Knee replacement surgery (arthroplasty) is a routine operation that involves replacing a damaged, worn or diseased knee with an artificial joint.
Adults of any age can be considered for a knee replacement, although most are carried out on people between the ages of 60 and 80. More people are now receiving this operation at a younger age.
WHEN A KNEE REPLACEMENT IS NEEDED
Knee replacement surgery is usually necessary when the knee joint is worn or damaged to the extent that your mobility is reduced and you experience pain even while resting.
The most common reason for knee replacement surgery is osteoarthritis. Other conditions that cause knee damage include:
disorders that cause unusual bone growth (bone dysplasias)
death of bone in the knee joint following blood supply problems (avascular necrosis)
knee deformity with pain and loss of cartilage
WHO IS OFFERED KNEE REPLACEMENT SURGERY
You may be offered knee replacement surgery if:
you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
your knee pain is so severe that it interferes with your quality of life and sleep
everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
you’re feeling depressed because of the pain and lack of mobility
you can’t work or have a normal social life
You’ll also need to be well enough to cope with both a major operation and the rehabilitation afterwards.
TYPES OF KNEE REPLACEMENT SURGERY
There are two main types of surgery, depending on the condition of the knee:
total knee replacement (TKR) – both sides of your knee joint are replaced
partial (half) knee replacement (PKR) – only one side of your joint is replaced in a smaller operation with a shorter hospital stay and recovery period
There are alternative surgeries to knee replacement, but results are often not as good in the long term. Your doctor will discuss the best treatment option with you. Alternatives may include:
arthroscopic washout and debridement – an arthroscope (tiny telescope) is inserted into the knee, which is then washed out with saline to clear out any bits of bone or cartilage
osteotomy – during an open operation, the surgeon cuts the shin bone and realigns it so that weight is no longer focused on the damaged part of the knee
mosaicplasty – a keyhole operation that involves transferring plugs of hard cartilage, together with some underlying bone from another part of your knee, to repair the damaged surface
CHOOSING A SPECIALIST
Choose a specialist who performs knee replacement regularly and can discuss their results with you.
This is even more important if you’re having a second or subsequent knee replacement (revision knee replacement), which is more difficult to perform.
Your local hospital trust website will show which specialists in your area do knee replacement. Your GP may also have a recommendation, or arrange for you to follow an enhanced recovery programme.
You can also read a guide to NHS waiting times.
PREPARING FOR KNEE REPLACEMENT SURGERY
Before you go into hospital, find out as much as you can about what’s involved in your operation. Your hospital should provide written information or videos.
Stay as active as you can. Strengthening the muscles around your knee will aid your recovery. If you can, continue to take gentle exercise, such as walking and swimming, in the weeks and months before your operation. You can be referred to a physiotherapist, who will give you helpful exercises.
Read about preparing for surgery, including information on travel arrangements, what to bring with you and attending a pre-operative assessment.
RECOVERING FROM KNEE REPLACEMENT SURGERY
You’ll usually be in hospital for three to five days, but recovery times can vary depending on the individual and type of surgery being carried out.
Once you’re able to be discharged, your hospital will give you advice about looking after your knee at home. You’ll need to use a frame or crutches at first and a physiotherapist will teach you exercises to help strengthen your knee.
Most people can stop using walking aids around six weeks after surgery, and start driving after about eight to 12 weeks.
Full recovery can take up to two years as scar tissue heals and your muscles are restored by exercise. A very small amount of people will continue to experience some pain after two years.
RISKS OF KNEE REPLACEMENT SURGERY
Knee replacement surgery is a common operation and most people don’t experience complications. However, as with any operation, there are risks as well as benefits.
Complications are rare but can include:
stiffness of the knee
infection of the wound
deep infection of the joint replacement, needing further surgery
unexpected bleeding into the knee joint
ligament, artery or nerve damage in the area around the knee joint
persistent pain the in the knee
fracture – a break in the bone around the knee replacement during or after the operation
In some cases, the new knee joint may not be completely stable and further surgery may be needed to correct it.
THE NATIONAL JOINT REGISTRY
The National Joint Registry (NJR) collects details of knee replacements carried out in England and Wales. Although it’s voluntary, it’s worth registering. This enables the NJR to monitor knee replacements, so you can be identified if any problems emerge in the future.
The registry also gives you the chance to participate in a patient feedback survey.
It’s confidential and you have a right under the Freedom of Information Act to see what details are kept about you.