THE PROCEDURE
Total knee replacement comprises resurfacing the bones of the tibia, femur, and patella with a metal implant and then placing a high-grade plastic spacer to create a gliding surface.
THE PROCEDURE
You will be in hospital for approximately 3 days after the operation. The ward physiotherapists will help you get up and walk on the first day after the operation with crutches, and you will need to use these for 6 weeks. You will be discharged once you are safely using crutches, and are able to walk up and down stairs. Post-operative physiotherapy is crucial to regaining muscle strength and range of movement.
THE RISKS
The major risks following a knee replacement are:
INFECTION – 1%
DEEP VEIN THROMBOSIS (DVT) – 2%
LOOSENING – IMPLANTS LAST 10-15 YEARS
THE PROCEDURE
In many cases patients only have arthritis in one part of the joint; this can be in the medial compartment (inside of the knee), lateral compartment (outside of the knee) or patellofemoral (between the front of the knee and the kneecap). If cartilage in the other parts of the knee joint is well preserved, then a patient will be suitable for a unicompartmental knee replacement (also known as a partial knee replacement).
Advantages of UKR
A SMALLER INCISION
QUICKER RECOVERY
BETTER FUNCTION (FEELS MORE LIKE A NATURAL KNEE)
BETTER RANGE OF MOVEMENT.
LOWER RISKS ASSOCIATED WITH SURGERY (I.E LESS CHANCE OF BLEEDING)
The main disadvantage is that a patient may require conversion to a total knee replacement at a later
date if the other compartments of the knee develop osteoarthritis.
The decision on whether to do a partial or total knee replacement depends on symptoms, clinical examination and imaging findings and will be discussed with you at your consultation.
THE RECOVERY
You are usually admitted to hospital on the day of surgery and as a rule will have a 2 night stay post- operatively. The operation is usually performed with a combination of spinal anaesthetic (numbing the leg from the waist down) and sedation. The surgery itself approximately 1 hour and the ward physiotherapists will help you get up and walk on the first day after the operation with crutches.
THE RECOVERY
Physiotherapy starts on the first day after the operation. You will get up and be able to put all your weight on the operated leg (on day one you will use a Zimmer frame for balance). You will have regular physiotherapy whilst in hospital and will be discharged once you are safely using crutches, and are able to walk up and down stairs. Post-operative physiotherapy is crucial to regaining muscle strength and range of movement. Crutches will be needed for 4-6 weeks after surgery and patients can drive once safely off the crutches.
Full recovery is around 3 months, which is much quicker than having a total knee replacement.
THE RISKS
A Partial Knee Replacement is a safe operation that dramatically improves the quality of one’s life. As with all surgery, there are still some complications:
Infection
the overall risk is around 1%. Antibiotics cannot penetrate an artificial material so the worst-case scenario is that the implant will need to be removed if infected.
Clots
Deep Vein Thrombosis and Pulmonary Embolism may occur in 2-3% of patients. All patients are placed on anticoagulants (blood-thinners) for 15 days after surgery to minimise the risk.
Damage to nerves or blood vessels
This is very rare (less than 1%) and may result in a foot drop if the common peroneal nerve is damaged.
Conversion to a total knee replacement
It is possible that arthritis may develop in other parts of the knee joint requiring further surgery at a later date.
Bleeding
Excessive bleeding may occur at the time if surgery and this may require a blood transfusion. Sometimes there can be bleeding after surgery (due to the blood thinners) and this can cause swelling around the knee.
Loosening
Knee replacements do not last forever. Rough estimates of around 15 years are quoted, the newer implants and bearing surfaces should last longer, although long-term data is required.
Ongoing pain
sometimes there can be on-going pain following a knee replacement. This may be due to structures around the knee, e.g. the muscles, or referred pain from the hip or spine.
Stiffness
sometimes a knee replacement remains stiff after surgery and there can be a loss of full straightening (extension) and bending (flexion).
THE IMPLANT
Partial knee replacements are not currently subject to mandatory ODEP (Orthopaedic Data Evaluation Panel) ratings. The implant I choose is the Journey II system and this has the added advantage of alternate low wear bearing surfaces (Oxynium).
