Dr Jozsef Nemes, Consultant Orthopaedic Surgeon at Emersons Green NHS Treatment Centre gives the low

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Aug 25, 2015

Total knee replacements are a very successful procedure. National Joint Registry patient reported outcome measures report patient satisfaction greater than 95%, with good to excellent results of approximately 83%. Consultant orthopaedic surgeon Jozsef Nemes from Emersons Green NHS Treatment Centre describes the treatment.

Before operating, other measures are tried first. These include rest or reduced activity, pain-relieving medication, anti-inflammatory medication (if no contra-indications), physiotherapy and weight loss. Steroid injection can give temporary relief. A limited number of people can benefit from lesser arthroscopic procedures. 

For many people, only knee replacement can give good pain relief. 

In the UK more than 90,000 patients undergo knee arthroscopy each year. Patients may experience a range of symptoms including:

• severe pain or stiffness
• chronic knee inflammation and swelling
• knee deformity and loss of function
• pain at rest and pain at night

It is my advice that whilst pain during activity can be managed according to personal tolerance, pain at rest, and especially at night, causes weariness and rapidly degrades a patient’s well being. A knee replacement will often greatly improve a patient’s quality of life.

The most valuable investigation for osteoarthritis is x-ray. At least one of the images must be taken with strict weight bearing on the affected limb. This may show bone touching bone with no remaining cartilage, in addition to other signs of osteophytes (extra bone lumps around the joint), geodes (cavities or cysts in the bone) or sclerosis (hardening of arthritic bone). 

Knee replacements are called knee arthroplasty and are a resurfacing procedure. In osteoarthritis, trauma and inflammatory arthritis, the smooth, low-friction, cartilage that cushions the joint is lost. In knee replacement surgery the damaged surfaces are excised. The thigh bone surface is covered with a smooth metal dome. The shin bone surface is covered with a metal tray into which fits a medical-grade plastic spacer that then functions as the smooth bearing surface on which the thigh bone glides. The patella can also be resurfaced with a plastic button.

Surgery can take between one and two hours. It is usually carried out with a spinal anaesthetic. Patients can also have a short-lasting intravenous sedative, so they snooze during the procedure, but recovery is enhanced having avoided a full general anaesthetic. 

The majority of patients are able to return home between two and four days later. 

Patients will then need to rest. There is considerable fatigue in the first six weeks. Analgesia, icepacks, elevation and a programme of rehabilitation are normal. By 10 to 12 weeks most patients are doing well, though knee replacements often improve for up to 18 months after surgery.

With any major surgery it must be remembered that there is a small risk of complication. These are always thoroughly discussed beforehand. Programmes of care and hospital routine are regularly revised to minimise these occurrences. Examples of progress mean that pulmonary embolism is now rare and our deep infection rate for arthroplasty at Emersons Green NHS Treatment Centre is less than three per thousand joints.

After total knee replacement the knee will always feel a little mechanical. Proprioception (natural stability) is reduced in some situations. A good functional range of movement is the norm. For the vast majority of patients a knee replacement is the most effective procedure for providing pain relief for an arthritic knee.