Which anaesthetic do I need?

For the operation to be performed you will require an anaesthetic and will discuss which type of anaesthetic is best for you with one of our Consultant anaesthetists. These may include: Spinal anaesthesia, Sedation, General anaesthesia, Local anaesthesia.

What happens after my total or partial knee replacement?

Your anaesthetist will prescribe painkillers to control the pain from surgery as much as possible, you are likely to have some pain but you will be encouraged to walk on your new knee as soon as it is safe for you to do so, this is usually on the same day as your surgery. Early mobilisation is important as it helps to reduce risks of blood clots, disturbance to your bladder and bowels, and issues with pressure areas. Experienced physiotherapists and nurses will be on hand to help you to get used to walking with your new knee. Once you are safely mobile, your wound is dry, your blood tests and X-rays have been reviewed, and your vital signs are satisfactory you are free to go home. This is usually on day one or two after your surgery, meaning you will likely be in hospital for one or two nights. NHS Patient Reported Outcome Measures (PROMs) show that 89% of people having a knee replacement feel that their knee is much better or a little better after the surgery, and 87% describe the results of their surgery as Good, Very Good, or Excellent.

What is a total knee replacement?

A total knee replacement is first and foremost a pain-relieving operation. The operation itself involves removing the cartilage from the end of the thigh bone (femur) and shin bone (tibia), these are replaced with metal components anchored to the bone either with cement or a textured surface the bone grows into. A plastic liner is inserted between the metal components to allow the joint to move freely, if needed the back of the kneecap (patella) is resurfaced with a plastic button.

What is a partial knee replacement?

A partial knee replacement is first and foremost a pain-relieving operation, it is used when the wear in the knee is confined to one area only. The operation itself involves removing the worn cartilage from the end of the thigh bone (femur) and shin bone (tibia) on the inside aspect of the knee. These are replaced with metal components anchored to the bone with cement. A plastic liner is inserted between the metal components to allow the joint to move freely. In this design of knee replacement the anterior cruciate ligament is retained, patients often report their knee feels more 'normal' because of this.

What is a knee injection?

A knee injection involves introducing a needle into the knee joint to inject a combination of local anaesthetic and steroid. The local anaesthetic gives rapid relief of symptoms caused by your knee joint, which makes it a useful test to see how much your knee is causing your pain. The steroid component lasts for longer; in some patients it can give many months of pain relief in which case repeating it may be an option, in other patients the relief can be much shorter. After a knee injection you should not undergo joint replacement surgery for at least 3 months due to the increased risk of infection.

What is knee arthritis?

This is a very common condition in which the healthy layer of cartilage in the hinge joint of your knee becomes thinned. In its advanced stages the cartilage may have completely disappeared resulting in 'bone-on-bone' arthritis. Cartilage is important for the smooth movement of joints, and the absorption of stress passing through the joint. When worn the joints become stiff and painful. X-rays are usually sufficient to confirm a diagnosis of knee arthritis. Not everyone with knee arthritis needs a knee replacement, many can cope with their symptoms through a combination of pain killers, exercise, activity modification, or using a stick for longer distance walks.

What is a knee arthroscopy?

This involves using telescopic cameras to assess the inside of your knee, and telescopic instruments to treat damaged areas. For meniscal tears this is often the trimming (debridement) of the unstable and damaged portion of the meniscus. Surgery is performed with a tourniquet to reduce bleeding and the two small incisions under your kneecap (patella) are closed with sutures. After the surgery you will be helped to mobilise with the physiotherapists and can go home on the same day.

Clarity Orthopaedics | Knee Surgery and Treatment

Knee pain can cause a range of problems in day-to-day life. Walking may become increasingly challenging, the knee may ‘lock’ (become stuck in one position) or give way, and sometimes the pain can move around.

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Through carefully exploring the nature of your symptoms, examining you, and undertaking investigations, I can help you to confirm the cause of your knee pain and identify potential treatment options.

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Younger patients often experience knee pain as a result of an acute incident or injury. X-rays can be helpful to assess the bony architecture of the knee joint but you may need an MRI scan to look in more detail at the soft tissue structures of the knee.

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Many soft tissue injuries of the knee can be managed without surgery. Expert physiotherapists can help you in your recovery with a programme tailored to your injury and your needs.

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One commonly injured structure are the menisci. These tough but flexible cartilage structures are semicircular in shape and sit between the thigh bone (femur) and shin bone (tibia) of your knee joint. They are important for shock absorbing and load bearing. Depending on the location of the meniscal tear, the age of the injury, and the condition of the remainder of your knee, surgery may be helpful to address symptoms. This often consists of removal of the damaged portion of the meniscus to improve symptoms of catching and pain.

Your anaesthetist will prescribe painkillers to control the pain from surgery as much as possible, you are likely to have some pain but you will be encouraged to walk on your new knee as soon as it is safe for you to do so, this is usually on the same day as your surgery. Early mobilisation is important as it helps to reduce risks of blood clots, disturbance to your bladder and bowels, and issues with pressure areas. Experienced physiotherapists and nurses will be on hand to help you to get used to walking with your new knee. They will provide instruction in regaining movement as stiffness after knee replacement is a very real risk if exercises are not carried out regularly. They will also guide you in the use of different walking aids (e.g. a frame or crutches).

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X-rays of your new knee will be taken to confirm its position, and blood tests will be taken to check your blood count and kidney function. Your vital signs (blood pressure, pulse, etc) will be regularly monitored.

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Once you are safely mobile, your wound is dry, your blood tests and X-rays have been reviewed, and your vital signs are satisfactory you are free to go home. This is usually on day one or two after your surgery, meaning you will likely be in hospital for one or two nights.

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At home your recovery continues as you complete exercises you learnt in hospital, with regular out-patient reviews with our physiotherapy team. At this time it is very important that you continue to perform your exercises regularly to obtain a successful result. A nurse will check your wound around two weeks after your surgery to confirm it is healthy and healing as expected.

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I will then see you in the out-patient clinic at 6-8 weeks after your surgery. This appointment is a clinical review of your progress but can sometimes involve an X-ray. With knee replacement surgery recovery can be very variable. Many patients are walking without crutches by the time of this appointment and their pain is well controlled, but others take longer for their knee to settle. It is not uncommon for a total knee replacement to take over a year to reach its maximum performance.

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NHS Patient Reported Outcome Measures (PROMs) show that 89% of people having a knee replacement feel that their knee is much better or a little better after the surgery, and 87% describe the results of their surgery as Good, Very Good, or Excellent. Although this does mean that some people who are less happy with their knee replacement, this group is quite small. The graph below shows the NHS outcome data for knee replacement surgery in more detail:

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NHS outcome data for knee replacement surgery

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Outcomes depend on many things including the complexity of your surgery, the level of function you had before your operation, and other medical conditions. Unfortunately predicting patients who are likely to have a poor outcome from knee replacement surgery is almost impossible, but working together with your physiotherapist and surgeon to regain movement while the knee is settling is key in obtaining the best outcome possible.

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