Knee Arthroplasty

About Knee Arthroplasty

You have been listed to undergo a form of elective knee replacement/knee arthroplasty. This will involve admission to the Hospital typically for 48 hours, although some patients go home on the day or in the first 24 hours.

The goals of surgery are to reduce pain, stiffness, and dysfunction and deformity in the knee.

Whenever we undertake this kind of surgery, we always stress to patients that they should have considered, used, or exhausted other forms of conservative/non-operative management. These would include weight loss, activity modification, painkillers and anti-inflammatories, braces, strengthening exercises and physiotherapy. You should also be aware by now that there are some injections that are used to relieve pain from osteoarthritis. Traditionally, arthroscopic keyhole knee surgery was used in this setting, but this seems to be relatively unsuccessful where there is osteoarthritis.

Your procedure will be carefully tailored to your anatomy and planned very carefully in which Therefore, forms of knee replacement such as a full or partial are being considered or will be considered. CT and others scans will be obtained if necessary to facilitate the planning and execution of your operation – particularly if we plan to use enhanced technologies like robotic assisted surgery.

Knee replacement surgery is expected to cause some common symptoms. You will have some side effects from the anaesthetic such as possible sickness and drowsiness. You will have some drug side effects which are similar in the peri-operative period from painkillers. You will of course have a scar, which usually fade over time, that will have numbness and swelling around it. You will feel discomfort, swelling heat and pain. These decrease over time, but it is perfectly normal for a knee replacement to have severe discomfort for the first six to eight weeks that may affect you at night, and some form of discomfort for six months or longer. It is common for patients to also have numbness on the outside of the scar, and to have swelling and heat in the knee for three months or more. Numbness can be permanent but usually reduces over time. Patients normally have a click after knee replacements which diminishes as the muscles around the knee get stronger. A small proportion of patients do not have complete pain relief.

Surgery is also associated with a number of generic risks. These include: chest infection, urinary infection, confusion, constipation, gastrointestinal bleeding, respiratory problems, pulmonary embolism, cardiac or cerebral events. Death is also possible with any surgical intervention. The risk of death is minimized by careful pre-operative assessment. If necessary, you may need be referred to one our medical consultants for clearance in order to facilitate your surgery in a safe manner.

There are a number of complications that can occur after knee replacement. Those that concern us the most are infections and blood clots. Infections can lead to readmission to hospital and possibly, more surgery. Blood clots, which can be in the leg, but can also track to the lung and be extremely dangerous. A number of measures are put in place to reduce the risk of these complications. These include antibiotics, early mobility, blood thinners, stockings and compression pumps.

Minor blood loss would be expected post-surgery. However, some patients may require a blood transfusion and the risk of having that is well under 5%

Bleeding, either into the tissues or from the wound can cause swelling of the leg. In extreme but very rare circumstances, this can be labelled as a “haematoma” and require further surgery. for such a scenario, further surgery is needed in less than 1% of the cases.

Patients may also have wounds that are slow to heal and that may require further intervention such as special dressings, multiple clinic visits and rarely a further minor procedure.

Patients may also feel some leg length inequality. We do our best to get the leg lengths equal, both in terms of planning and execution. Occasionally, some adjustment is needed to compensate for deformity due to arthritis and to make the knee stable. Most patients find that their perception of inequality resolves over the first 6 months as the body adjusts to new found mobility.

Other risks include fractures. These are very rare in modern practice at less than 1%.

Some patients are dissatisfied with the outcome even though the procedure was technically fine.

There are also very rare complications that ought to be mentioned. These include damage to the nerves or blood vessels, damage to the bone or fracture, stiffness, failure of either the operation or the implant requiring re-operation, the formation of excess bone, called heterotopic ossification, wear or loosening revision surgery for mechanical problems or an allergic reaction to the surgical implant and/or dressing.

I appreciate that the info sheet is full of medical terminology. It is to highlight some of the issues that you must think about before asking to have surgery and consenting to it. Do please discuss any questions at your preassessment and get in touch with my office if you have further queries. We want you to have a seamless and confident journey to your new knee.