Joint replacement surgery is an important area of treatment for certain kinds of severe knee pain. The charity Arthritis Research UK estimates that 70,000 knee replacement operations are carried out each year, and they certainly feature prominently in our caseload here at Chris Bailey Orthopaedics: on average, I perform about four knee replacements every week. So what exactly is involved in the surgery? Here’s a quick primer to help you understand more about it.
What is knee replacement surgery?
In a nutshell, it’s a surgical procedure in which part (or the entirety) of a damaged or diseased knee joint is replaced with an artificial joint . Usually this involves removing the worn-away cartilage and bone of the knee and replacing it with a part made of metal or plastic, which enables us to restore movement and stability to the joint. The operation is also known as an arthroplasty.
What are the different types of knee replacement?
There are two main types: Total Knee Replacement (often short-handed to TKR) and Partial (or Unicompartmental) Knee Replacement (PKR, or sometimes UNI). TKR involves full replacement of the knee with an artificial joint. PKR involves replacing only part of the joint – when osteoarthritis has damaged a single side of the knee, for example. Less common types of replacement include kneecap replacement and complex (or revision) replacement, where a more technically-complicated joint is secured in the knee (this tends to be used in cases of major deformity or bone loss).
What kinds of conditions cause people to have this procedure?
The most common reason for having a knee replacement is to treat osteoarthritis. This is when the protective cartilage of the knee joint becomes worn away, causing the bones of the joint to rub more closely against each other. The result of the rubbing can be pain, swelling, stiffness, a grating noise or sensation, and / or instability. Rheumatoid arthritis (an autoimmune disease that causes inflammation of joints around the body) is perhaps the next most common reason, followed by post-traumatic arthritis. Other conditions that may lead to knee replacements include gout, avascular necrosis (death of bone in the knee joint) and haemophilia.
How do I know if I need a knee replacement?
This is a question I’m asked on a daily basis – in fact it’s one of the most common topics of conversation in our clinic. The need for a knee replacement can only ever be judged on an individual basis, but most doctors will only recommend one when other options – such as physiotherapy, medication and steroid injections – have been exhausted. What does that mean in practice? It generally means that the condition has come to affect all aspects of day-to-day life in a very negative way. A phrase I use often is: “Is life manageable? Or is life miserable?” If it’s manageable, then it may be preferable to do just that, while avoiding activities that exacerbate pain. If everyday activities have become miserable, then it may be time to consider surgical options.
How long will it take to recover?
In truth, we find that most patients tend to underestimate the recovery time for a replacement operation. Whether TKR or PKR, a knee replacement is major surgery and shouldn’t be taken lightly. The first fortnight can be very uncomfortable, and needs to be managed carefully with pain relief medication. The good news, though, is that patients often see a turnaround after about two weeks. From that point on, progress is usually steady. Recovery varies from patient to patient, of course, but we tend to estimate that it will take six weeks to return to everyday activities, and around 12 months for a full recovery.
