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Advice on Total Knee Replacement &
Unicompartmental Knee Replacement

Before embarking on knee replacement you should be aware of the following facts. If you have any other questions you should ask your surgeon for further information.

Benefits

• Relief of pain:  Over 90% of patients can expect to lose all, or virtually all, of their knee pain.

• Mobility:   Mobility should improve. Most patients are able to walk unlimited distances after their knee replacement. Activities such as gardening and playing golf are normally possible. Other more energetic activities such as playing tennis are skiing may be possible, although are not generally recommended; you should discuss this further with your surgeon if you intend continuing this type of activity.

• Kneeling:  About half of patients find kneeling uncomfortable because of the position of the scar. However kneeling will not cause any damage to the replacement and there is no medical reason why you should not kneel.

Risks

General risks associated with any surgery

• Cardiovascular problems:  Heart attack and stroke can occasionally be caused by anaesthesia and surgery. The risks of this complication is normally exceedingly small in healthy individuals. The risk may be greater if you have pre-existing disease, in which case your anaesthetist / surgeon will discuss this with you.

• Thromboembolism:  Blood clots may sometimes form in the veins of your legs, a condition known as 'deep vein thrombosis.' This may cause excessive swelling of your legs and may require treatment with blood thinning drugs. Extremely rarely the clot may become detached and travel to the lungs; this is a potentially fatal complication known as a 'pulmonary embolus.' There are some conditions in which the risk of thromboembolism is increased (e.g. patients on the contraceptive pill or HRT), in which case you may be given medication to reduce the risk.

 

Specific risks of knee replacement

• Infection:  Infection can complicate any surgery. It may be possible to treat this with antibiotics alone, but more commonly further surgery and removal of the replacement is necessary. The chance of this occurring is less than 1%

• Nerve and blood vessel injury:  There is a very small risk (<1%) of damage to nerves or blood vessels around the knee.

• Loosening:   It is possible that with time the hip replacement will lose its fixation to the bone. This may be associated with deep seated infection, but often occurs without any apparent cause. The chance of this occurring increases with time; there is approximately a 5-10% chance of this occurring within the first 10 years after surgery. Thereafter the risk of loosening increases and by 15 years about 30% replacements will require revision.

• Wear:  Physical wear of the prosthesis becomes a problem the longer it has been implanted. Wear debris may induce loosening of the components.

Revision surgery

• If your knee becomes loose, worn or infected further surgery may be necessary. It is normally possible to re-insert a new replacement. This type of surgery is normally successful, although is the complication rate is higher than that following primary replacement surgery.
  If further replacement is not possible the knee may have to be stiffened or on very rare occasions an amputation may be necessary. It should be stressed that this is an extremely small risk.

Surgery details

• Surgery will be done under either general or regional anaesthesia. Your anaesthetist will discuss this with you.

• The operation will take about 1 to 1½ hours

• Following surgery you will have an intravenous drip for up to 24 hours. Blood transfusion is required in about 15% of cases.

• You will normally start walking within 12 to 24 hours of operation.

• You will be taught to climb / descend stairs within  3 days of surgery.

• Most patients return home 4 to 5 days after their operation.

• On return home you will be using 1 or 2 sticks. Crutches at this stage may sometimes be required

Recovery

• Walking aids can normally be discarded within about 6 weeks of surgery

• Outpatient physiotherapy is often, but not always, required for a few weeks after surgery.

• Driving is normally allowed by 6 weeks and sometimes sooner than this dependent on post operative progress.

• Showers may be taken as soon as the wound is dry (normally within 72 hours). Bathing is usually possible by about 6 weeks.

• Your progress will be monitored by our physiotherapists and all patients will have a routine follow up check 6 weeks after surgery.

• All patients will have life long follow up in clinics run by the Basingstoke Joint Registry.

 

For further information please see  www.johnbritton-orthopaedics.co.uk

John Britton FRCS
Consultant Orthopaedic Surgeon