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Total Knee Replacement

  • If you have severe arthritis of the knee (i.e. pain on walking and disturbed sleep because of pain) and have not responded to non- operative treatment then total knee Arthroplasty can be considered.
  • The aim of surgery is to provide pain relief and correct deformity of the knee.
  • Knee replacement surgery is common around 100,000 being performed each year in the U.K.

Diagnosis

Your surgeon will ask you some questions about your knee symptoms and also enquire about your general health.

Your surgeon will also arrange for x-rays of your knee to be taken, to give further information about the extent of osteoarthritis.

Is Total Knee Replacement suitable for you?

After taking a history, examining your knee at the x-rays your surgeon will be able to discuss surgery

He will listen listen to do your ideas, concerns and expectations of knee replacement surgery and present objective information about expected benefit of surgery and also inform you about the rare but important risks which are associated will knee replacements.

The risks include infection, nerve and blood vessel damage, fracture,continued pain, stiffness or instability of the knee, numbness around the surgical scar, the need for further knee surgery should the implant wear out- theses are uncommon and occur in less than 2% of patients. There are also general complications which are even rarer and include blood clots in the legs going to the lungs, heart attack, stroke and the risk of dying.

Before Surgery

Prior to surgery you will undergo pre-assessment which aims to ensure optimum health before surgery.

You will undergo blood test investigations and a heart tracing (ECG). Skin swabs as well as a sample of urine will be taken.

Finally your social and home circumstances will be evaluated. It is important that after you are able to cope with activities of daily living when you get discharged. A number of modifications around the home can make the convalescence period after surgery much easier, e.g. handrails on the staircase, a safety bar in the shower and a toilet seat raise.

Day of Surgery

You will come to surgery on the day of surgery and admitted to the ward where you will be seen by the Consultant Anaesthetist. The commonest form of anaesthesia is a general anaesthetic or a spinal (where a fine needle is placed in your back, causing you to feel numb below the waist). You can have the option to be sedated if you want to be unaware of the procedure if you have had a spinal.

Spinal blocks offer a number of advantages such as reducing the risk of blood clots in the legs and the reduce the requirement for opiate pain killers, which have the side effect of nausea and drowsiness.

The surgical procedure lasts just over an hour. The surgeon will apply a tourniquet to your thigh to reduce any blood loss and replace the worn joint with implants.

Post Operative phase

You undergo a Rapid Recovery Programme after surgery, the aim of which is to promote early mobilisation. This occurs on the day of surgery and is supervised by the Physiotherapist. You will be taught exercises to restore knee range of movement and muscle power.

You will be given injections to thin your blood to reduce the risk of blood clots- this is called Tinzaparin and continues for a period of 28 days after the operation.

The day after your surgery blood tests will be performed and an x-ray of your replaced knee will be taken.

Once you feel happy to be discharged and have passed the physiotherapy assessments of bending the knee over 90 degrees and mobilising safely then you can go home.

The physiotherapist will then see you to supervise you rehabilitation and check the surgical wound.

You will be seen by your Consultant surgeon 2 weeks after the surgery.

Outcome

The aim of knee replacement surgery is to significantly reduce the pain of an arthritic knee.  Your replaced knee will not feel like it may have done 40 years ago when you had no pain. The range of movement in the replaced knee is determined by the range of movement prior to the operation, that is to say if you had a limited range of movement before

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