Knee Replacement: Understanding the Options, Risks and Benefits

Knee replacement or Arthroplasty is a common procedure that many of us will have either heard of or know someone who has had this procedure.  First carried performed in 1968, knee replacement is one of the most important orthopaedic surgical advances of the twentieth century.  Since then has seen both a surge in demand but also significant developments in both technique and the surgical materials used with over 115,000 people undergoing this procedure each year in the UK. 

Knee replacement is commonly performed in patient groups aged 60 to 80 years of age, however it is important to understand that knee replacement can be offered to younger patients too.

Clinician manipulating patient's knee

Why knee replacement may be considered

There are several causes as to why knee replacement may be an option for patient treatment.  The primary indication is for pain relief secondary most commonly to Osteoarthritis. It may also be undertaken for Inflammatory arthritis and occasionally trauma.

It is usually considered when all other conservative measures have been exhausted. These include: Physiotherapy, weight loss, activity modification, use of a stick, regular pain relief and occasionally injections of steroid or hyaluronic acid as well as considered use of a brace.

It is usually considered when the benefits of surgery out way the risks for the individual.

For me as a Surgeon, it is when the patient has one or a combination of the following: cannot sleep without interruption, has severely limited mobility and their personal quality of life is so limited by the arthritis that they are prepared to undergo replacement to relieve their pain.

In many cases, knee replacement has a huge impact on improving a patient’s quality of life, but in a small percentage, the operation does not live up to the patient’s expectations. We do not fully understand why some patients do better than others but those that tend to fare a little worse are patients younger than 60, patients where the knee arthritis is not down to bone on bone at the time of the replacement and those that are suffering from depression prior to the surgery. I often explain to patients that I cannot give them an 18-year-old knee but can give them a mechanical substitute for a knee that they have worn out already.

What to expect from a consultation with your operating surgeon

Much of the consultation with the operating Surgeon should centre around exploring what the patients hopes and aspirations for a replacement are prior to surgery so that they have realistic expectations.

I tell my patients that a knee replacement has an excellent chance of significantly improving the pain that they are in but there are no 100% guarantees. I describe it as a pro-active process rather than a reactive process; by which I mean that it is essential to engage in the Physiotherapy and post-operative mobilisation in order to get the best result.

I also tell them that they will “Hate me for 6 weeks, think I’m ok at 3 months but not be really pleased they have had it done sometimes for up to a year). Physiotherapy is an essential part of the process of knee replacement. It is so important that the patient really engages and works hard to regain the range of motion of the knee (bending and getting it right out straight) or they will never be happy with the result.

Clinician in consultation with female patient

What sort of knee replacement options are there?

There are several different types of knee replacements. Lots of companies offer their own options and they would have us believe their own is always the best option. You should discuss with your Surgeon which knee replacement they are using and potentially why.

In addition to different makes, there are also different types. A total knee replacement replaces the end of the thigh bone, top of the shin bone and the under surface of the knee cap (though some Surgeons opt not to replace this as part of a total knee). In addition, there are Uni-knee replacements which may resurface just the inside of the knee outside of the knee or under surface of the knee cap joint- dependent on where the arthritis is. There are pro’s and cons for these options and they should be explored for the individual with their Surgeon.

How to prepare for surgery and what are the risks?

Prior to the operation, the patient will have to undergo a process of consent and sign a form to say they understand the risks they are undertaking. They may also be given a booklet on the process and be enrolled into a “Joint School” to further familiarise themselves with the process.

Of course, no operation is without risk. The key risks for me are that the procedure doesn’t meet the patient’s expectations and they are dissatisfied with the outcome. The risks specific to the patient will need to be explored with the consenting Surgeon but they do include:

  • the risk of infection
  • clot in leg going to chest with potentially fatal results
  • inability to kneel post op
  • scar over knee with pain/numbness on outside of scar
  • fracture of bone
  • dislocation
  • requirement for revision surgery and potential damage to nerve or blood vessel

It is important to appreciate that though these risks are very significant, they are also very rare. It is important that you express any concerns or raise any questions directly with your consultant, these present opportunities in which you can explore all options available to you in order that you can make well informed decisions.  In my opinion, the right time for Surgery is when the patient advises me that they understand the risks but still wish to proceed with the surgery in order to relieve their pain and improve their quality of life.

 

Want to keep learning?  Find out more about the author, Mr Michael Radford - Somerset Surgical Services.


Musculoskeletal Health

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