The Knee is the largest joint in your body, and it sustains great pressures doing simple everyday activities. Over time the cartilage or gristle that covers the end of the bones wears out; this is known as Osteoarthritis. Some patients develop osteoarthritis at an earlier age, either because of trauma, an accident, or a sporting injury that they may have sustained. Additionally, some people are at increased risk of developing arthritis due to the physical job they job, due to their genetics or due to other conditions like rheumatoid arthritis. As a result of arthritis, the knee becomes painful, swollen and stiff, eventually affecting your mobility.
Non Surgical Management
Not everyone with arthritis needs to have surgery. Most patients can manage their pain with physio and exercise, weight loss and painkillers (eg Paracetamol or Ibuprofen). Your GP can provide you with more information about suitable non-surgical treatment options.
There are several non-surgical treatments to try prior to surgery such as:
- Non-impact exercises, such as swimming and cycling.
- Weight loss
- Pain medications and Anti-inflammatories
- Off-loader braces
But if you have constant pain in your knee that affects your quality of life and function despite maximising non-surgical treatment, then Dr Balendra, who is a knee replacement specialist, will discuss surgery with you in more detail.
What is a Total Knee Replacement?
A Total Knee Replacement is a joint replacement procedure to replace the worn out (arthritic) or damaged parts of your knee joint. The joint surface of the thigh (femur) and shin (tibia) bones are removed and replaced with metallic components (prosthesis or implants) that covers the surface of the bone, and a plastic spacer is inserted between the metal components to create a smooth gliding surface for the knee to bend. Some surgeons will also replace the surface of your knee cap (patella) with a plastic spacer.
What is the success of a Total Knee Replacement?
A Total Knee Replacement is a very successful operation. Knee replacement surgery was first performed in 1968. Since then, improvements in surgical materials and techniques have greatly improved the surgical outcomes. Since 2000 more than 800,000 Total Knee Replacements have been performed in Australia, with the majority patients reporting significant improvement in pain and function.
The implants that are used in joint replacements are monitored by the Australian Joint Replacement Registry, which has been funded by the Commonwealth Government since 1999. The modern prosthesis that are being used for Total Knee Replacements have a proven track record with more than 90% lasting at least 20 years.
What can I expect from my Total Knee Replacement?
Most patients who undergo a Total Knee Replacement surgery experience a dramatic reduction of knee pain and a significant improvement in their function. But you need to remember that it is an artificial joint, and therefore excessive activity or weight will cause it to wear out quicker. Therefore, most surgeons advise against high-impact activities such as running, jogging, jumping, or other high-impact sports after surgery. Realistic activities following surgery include walking, swimming, golf, light hiking, cycling, ballroom dancing, and other low-impact activities.
What are the risks of surgery?
The complication rate following Total Knee Replacement is low, but as with any surgery complications can occur. If you are overweight, smoke or have other chronic medical conditions, you are at increased risk of complications. You should always ask your surgeon about the risks of surgery.
The following are some of the complications that can occur after surgery:
Infection – Infection after a joint replacement is rare, but can be potentially catastrophic. A minor wound complication can happen within the first 2 weeks after surgery and can generally be treated with antibiotics. More serious is a deep infection that can occurs weeks, months or even years after your surgery. This a major complication and may require more surgery and even removal of the prosthesis.
Blood clots – Blood clots in your leg veins (Deep vein thrombosis or DVT) are one of the most common complications of knee replacement surgery. These clots can be life-threatening if they get dislodged and travel to your lungs (Pulmonary embolism or PE). Your orthopaedic surgeon will preventative measures to reduce the risk of developing blood clots and will give you medication (tablets or injections) to thin your blood.
Neurovascular injury – Injury to major blood vessels or nerves around the knee are extremely rare. The most common nerve injury is to superficial skin nerves on the front and side of the knee; these nerves are unavoidably injured when your surgeon makes the incision for the operation.
Ongoing Pain and Stiffness – While most patients get a good result from surgery, some patients will have ongoing pain or stiffness after the operation.
Revision surgery – While modern day implants have excellent longevity, over time the components can wear down and you may need to have your joint replacement revised and have new implants placed. This is a bigger operation, and your surgeon will discuss this in more detail with you.
Do I need a Robotic Knee Replacement?
There are many ways to do a knee replacement, but over the last 5 years, Robotic Assisted Total Knee Replacements have become more commonly performed in Australia, with 22.5% of all Knee replacements in 2021 being performed robotically. Dr Balendra has been performing Robotic Knee replacements since 2019 to give his patients the best outcome with more accurate placement of the prosthesis.. Further information about robotic surgery can be found here.
I have pain in both knees. Can I get both my knee’s replaced at the same time?
Having Total Knee Replacement surgery on both your knees is a much bigger operation than having just one knee done. The operation takes longer and so does the recovery during the first few weeks. Dr Balendra will need to ensure that you are healthy enough to have such a big operation, and may need to discuss this with his Anaesthetist and your GP or other medical specialists. You will likely have a longer hospital stay as you will have more pain after operation, and you will be less mobile as both your legs have been operated on. But usually by 6 weeks most patients have recovered to a similar level of function as if they had only one side done.
The procedure generally takes 1-2 hours, and is usually conducted under a Spinal Anaesthetic or a General Anaesthetic. You will be able to discuss the type of Anaesthetic used with the Anaesthetist prior to surgery.
On the day of surgery, with the aid of a physiotherapist, we will get you out of bed and walking around for a short period of time. The physiotherapist will also provide you with a set of exercises to help strengthen the knee joint. Most patients stay in hospital for 3-4 days after the operation, but the pain from a knee replacement usually takes a few weeks to settle.
It is important not to do too much too soon, so as to allow yourself to recover completely. Most patients will be back doing their day to day activity 4-5 weeks after surgery, but usually you cannot drive till 6 weeks after surgery, especially if you are still taking strong pain medication. By 6 weeks most patients are able to walk independently and have a good degree of bend in their knee. But you need to keep doing the exercises for the first 6 to 12 months after surgery to get the best possible outcome from the operation. Dr Balendra will advise you when you can resume heavier physical activity such as sport.