Considering knee replacement surgery? An expert answers your questions

Symptoms of pain and stiffness caused by arthritis in the knee can disrupt daily activities and seriously limit a person’s ability to maintain an active lifestyle. Following unsuccessful treatment with medication or lifestyle measures, knee replacement surgery may offer effective treatment to resolve symptoms and improve the knee’s function. In this informative article, the first in this series on knee replacement, renowned consultant trauma and orthopaedic surgeon Mr Simon Hoskinson offers expert advice on when to consider knee replacement surgery and what to expect from the recovery period. The leading specialist also details which complications can occur in rare cases but also explains how the majority of patients are very satisfied with the results of knee replacement surgery.

When should knee replacement surgery be considered?

Patients should consider undergoing knee replacement surgery if they have a painful, arthritic knee which has not responded sufficiently well to simple treatment measures. This conservative (non-surgical) treatment may include:

• physiotherapy
• special forms of exercise
• pain killers
• the use of walking sticks
• lifestyle modifications

If the patient has tried all of these measures and the knee remains painful, it may be time to consider surgery. This is especially important if knee pain is so severe that it affects the patient’s everyday life, such as preventing them from walking significant distances or disturbing their sleep at night. As well as pain in the joint, a knee that often collapses or is significantly stiff can seriously impact quality of life and so, should non-surgical treatments fail, knee replacement may be the answer.

Are there possible complications to knee replacement surgery?

In the majority of cases, knee replacement surgery successfully relieves pain and improves the function of the patient’s knee and between eighty and eighty-five per cent of patients are very happy with their results.

Unfortunately, as with any form of operation, there are small number of patients that can suffer from complications of surgery. Some of the potential complications of knee replacement surgery are very serious while others are less so. Thankfully, complications are generally very rare.

One serious complication of knee replacement surgery is infection and should the artificial joint become infected, further surgery may be required. Patients can also suffer from blood clots in the legs which can travel to the lungs, resulting in serious health concerns. However, all patients are given medication to help thin the blood for around two weeks after their knee replacement to try to minimise this risk, although it doesn’t reduce the risk to zero.

There can be problems with damage to nerves or blood vessels behind the knee joint as a result of knee replacement surgery but thankfully this is extremely rare. Additionally, some patients can sustain damage to tendons and ligaments around the knee at the time of surgery, however this is also very uncommon. Should this occur, the problem can be dealt with at the time of surgery but the patient’s rehabilitation may need to be a little more cautious than usual.

Patients can suffer with stiffness of the knee replacement and therefore it’s vital that they work very hard in the days and weeks following their operation to try to get the knee moving as far as possible before stiffness and scar tissue can set in. Despite the best efforts of some patients, they may require manipulation under anaesthetic to try to get the knee moving better if it cannot bend easily or as far as desired.

As with any operation like knee replacement, there is a small risk of fracture of the bone, either during the operation or in the future should the patient have an accident. If this happens, the break can usually be dealt with in further surgery. Knee replacement implants may also wear out in the long term and can work loose from the bone and therefore revision surgery may be required.

The majority of patients who undergo knee replacement surgery will have a patch of numbness of the skin over the front of the knee. Although this can be permanent, in many patients this sensation is slowly recovered over time. Patients with knee replacements generally find it uncomfortable to kneel down because it can be uncomfortable although it is safe to do so.

Although there are serious risks to be considered, it is important to remember that these complications are extremely rare. The majority of patients are pleased with their knee replacements and enjoy a significant improvement in knee function and a marked reduction in pain and stiffness.

What can patients expect after surgery?

Following knee replacement surgery, patients can expect to spend two to three nights in hospital before going home to continue recovery. Initially, the knee feels very swollen and stiff and patients will need plenty of pain killers in the days following surgery. Over the first three to six weeks, the pain gradually fades, the range of movement of the knee improves and they start to feel that the knee’s function is even better than it was before the operation. The patient may experience some numbness which generally settles over time, although in some cases this can be permanent.

After the first three months, patients can generally walk without walking sticks and their knee starts to feel much better. Unfortunately, occasional patients experience long term discomfort or pain from knee replacement.

A replaced knee may always have some clicking sensation to it and of course won’t feel exactly like a normal knee, but the aim is to give patients a knee that can function better and cause far less pain than their original arthritic knee.

If you are considering knee replacement surgery and would like to discuss your options with Mr Hoskinson, you can schedule a consultation with him by visiting his Top Doctors profile.