Total knee replacement surgery

Total knee replacement surgery replaces your damaged knee joint with an artificial joint. A knee replacement operation (arthroplasty) is usually only recommended after non-surgical knee treatments such as pain relief, therapy and muscle strengthening have been tried first. 

A total knee replacement is recommended if your knee is badly worn and damaged, affecting your mobility and causing significant pain.

In a healthy knee, the surfaces of the joint are lined with cartilage which helps it move smoothly and easily without pain. When the knee joint surfaces become worn, your normal movement can become painful as the ends of the bones start to rub or grind together and the joint becomes stiff and inflamed.

There are many reasons why the joint lining can become worn or damaged:

Osteoarthritis in your knee

Osteoarthritis is the most common reason for knee replacement surgery. This occurs when the cartilage wears down and the bones within the joint rub against each other. This leads to increasing pain and can restrict movement of the knee joint.

The bones may compensate by growing thicker and producing bony outgrowths to try to repair themselves. This can cause more friction and pain.

Rheumatoid arthritis

This is where the body’s own immune system (the body’s defence against infection) affects the lining of the joint in the knee, resulting in stiffness and pain.

Traumatic arthritis

This results from a serious knee injury such as a fracture, ligament damage or meniscus tear. The impact of the accident also causes ‘mini trauma’ to the cartilage which, over time, develops into osteoarthritis which causes knee pain and stiffness. If non-surgical knee treatments such as muscle strengthening haven’t worked, you might need to consider a total knee replacement.

Knee replacements are either fixed to the bone with cement or are uncemented. Uncemented replacements rely on the body to grow bone into the knee replacement. After around nine months to a year, the knee replacement is fixed strongly to the bone.

A cemented replacement will be as strong as it’s going to be by the time the operation is finished.

Replacing both knees together isn’t common practice and, at Benenden Hospital, we don’t operate on both knees at the same time.

A knee replacement is a major operation and can cause quite a lot of stress to the body. If you have underlying medical conditions, you may be at higher risk of complications during anaesthetic, breathing problems, heart problems or blood clots – so it’s better to minimise the impact on your body by doing one procedure at a time.

If you have severe arthritis of both knees, we’d do staged operations, with the worst knee first. Once you’ve recovered, at around six weeks, we’ll talk to you about planning to replace the other knee three to six months later.

Your Consultant will discuss your medical history and look at how well you move and the strength of your muscles. They’ll also view x-rays of the knee joint damage before recommending the best course of treatment. Knee replacement surgery will only be recommended after you’ve tried non-surgical treatments, such as pain relief and physiotherapy.

If you’ve agreed that total knee replacement surgery is the best treatment, your initial consultation might include tests and diagnostic imaging (x-rays or MRI scans). We may also be able to assess your fitness for anaesthesia on the same day, to reduce the number of visits you need to make to the hospital.

Your Consultant may recommend that you start an exercise programme to strengthen your muscles around the knee joint and increase flexibility before surgery as this can shorten recovery time after your operation.

On the day of your knee replacement operation, you'll meet your Consultant and Anaesthetist, who’ll answer any questions you have before we help you get ready for theatre.

A total knee replacement operation typically takes no longer than two hours, including anaesthetic, but it’ll depend on the complexity of the operation, the severity of your arthritis, and your physique or build.

The surgery is usually carried out under a spinal (or epidural) anaesthetic. This is when an anaesthetic is injected into your lower back (between the bones of your spine) making the lower part of the body numb so you do not feel the pain of the operation and can stay awake. During your spinal anaesthetic you may be fully awake or sedated with drugs that make you relaxed but not unconscious.

Your surgeon will make a midline incision into the knee through which they'll perform the surgery. The worn bone will be removed and an artificial joint implanted and fixed with bone cement. The wound will be closed with absorbable sutures or skin clips and a pressure dressing applied.

After surgery we’ll move you to our recovery room for observation until you’re ready to return to the ward, where you’ll be looked after by our experienced nursing team. Your Consultant will advise when you can start your recovery with our expert physiotherapy team.

How long it takes to recover will vary depending on your general health and fitness and the type of knee surgery you’ve had.

As a rule, you’ll spend two to three days in hospital and during that time your knee will be sore. You’ll have a large protective dressing on your knee, and you may have a drain to remove blood from your wound.

While you're staying with us, any pain will be controlled with the medication. You’ll be cared for by a highly skilled team of nurses and visited daily by our Physiotherapist who’ll help you regain your mobility through carefully planned exercise. We’ll only let you leave hospital once we're happy that it’s safe for you to do so.

We’ll give you a frame or crutches to start with, but after about a week most people can walk independently with sticks.

For the first two weeks, while the metal clips and staples are holding the wound closed, your knee might feel a bit bruised.

By six weeks most people have turned the corner; the pain is still there but less intense. You may be able to cope on less strong painkillers. You should be able to walk around at home, or outside briefly, and drive your car for a short distance. You must continue to do your exercises in order to keep your knee replacement moving.

By three months, when you come back to the clinic, you’ll be able to feel the benefit of the operation. However, it may take another six months to make a full recovery and return to your normal activities. Following your Consultant’s advice on how to look after your new knee and sticking to the exercises given to you by your Physiotherapist are important aspects of the recovery process and it's important to follow their guidance.

If you don't have any pain from the knee replacement then once the knee replacement has fully settled down, it’s fine to use a vibration plate. However, if the muscles around your knee become aggravated, and you start feeling pain when using the vibration plate, you should stop.

The best exercises to do at the gym following a knee replacement are ones that build up the thigh muscles, the quadriceps and the hamstrings. These will help keep the knee replacement stable in the long term.