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Knee Replacement

Two types of surgery to consider

Andrew Wheelton

Andrew

Two types of knee replacement surgery
Partial knee replacement

Conceptually the knee can be divided into three ‘compartments’. The patella-femoral joint (between the back of the knee cap and the front of the thigh bone). 2 spaces between the end of the femur (thigh bone) and top of the tibia (shin bone) – the medial and lateral tibio-femoral compartments

Some patients with osteoarthritis have a pattern of arthritis where the cartilage is only lost from one of these compartments and preserved in the others. In appropriate patients a partial knee replacement can be considered.

Some potential benefits of partial knee replacements when compared to total knee replacements include:

  • Smaller incision with less insult to the tissues and less inflammation
  • Patients typically have a quicker recovery
  • There is less risk of medical problems such as blood clots etc
  • The knee typically feels more like the patients own then after total knee replacement

A potential drawback of a partial knee replacement procedure is that it may not survive quite as long as a total knee replacement. In total knee replacement surgery, 95% of joints are lasting 15 years. In partial knee replacement, that figure is approximately 90%.

Total knee replacement

Knee replacement surgery, involves replacing the damaged or worn-out parts of the knee joint with artificial components to relieve pain and restore function. It is commonly performed for patients with severe knee arthritis or injury that affects mobility and quality of life. In this procedure all 3 of the compartments are replaced.

  • Anaesthesia: You will be given either general anaesthesia (you’ll be asleep) or spinal/epidural anaesthesia (you’ll be awake but numb from the waist down).
  • Incision: A cut is made at the front of the knee to access the joint.
  • Reshaping Bone: The damaged cartilage and bone surfaces at the ends of the femur (thighbone) and tibia (shinbone) are removed.
  • Placement of Implants: Metal components are attached to the prepared bone surfaces, either by cement or by allowing the bone to grow onto the components. A plastic spacer is inserted between the metal parts to create a smooth gliding surface.
  • Closure: The incision is stitched or stapled closed, and the knee is bandaged
Is knee replacement surgery painful?

Knee replacement is a major surgery which will result in some pain after the procedure. A variety of techniques are taken to reduce the pain during your stay in the hospital and once you are discharged. At the end of the surgery local anaesthetic injections into the joint will help with pain relief and strong painkillers are administered. A device called cryocuff will be provided and will help in easing the pain. Painkillers are provided for discharge.

Complications of knee replacement surgery

Although knee replacement surgery is very successful, it is a major operation and complications do happen. The commonest complications are:

  • Deep infection (around 1%). This will be higher if you are diabetic, obese or are medication that affect your immune system. The figure in partial knee replacement is approximately 0.5%.
  • Blood clots (about 1.5% in the leg and 0.5% in the lung). The risk is higher if you have had previous clots; if you are obese; have a family history; have a genetic condition that affects your clotting or have certain cancers. The risk in partial knee replacement is lower.
  • Severe stiffness (1%). Some people can find it hard to get the knee moving after the surgery, despite the help of physio. It may be necessary to have a procedure called a manipulation under a general anaesthetic.
  • Fracture (0.5%). Bone is hard, and power saws and hammers are used in the surgery. Sometimes there is a crack in the bone, which is usually noted at the time of surgery and dealt with immediately, with the surgery then proceeding as planned. Occasionally it is only identified after the operation and may need a return to theatre.
  • Dislocation.  <1% in partial knee replacement the bearing between the implants can dislocate from the space it is intended to sit in. This will usually require an operation to address.
  • Long term pain. Approximately 10% of patients have some ongoing symptoms of pain after a knee replacement. Although usually less severe than before the operation, it can still be troublesome and limit function.
  • Blood Transfusion (less than 10%): Blood transfusion is uncommon after modern joint replacement surgery due to newer techniques and medications.

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