TOTAL KNEE REPLACEMENTS
Follow up consultation £150
Surgery Cost £11,000 - £13,000
Depending on location and procedure, inclusive of follow up consultation, surgery, follow up and physio/after care)
Why do I need it?
Knee replacement is performed on patients with a worn out/arthritic knee joint, where symptoms have failed to respond to non-operative treatments such as pain-killers and physiotherapy. It is an excellent pain relieving operation.
Are there alternatives to a total knee replacement?
Alongside painkillers, dietary supplements, such as Glucosamine & Chondroitin and cod liver oill can help alleviate some of your symptoms. Steroid (cortisone) injections can be very successful initially, however, they tend to become less effective with repeated injections and they cannot be performed too often.
Keyhole (arthroscopic) knee surgery is generally not successful for very arthritic knees and is not recommended in the NICE guidelines.
If you decide not to go ahead with surgery, your symptoms will probably deteriorate with time. It's not life threatening but could become very disabling.
What does the operation involve?
A variety of anaesthetic methods are used, most commonly it will involve a 'spinal' (local anaesthetic injection in the back) which means that you can be as awake throughout the procedure as you wish. This avoids the risks of a general anaesthetic and gives good pain relief in the initial post-op period.
An incision is made on the front of the knee and using specific equipment, and the damaged joint surfaces are removed. The ends of the bones that form the knee (tibia and femur) are resurfaced with specially designed prostheses made of cobalt-chrome and titanium. In addition a polyethylene (very hard wearing plastic) bearing fits on the tibial component and articulates with the femoral component. The components are held in place with bone cement. The kneecap is only replaced if it is very badly affected.
The operation itself usually takes an hour.
What are the risks?
All surgery carries an element of risk. Knee replacement surgery is a very successful pain-relieving and function-restoring operation. The main risks are Infection (1%), Stiffness (1%) and Blood clots (2%).
The knee replacement may loosen after a number of years and become painful. This may mean revision surgery is required. The knee replacements we use, have excellent long term results with a proven track record.
What happens after the operation?
You will be able to put your full weight through the leg straight away and the physiotherapists will aim to mobilise you the day of surgery. The quicker you are able to 'get up and about' the lower your risk of developing blood clots.
The physios will show you how to use crutches or a frame if need be and they will ensure that you can mobilise adequately, getting up and down stairs before you are discharged. Therapy will also continue for several sessions as an out-patient.
A drain will be placed in the joint at the end of the surgery to remove any excess blood. This blood will normally be given back to you. The drain is removed the next day.
Local anaesthetic is injected into the tissues around the knee at the end of surgery to give you good pain relief for the first 16-24 hours. Cooling bandages/cryocuff will also help to control pain and ensure early mobilization. This will be continued following discharge from hospital.
The deep sutures are dissolvable, however, the surgical clips will need to be removed about 10-14 days following the operation.
How long will I be in hospital?
Most patients will be able to leave after 2- 4 days.
How long will I need of off work?
This is variable and depends really on the nature of your work. As a general rule, you will be uninsured to drive for six weeks following the operation. Most people would probably require a similar time off work. However, working from home would be possible after a couple of weeks.
How long until the knee is pain free?
Generally, most of the pain subsides within 6 weeks and most patients can mobilise without the need of any crutches or sticks. By 3 months, almost all patients are pain free and very happy with the results. It can take up to 18 months for the knee to fully settle though. You will probably always find kneeling uncomfortable.
What exercises should I do when I get home?
To get the best out of your new knee, you need to work! Exercise regularly, 10 minutes 6-8 times a day. Do not spend all of your time exercising or your knee may become inflamed, swollen and painful. It needs a mixture of rest and regular exercise and taking your painkillers is important as it will allow you to exercise and get your knee going.