Knee Replacement Surgery

What is knee replacement surgery?

The knee is divided into three compartments: the medial (inner), the lateral (outer) and the patello-femoral. Any of these compartments can be replaced, without replacing the entire knee joint.

Knee replacement is sometimes the only surgical option available to patients with knee conditions such as arthritis that cause damage to the knee joint, resulting in problems carrying out everyday activities. The aim of the operation is to relieve pain and improve mobility by replacing the worn-out parts of the arthritic knee with specially designed metal and plastic components.

Most knee replacement surgery is carried out on older people, although it can be offered to patients of any age. In most cases, a replacement knee will last over 20 years.

While knee replacement may be the answer for some people, for others – particularly if you are a younger patient, an athlete, or an older patient who is still very active – removing the knee joint, which also means taking away a great deal of healthy tissue, may not be the best option. In some cases, you may be offered knee realignment surgery (osteotomy) instead; this new procedure can significantly delay, or in some cases even avoid, the need for knee replacement surgery.

Why might I need knee replacement surgery?

You are more likely to need total or partial knee replacement surgery if you have:

Arthritis. Wear and tear arthritis is by far the most common indication.
Rheumatoid arthritis
Psoriatic arthritis
Haemophilia
Gout
Arthritis caused by a previous knee injury
Deformity of bones in the knee
Bone death due to poor blood supply (avascular necrosis)

There are two types of knee replacement surgery:

Total knee replacement (TKR) where both sides of your knee joint are replaced
Partial (half) knee replacement (PKR) where one part of the joint is replaced

In some cases, your consultant may advise that you have an examination of the knee joint under an anaesthetic using keyhole surgery to decide on the option that is best for you.

Total knee replacement (TKR)

This operation, first carried out in 1968, is now very common and involves replacing all the surfaces of your worn-out knee with metal and plastic components. It’s offered when lifestyle modifications, painkillers and physiotherapy haven’t relieved your pain or mobility problems.

What’s involved in TKR?

Damaged cartilage, along with some bone, is removed and replaced with metal parts to form a new joint surface. These are fixed with specially designed cement. The underside of the kneecap is cut and the surface replaced with a plastic component. A spacer is placed between the metal parts to enable the joint to glide smoothly.

What are the advantages of TKR?

More than 90% of people who have TKR surgery have much less knee pain and find it significantly easier to carry out their everyday activities afterwards.

Will the new knee wear out?

Even with normal use, the replacement knee will eventually wear out but it should last for at 15 if not 20 years. However, putting excessive stress on the new joint can make it loose and painful.

What will I be able to do after TKR?

You should be able to walk as much as you want, swim, play golf, drive, cycle, and take part in low-impact sports.

What won’t I be able to do after TKR?

You’ll be advised not to take part in high-impact sports including team sports, running, jogging or jumping. These put too much strain on the artificial joint.

How long does it take to recover from TKR?

The time it takes to recover from TKR will depend on how closely you follow your rehabilitation programme once you return home after surgery, but it can be between three months and a year before you get back to normal.

To achieve the best possible outcome, it’s important to follow your exercise plan which includes gradually increasing walking, and other low-impact exercises. It’s important to avoid falling or injuring your new knee. Let your dentist know that you’ve had a knee replacement as you may need to take antibiotics before certain dental procedures to avoid the chance of an infection in the joint.

Your consultant will be able to advise you about when it’s safe to drive again – this is usually around 4-6 weeks after surgery.

Partial knee replacement (PKR)

This operation is offered if only one of the three knee compartments is damaged. In most cases, this is the medial (inner) compartment. As the procedure involves replacing just one part of the knee, the scar tends to be smaller, recovery is faster with less pain, and the range of movement remains better than with a TKR.

What’s involved in PKR?

A small incision is made and damaged cartilage in one part of the knee, along with some bone, is removed and replaced with metal parts to form a new joint surface. These are fixed with specially designed cement.

What are the advantages of PKR?

There is a smaller wound and a shorter procedure than with TKR, meaning a quicker recovery, less blood loss and less pain afterwards. Because much of the knee is preserved, you are likely to retain a greater range of movement than you would after a TKR.

What are the disadvantages of PKR?

You may need to have total knee replacement surgery in the future if arthritis causes problems in other compartments of the knee. Having said this the outcome of partial knee replacement is very similar to that for total joint surgery.

How long does it take to recover from PKR?

The time it takes to recover from PKR will depend on how closely you follow your rehabilitation programme once you return home after surgery. You’ll be able to get up and walk shortly after surgery and will be given physiotherapy exercises to carry out at home, but it’s important to avoid falling or injuring your knee. You should also let your dentist know that you’ve had a PKR as you may need to take antibiotics before certain dental procedures to avoid the chance of an infection in the joint.

Most people can get back to their normal everyday activities after about six weeks.

Your consultant will be able to advise you about when it’s safe to drive again – usually around 4-6 weeks after surgery.

Revision total knee replacement (TKR)

If your previous knee replacement hasn’t been successful, you can have a second procedure where some or all of the artificial components in the knee are replaced with new ones.

Problems with previous surgery may be due to wear and tear or loosening of the new knee joint, instability due to ligament damage, stiffness, a fracture or, in some cases, infection.

Revision surgery tends to take longer, and is often more complex, than the original knee replacement, with extensive planning and rehabilitation needed to achieve a good recovery. Your consultant will be able to advise you about your surgical options and help you decide which is likely to have the best outcome.

Dr. Prasad Bhagunde

MS Ortho D Ortho DNB

Senior Orthopaedic Consultant and Sports Medicine Surgeon