Brief questions and answers about knee replacement

Mark Wilkinson is the Professor of Orthopaedic Surgery at the University of Sheffield, and a Consultant Orthopaedic Surgeon in the NHS. He also sees patients privately at BMI Thornbury Hospital as part of our team of orthopaedic consultants. Prof Wilkinson specialises in the treatment of patients with hip and knee arthritis. He also specialises in joint replacement in patients with inflammatory arthritis.

What kinds of people get total knee replacement surgery? Why do patients typically require this surgery?

Knee replacement is currently the only established successful treatment for arthritis of the knee that does not respond to lifestyle measures (diet and exercise) and painkillers. Patients come to knee replacement from all ages and walks of life. The reason they come to surgery is because they have had enough of the pain and reduced ability to maintain their normal activities.

What are the key stages in getting total knee replacement surgery?

Perhaps the first stage in the treatment of knee arthritis is to remain as active as you can manage.Research shows us that regular exercise does not risk making the knee arthritis itself worse, and is good for your general health. Activities such as walking, cycling and swimming are good for maintaining muscle strength and are good for your heart too!

Taking regular painkiller, even before doing something that you know may hurt the knee, is also a good idea. People who know that antiinflammatory tablets are bad for them can usually use a topical anti-inflammatory gel or cream on the skin over the joint safely, but always check with your GP first. Physiotherapy advice is also very helpful in the early stages of arthritis to make sure you are doing the right sorts of exercise.

If the pain and disability becomes too bad despite the actions above, then it is time to get referred for a specialist opinion. The consultant will ask you about your symptoms and arrange for some imaging of the knee, which might include looking at the hip, which can be the actual source of the pain and stiffness. If the shared decision between you and the surgeon is to go for knee replacement, then a date for surgery will be arranged. The final step before the day of surgery is to have a pre-operative assessment, where the staff check everything is OK to proceed. This may involve getting some further tests done, but usually this is straightforward. You will also be seen by a physio and other healthcare professionals to help plan your recovery after surgery. The next step is the surgery itself.

What are the risks involved? What is recovery from this surgery like?

All operations have risks, and with knee replacement these are general very uncommon. Heart attacks and other major health events are fortunately very rare, and are further reduced by effective preoperative assessment. Getting an infection in the knee replacement is also very rare.

It does take time to get over a knee replacement. Most people get mostly back to their old selves within 2 to 3 months, but the last little bit of getting the full benefit from surgery takes longer.

How much time do patients need to take off work?

If you were to require knee replacement surgery your consultant would discuss thoroughly the associated risks and recovery time.

Are there any alternatives to this surgery?

Once the knee has got to the point where you feel you can’t carry on with the symptoms despite the lifestyle measures outlined above, then joint replacement is currently the only proven treatment. Beware of being offered unproven treatments, such as new injections or types of tablets. Based on current best evidence, these treatments have not yet been shown to be better than the established ones. In the future we may find better ways of treating severe arthritis, but we are not there yet.

How long does a knee replacement last? Will it need to be replaced?

A knee replacement should least 15 years in 90% of people*, and we expect most to last much longer. If you are very young or active a knee replacement may not last quite as long, but this should not put you off seeing and having a discussion with your surgeon about the risks and benefits of surgery personalised to your own circumstances.