without any pain and still play 18 holes of golf. However, if there are deformities within the leg, such as bowing or knocked knees, then a knee replacement is a fantastic way to correct alignment. If your arthritis is severe, it can alter the loading of the body and start affecting your hips and spine. It can also over-stretch ligaments and tendons, making the knee replacement more difficult. The longer you leave your knee problems untreated, the longer the recovery will be and the more likely that complications can happen. Plus, long-term use of painkillers like ibuprofen can have a negative effect on the kidneys and blood pressure.” – Professor Paul Lee, leading consultant orthopaedic surgeon and founder of London Cartilage Clinic
Any tips for finding a clinic?
“The best advice comes from those you know who have been through a similar experience. Ask friends and family about local services – would they recommend their surgeon and clinic? Speak to your GP who can provide a referral, and physiotherapists will often have the inside track on how patients recover after surgery. Beware of shiny websites selling services – trust first-hand experience of friends and family above internet advertisements. Although knee replacement is routine surgery these days, complications can arise, and you should be sure that the clinic you choose has the right facilities to look after you come what may. Does it have access to intensive care? Are there other services, such as medical and cardiology cover available? How many procedures do they carry out each year? Look for individual surgeons on the National Joint Registry and the Private Healthcare Information Network. Ultimately, surgeons with busy practices in teaching hospitals will see the most challenging cases and be best placed to look after you.” – Sam
How can you prepare for surgery?
“Physio and sports massage are an important part of recovery post-surgery, but you should start pre-operation for the best results. There is a very important muscle on the inside of your thigh called vastus medialis oblique (often referred to as VMO) – a stronger VMO is the key to quick recovery, so chat about this with your physio prior to surgery. I routinely prescribe my patients protein and collagen supplements four weeks before and four weeks after surgery – studies show both can aid recovery from muscular injury. If you smoke, you should give up at least six months prior to surgery. This will help your body to heal quicker and prepare your lungs for the anaesthetic.” – Paul
What exactly happens during a knee replacement?
“The operation takes place under general or local anaesthetic. There are different types of knee replacement available, from replacing a damaged part of the knee (partial joint replacement) to replacing all three main parts of the joint (total knee replacement). Your surgeon will discuss the pros and cons with you and make a recommendation based on the extent of wear and tear affecting your knee. During the surgery, the surgical team use instruments to remove a thin layer of damaged cartilage and bone from the end of the thigh bone and top of the shin bone. These are then replaced by metal components, with a thin sheet of plastic separating them. The latest techniques use robotic technology to match the new knee joint perfectly with the surrounding tissues. Once the new surfaces are fixed in position, the tissues and skin are closed with stitches which will ultimately heal to form a linear scar over the front of the knee. The operation takes no longer than 90 minutes, depending on the technique used and complexity of the procedure.” – Sam
What should you expect immediately after surgery?
“Your knee will be painful and swollen. The quadriceps muscles (those which allow the knee to be extended, found at the front of the thigh) are often inhibited and the knee will feel wobbly until it becomes active again, which can take up to three days. The knee will usually be wrapped in a bandage and the clinical team will take multiple blood pressure and oxygen readings to ensure your recovery is progressing smoothly. You should expect to spend up to two nights in hospital.” – Sam
What level of pain should you expect?
“Your knee is a very sensitive part of your anatomy. It relies on a huge number of nerve endings – anyone who has banged their knee knows that the pain is quite severe and can linger. Pain after knee replacement varies from patient to patient but most find the first few days difficult and rely on strong medication to manage the pain. Ice packs are an excellent adjunct and do not have the same side effects as strong painkillers. Initial pain tends to subside after the first few days and becomes more manageable. Crutches are used for the first few weeks to rest the knee while it recovers but frequent exercises must be done to restore full function. Painkillers are usually discontinued after four to six weeks, and by eight to 12 weeks function is usually better than pre-operatively, improving further still as more muscle is gained.” – Sam
How soon after the operation will you be back to normal?
“Recovery from a knee replacement surgery is a gradual process that takes place over a period of weeks and months. During the first few weeks at home, you’ll need to take it easy and avoid putting too much stress on the new knee. Physiotherapy is also vital at this stage – this makes a real difference when it comes to helping you regain strength and range of motion in your knee. Full recovery from knee replacement surgery can take up to six months, although most patients will notice a significant improvement in three to four months. In general, you can expect to return to most of your normal activities within six to eight weeks after surgery. There are several things you can do to aid recovery – the first is to load the knee as soon as possible after surgery as well as find a good team of physios to work with; it’s also important to keep on top of the pain and ice regularly. It’s also vital to have a clear plan when it comes to pain relief and have enough stock of the appropriate painkillers, so you aren’t caught short.” – Paul
How long will a new knee last?
“The lifespan of the joint depends on how much you use it and therefore how quickly it wears out. Overall, a majority of people who have a knee replacement have less than a 5% chance of needing the knee redone within 13 years of the original operation. A modern knee replacement should last 15 to 20 years.” – Manoj
Here, Professor Paul Lee shares his dos and don’ts…
- Try to delay the knee replacement for as long as possible within reason; there are other solutions that can be useful to treat mild to moderate arthritis.
- Prepare. The four weeks following surgery is not easy, make sure you have a game plan for it. Fail to plan, plan to fail. It is much easier to get things organised before you have surgery.
- Ask questions. Ask detailed questions about the recovery programme especially – this is the most important factor for a successful replacement.
- Overthink the surgery. Don’t dwell too much on the technical details of how the surgery is done. It’s just a small part of the process and many studies have shown it makes no difference. Focus on the big picture.
- Rush. Do your research and wait for the right team for the operation. There is always a reason why the queue is shorter next door. Doing more or quicker doesn’t always mean better.
- Overdo it. In the first three weeks after surgery, you need to take it easy. The wound needs time and energy to heal, and your body needs to recover.
For more information visit HCAHealthcare.co.uk, HipAndKneeSurgery.co.uk, ProfessorLee.uk and LondonCartilage.com
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