The ins and outs of knee replacement surgery

Mr Harminder Gosal Mr Gosal is a specialist knee surgeon based in Cheltenham. More by this author
If you’re considering knee replacement surgery you might wonder what to expect. From anaesthesia to recovery, Surgeon Harminder Gosal fills us in on the process.

Living with daily pain and reduced mobility in your knees can have a significant impact on your lifestyle, making even everyday tasks like housework feel like a huge challenge.

One of the main causes of knee pain and immobility is osteoarthritis (OA), accounting for a great many of the 90,000 knee replacements carried out in England and Wales annually.

There are many ways of managing the symptoms of osteoarthritis including exercise, physiotherapy, pain relieving medication, and sometimes injections such as steroid or hyaluronic acid (viscosupplementation). But when the symptoms can’t be managed by these, you may decide you’d like to be considered for a knee replacement.

Deciding on a knee replacement

The decision to carry out knee replacement is made jointly between you, your GP and your surgeon. There's almost never an absolute indication for knee replacement surgery but ultimately it’s your decision when you can’t live with the pain and the disability. While the average age of a knee replacement patient is 69 years, very many younger patients also benefit from successful knee replacement surgery.

Surgeons carry out either a partial (medial, lateral or patello-femoral) or total knee replacement. Which surgery you receive depends on your symptoms and x-ray findings and would follow a discussion with your surgeon about the expected outcomes of each.

The day of surgery

Patients are usually admitted on the day of surgery. To try and minimise the risk of infection antibiotics are given in the operating theatre just before the start of surgery and for two or three doses afterward, depending on the type of drug used. This varies, as some people are allergic to certain types of antibiotics.

Surgery is carried out under spinal or general anaesthetic, sometimes with a local nerve block, depending on what you, the anaesthetist and the surgeon decide.

What to expect after knee replacement surgery

A padded bandage dressing is applied to the knee immediately after surgery and then reduced at around 48 hours. Patients are encouraged to get out of bed and walk with the help of the physiotherapists on the day of surgery or the following day, helping to prevent stiffness and maintain healthy circulation. To reduce the risk of thrombosis you would also likely be given blood thinning medication. An x-ray is carried out after surgery to check the position of the implants and routine blood tests are done around 24 hours post-operatively. You’ll be given pain relieving medication to manage your recovery.

Getting back to daily life

Patients are usually discharged when they are able to walk with sticks, manage stairs and do simple day-to-day tasks. Typically it’s around four or five days before you leave hospital.

It usually takes between 10 to 14 days for the wound to heal, but everybody heals differently. Your surgeon may suture wounds with dissolving stitches to avoid any need for removal. For six weeks post-knee replacement it’s recommended you don’t drive as your reaction times are slowed, particularly for emergency stops.

As an outpatient you would have physiotherapy and be reviewed in clinic a few weeks later. Initially, as activity increases the knee can be sore, but with appropriate medication and gentle exercise, your recovery should proceed smoothly. You’ll be recommended to have a check-up x-ray 12 months after surgery as well as prosthesis monitoring.

Major surgery with life-changing outcomes

While a knee replacement is a common surgery, it is a major operation and carries some risks, such as thrombosis, infection, stiffness, wear and nerve or vessel damage.

But if all goes to plan your knee joint symptoms continue to improve for up to 12 months post-surgery and most people experience significant improvement in the symptoms of pain and mobility for many years post-surgery, with most replacements helping patients live active lives for up to 15 years.

Harminder Gosal is a specialist knee surgeon based in Cheltenham.

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Monday 14 January 2019