Knee replacements: Why do people fear them more than hip replacements?

It’s true that people who are in need of a knee replacement due to knee arthritis are often more concerned about the operation than those who need their hip replaced. While it is perfectly normal to have concerns before any operation, knee replacements, when performed by an experienced knee surgeon, will have reliable results.

We asked Mr Manoj Sood, one of London's leading specialist hip and knee surgeons, about the different concerns that people have before knee replacement surgery and how patients can feel reassured about the process.

When do I need my knee replaced?

While hip replacements work well in most people and require little rehabilitation, knee replacements can be tricker. However, if the knee replacement is done at the right time, by the right specialist and the patient has the right rehabilitation after the operation, the outcome is generally very good.

It’s important to get the timing right when performing a knee replacement. There is a danger that performing a knee replacement too soon, when the degree of pain present can be managed by other methods, may not relieve the pain as expected or, worse still, the patient may suffer an unnecessary complication and regret having the operation. If pain is not severe or limiting day-to-day activities, the operation should be postponed and other effective treatments offered to help any pain that exists until the replacement becomes necessary.

When surgery is needed, choosing the right surgeon who is skilled in knee replacement surgery is important. Knee replacements are more difficult to get right than hip replacements. This is why so many patients worry about having their knee replaced. Choosing a surgeon who has performed many successful knee replacements will be more likely to lead to better results.

You should try to understand how many replacements your surgeon has done, which is easy to find out, and how successful these have been, which is much more difficult to find out. Your surgeon should be a specialist knee replacement surgeon who has undergone advanced training in replacement surgery.

Proper assessment, including obtaining the correct X-rays prior to surgery, planning surgery, skilful surgery and supervised rehabilitation are very important for the surgical result to be successful.

Is a knee replacement painful?

Patients generally experience more pain after a knee replacement than after a hip replacement because the knee can swell and become tight and stiff. This can make everyday activities like bending more difficult. The arthritic pain will disappear straight after surgery, however, the tightness and swelling can take some time to resolve.

To control the pain after a knee replacement, pain relieving medication and regular icing helps enormously. In addition, the way in which the surgery is performed, how the wound is closed and the surgical techniques used will have a large impact on recovery and the pain felt by patients after the procedure. Although there will always be some pain, patients can walk on the day of the surgery, or the day after. Mr Sood’s patients go home the day following the surgery or the day after this, with good pain management and a mobile knee joint.

Will I need a lot of physiotherapy after surgery?

Usually, six to eight sessions of physiotherapy will be required after surgery. A well-performed surgery will make physiotherapy much easier, as the knee will be able to move more easily and the muscles will strengthen much faster. For a speedy recovery, it’s vital for your surgeon to keep track of your physiotherapy progress. This allows them to identify any reasons for a slower recovery and take appropriate action.

Sometimes it is necessary to manipulate the knee under anaesthetic if the knee is taking longer than expected to regain movement. As a guide, I only manipulate one knee replacement per year on average (less than one per cent of all replacements that he performs). Some less experienced surgeons have higher rates of manipulation and sometimes this signifies a problem with the surgery.

Will I be able to bend my knee properly?

If a knee replacement is performed well, the knee should bend just as well as it did before the operation and sometimes even better than before. Where patients have limited bending of the knee prior to surgery, surgical techniques can be used to improve the bend after the surgery.

Will kneeling will be a problem after surgery?

Most people are able to kneel after a knee replacement, but many don’t. It’s estimated that 60 to 80 per cent of people can kneel after total knee replacement when encouraged to do so.

Many patients don’t kneel due to a fear of damaging the replacement or because kneeling doesn’t feel right. For some, the knee may not bend enough to allow proper kneeling. This is another reason to have a specialist surgeon perform the procedure, to ensure that lack of bend doesn’t compromise activities.

In summary, ensure that other methods of treating the arthritic knee are explored before considering surgery. When a replacement becomes necessary, do your homework and choose a skilled specialist surgeon, and you will have an excellent chance of having a good result. Good luck!

If you’d like to discuss knee replacement surgery with Mr Manoj Sood, visit his Top Doctors profile here for a consultation.