Total Knee Replacement surgery

Arthritis of the knee joint

Arthritis is wear & tear of the knee joint.

Symptoms consist of pain, clicking, locking, giving way, recurrent effusions(swelling) restriction of movements , limping, limitation of walking & other activities such as stair climbing, difficulty driving, putting on shoes & socks, pain at night etc

Confirmed by X-rays  MRI scans or key hole operations(Arthroscopies)

Treatment consists of pain killers, Anti-inflammatories, Physiotherapy, Cortisone injections into the joint.

If pain is unrelieved & you have to take frequent or daily painkillers & anti-inflammatories which can have side effects such as acidity in your stomach, heart burn or in the long term Kidney damage it may be better to consider surgical intervention.

Knee replacement is a good option to relieve pain.

 

Indications for total knee replacement surgery(or Total knee arthroplasty) :

Osetoarthritis

Rheumatoid Arthritis, gout, psoriatic arthritis, arthritis associated with crowns disease, ulcerative colitis  & other inflammatory arthritis

Arthritis secondary to trauma / post-traumatic arthritis(fractures or joint injuries)

Post infectious (arthritis caused by destruction of joint surface by infection)

 

Partial knee replacement or unicompartmental knee replacement

There are specific indications when only part of the knee may be replaced. This may be the knee cap joint or “Patello-femoral replacement”, Just the inner part of the knee joint or “Medial uni-compartmental knee replacement” or  just the outer side of the knee when it is called the “Lateral uni-compartmental knee replacement”  These operations are indicated when only these parts of the knee are affected by arthritis & the rest of the knee is completely unaffected. Advantages of partial knee replacements are that they are less invasive operations & rehabilitation is quicker but  have a four times higher re-do or revision rate compared to a Total knee replacement.

Uni.knee

 

Patello-femoral replacement        

This is replacement  of the joint under the knee cap (patella). The under surface of the knee cap is taken off & replaced with a plastic surface &the corresponding side of the knee is replaced with a metal surface. Rest of the knee is “untouched”

                                                                                                                                                                                                                                                                                                                                                                                                                          

For instrumentation individually made for a patient click on the link below           
Patient specific Knee instrumentation

 

Computer assisted surgery or CAS

In the vast majority of hip & knee replacements CAS does not influence the outcome. Very rarely computer assisted surgery becomes necessary to get the alignment right particularly with knee replacements (for e.g., with malaligned bones due to fractures) Your surgeon will discuss this with you if it is indicated.

Minimally invasive surgery/mini incision surgery      

                                                                                                                                                                  What matters most is the positioning of the components, fixing the components in the bone properly, alignment of the components, respecting soft tissues/ gentle handling of the  tissues during surgery. The size of the incision ( a centimetre or two more) does not make any difference to the end result of the operation. Trying to make a small incision & getting the implant positions wrong or retracting & pulling on the tissues can have an adverse effect on the outcome of the operation. So the adage is                          ” As big as necessary but as small as possible”.

 

Robotic surgery

At the present time robotic hip & knee replacements are experimental & there is no good evidence to show that this is better than conventional surgery for routine operations.

 

Click the link below for further information on knee replacement surgery

A guide to your knee replacement and rehabilitation