Knee Replacement Surgery
As the physically active baby boom generation “ages gracefully”, their joints are showing signs of wear and tear (osteoarthritis). Yet, they are keen to continue active lifestyles in spite of their arthritis. Improved technology and increased availability is leading to more people opting for joint replacement surgery. Barbara Taylor, Specialist Physiotherapist for Physio2go St. Albans joins forces with Mr. Neil Davies, consultant orthopaedic surgeon at the Elms in St. Albans and Spire Hospital Harpenden, to answer frequently asked questions about knee surgery.
Why do I need a new knee?
Knee replacement surgery is a treatment predominantly for painful arthritis of the knee. The most common form of arthritis is osteoarthritis. In this condition joint surfaces become increasingly worn. Initially the cartilage that covers the surfaces is affected. As the arthritis progresses the bone underneath becomes damaged.
A knee replacement is considered when:
1. There is increasing knee pain.
2. Pain and stiffness in your knee are affecting your everyday activities so that you are becoming less independent.
3. Your mobility has reduced and you have problems getting around.
4. Your arthritis is not responding to other forms of treatment.
What If I don’t want a new knee?
There are various things you can do to help yourself.
1. Keep active. Regular exercise such as walking or swimming can reduce the pain and keep you mobile.
2. Keep your weight within normal limits as extra weight puts increased strain on your arthritic knee.
3. Physiotherapy can strengthen your muscles maintain knee mobility and improve gait.
4. A walking aid, such as a stick, reduces the strain on your knee as well as keeping you active.
5. Painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) help with pain management.
As with all major surgery there are risks involved. Please discuss these fully with your GP or surgeon.
What is a knee replacement?
The knee works as a hinge joint between the thigh bone (femur) and the shin bone (tibia). It has three compartments including an articular surface between the kneecap (patella) and the femur. In a normal knee joint the ends of the femur and tibia are covered with a smooth layer of articular cartilage that allows the bones to move over each other. In an arthritic knee the surfaces become roughened. Therefore the knee movements are restricted and painful. A knee replacement is designed to relieve pain, improve movement and make activity easier.
In knee replacement surgery the worn ends of the bones are removed and are replaced with a combination of metal and plastic.
In a total knee replacement both the femoral and tibia articular surfaces are replaced and usually cemented in place. If only one side (compartment) of the knee is affected by arthritis it may be possible to have half a knee replacement (unicompartmental). Replacement of the kneecap (patella) can be undertaken if the joint between the kneecap and the thighbone is affected by arthritis (patellofemoral joint replacement). Current advances in knee replacement surgery include computer-assisted surgery, minimally invasive surgery and robotic assisted surgery. Many of these techniques are still in their infancy and are still being evaluated.
What are the other surgical procedures?
• Arthroscopy (keyhole): Using small incisions, the joint can be examined and damaged areas can be repaired or cleared to stop the knee from hurting, giving way or locking.
• Osteotomy: In this operation the bone is cut, repositioned and allowed to heal in the new position. This procedure shifts the weight bearing from one worn area to another less affected area.
• Recent improvements in cell biology allow the surgeon to take a small piece of articular cartilage from your knee, multiply the cells in a laboratory so that they can then be reattached to cover cartilage defects in the knee. This technique is called Autologous Cartilage Implantation (ACI) or Matrix-Induced Autologous Cartilage Implantation (MACI). This is generally used for younger patients i.e. 15 to 55 years.
Please discuss any of these surgical options with your orthopaedic surgeon.
How can I best prepare for surgery?
Stop smoking as soon as possible. If you are overweight try to reduce your weight as this will both lower the risks of an anaesthetic and improve the beneficial effects of the surgery. It is important to attend any pre-operative clinics, as these will ensure you are fit for surgery as well as answering any questions you or your family may have. Check around your home to make sure that loose rugs and mats are removed, electrical cords moved safely out of the way and small objects are removed from the floor.
What can I expect after my knee operation?
After surgery you will be visited by the hospital based physiotherapist who will show you deep breathing exercises and exercises to maintain good circulation in your legs.
You will be mobilised early and begin specific postoperative exercises for your knee. These will need to be reviewed and progressed as your strength and mobility improve.
Please follow the advice of your consultant as to specific precautions and time scales that they recommend, as these may vary depending on the type of surgery performed and your general medical condition.
When you return home it is important to continue with the regime that has been prescribed to you by your physiotherapist. This generally includes exercises to improve the strength of your thigh muscle (quadriceps) and range of movement of the knee, gait re-education and activities of daily living. Some activities should be avoided during the first six weeks after surgery. These include kneeling, heavy lifting or strenuous activity.
Time in hospital following joint replacement surgery in both the private sector and NHS is normally 5 days. This limits the amount of physiotherapy treatment received in hospital. Home based physiotherapy is a way of continuing your rehabilitation, improving the range of movement in your knee and your mobilisation in the important 1-4 weeks following your surgery.
In addition to our extended clinic hours, Physio2go provides a home-based physiotherapy service. Our experienced Specialist Physiotherapists offer advice and treatment to patients before and after surgery as well as those who wish to manage the symptoms of arthritis without surgical intervention.
For further information please contact:
St. Peters St,
AL 1 3HD
Telephone: 01727 850925