What to expect from knee replacement surgery

Patients suffering from persistent and debilitating knee pain caused by arthritis may opt for surgical replacement of the joint should other types of treatment fail to provide relief. In this detailed guide which is the second in this series on knee replacement, leading consultant trauma and orthopaedic surgeon Mr Simon Hoskinson offers guidance for patients preparing to undergo a knee replacement on what to expect from the surgical procedure and the recovery period to follow.

How is a knee replacement performed?

Once the decision has been made to undergo knee replacement surgery, the patient is seen in the pre-assessment clinic of the hospital where they will have their surgery. This is to make sure that the patient is fit enough for surgery and to do any investigations that are needed beforehand to help ensure that the procedure will be as safe as it possibly can be.

Given that the pre-assessment is satisfactory, the patient will come into the hospital on the day of their operation and will meet their surgeon and anaesthetist before surgery. When it’s time for the operation, the patient is then taken to the anaesthetic room in the operating theatre complex to be given their anaesthetic. For knee replacement surgery, this is often a spinal anaesthetic which makes the patient numb from the waist down, along with some sedation. For other patients, a spinal anaesthetic may be used instead with a general anaesthetic but this is generally discussed with the anaesthetist beforehand.

The patient is then safely positioned ready for surgery and is taken into the operating theatre. Before surgery starts, the skin is disinfected with a special skin preparation solution and drapes are applied around the knee.

An incision is then made vertically on the front of the knee and the knee joint is exposed by moving the knee cap out of the way. The worn, arthritic cartilage and the layer of bone underlying that cartilage is removed and the bones are shaped in order to fit the new implant. We ensure that the angles are cut correctly by using various jigs and alignment guides.

Trial implants, which are not the real implants, are then inserted to help ensure that the knee has a good range of movement, feels stable and that the knee cap is tracking properly. Once we’re happy with this, the bone ends are cleaned thoroughly and the final implants are inserted and cemented in place.

We then do some more final checks before deciding the thickness of the plastic insert that is put in to the knee. Once this has been put inside, the knee can be closed with multiple layers of stitching. A drain is usually inserted which comes out of the knee following the operation. It helps to drain any excess bleeding into the knee joint so it can be removed the following day.

Bandages are then applied to the knee and the patient is woken up from their anaesthetic before being transferred to the anaesthetic room and then back to the ward where their recovery starts.

What is recovery time like following knee replacement surgery?

A full recovery following knee replacement surgery may take from six to twelve months. Having said that, after six to twelve weeks the pain of the operation has generally settled down and most patients will notice that their knee causes them less pain and discomfort than it did before the operation.

The first two to three weeks can be quite challenging for the patient because the knee is painful and plenty of painkillers will be required. The knee also feels stiff and swollen and as if it doesn’t want to move properly.

The patient will initially find it difficult to lift the leg off the bed or to straighten the knee fully. This is normal after a knee replacement but it is important to get the knee moving as far and as quickly as possible. Once the patient has got through the first few weeks, they start to turn a corner and feel that the knee is actually getting better.

The surgical wound itself takes around two weeks to heal. During that time the wound needs to be kept dry and the dressing should be kept in place as much as possible.

If you are considering knee replacement surgery and wish to discuss your options further, you can book an appointment with Mr Hoskinson by visiting his Top Doctors profile.