Total Knee Replacement
Indications
Total knee replacement surgery is a commonly performed operation carried out for arthritis of the knee joint. The purpose of the operation is to relieve pain and thereby improve mobility.
Operation
A standard total knee replacement may be carried out under either a regional (epidural) anaesthetic with sedation or a general anaesthetic depending on the patients’ medical needs. The Consultant Anaesthetist will discuss this with you in detail.
The scar for the operation is directly over the front of the knee. If previous surgery has been performed on the knee and there are a number of scars over the knee joint, great care needs to be taken in the siting of the scar to allow the wound to heal without risk. The operation to replace the knee normally takes about 1 hour to perform and the operation involves removing the worn out surfaces of the femur (thigh bone) and the worn out surface of the tibia (shin bone) and replacing them with metal and plastic allowing the normal range of movement to return in a stable knee joint. The replacement parts can be either cemented into place or be uncemented depending upon a number of patient related factors such as bone quality, and deformity of the knee. It is often the case that the knee cap (patella) may not need to be replaced.
Patients normally stand the day after the operation and are often safe to return home by between two and five days. They are normally walking with two sticks at this stage and may not require any additional physiotherapy other than continuing with the exercises that they have been taught during their stay in hospital.
By the time the patients leave, they should be able to safely negotiate stairs, walk with sticks but should not drive for approximately 4 weeks or until they are seen for follow up some six weeks after the operation. All patients are seen at six weeks for a check up and an X-ray, which is performed with the patient standing so that the alignment of the knee can be assessed. It is important to achieve a normal alignment of the knee following surgery. Activities such as driving and returning to work will be considered and discussed at this consultation. It is often possible to return to driving at this stage.
Improvement in function and pain relief following knee replacement surgery will continue for at least three months from the time of surgery and the knee can continue to improve for up to two years.
Results
Mr Drabu has personally carried out more than 8500 joint replacements since 1988. The results of such surgery show that long lasting pain relief and a return to good mobility are achieved in over 90% of patients.
The type of knee replacement that Mr Drabu uses for an uncomplicated arthritic knee is the LCS knee replacement (DePuy Intl Ltd). This has been his implant of choice for the past fifteen years and the data on the results of this implant performed worldwide show that the survivorship of this knee at twenty years is greater than 80%
Complications
All surgery can be associated with certain risks and the possibility of complications. These complications, if they arise may not affect in any way the result of the knee replacement. However, these risks and complications need to carefully considered and discussed with Mr Drabu before proceeding with such surgery.
The risk of a complication is very small, but the following are possible:
Infection
A deep knee infection is extremely rare especially in the environment of a private hospital where no emergency surgery is carried out. Should such and unfortunate complication occur, the need to revise the infected joint will be considered (see knee revisions). The risk of a deep infection is below 1%.
Thrombosis
Thrombosis is a clot in the leg. We try to prevent this complication arising by encouraging early patient mobility and the use of adjunctive treatments such as foot pumps to encourage better blood flow through the legs, anti-thrombotic agents and TED (support) stockings.
Swelling
Swelling following surgery is not uncommon, and may continue for up to three months. It can be managed by appropriate physical therapy
Nerve Injury
The common peroneal nerve runs close to the outer side of the knee joint, around the fibular neck and can be bruised during the course of a knee operation. This may lead to a temporary weakness in the foot. However, recovery is probable within a matter of weeks or months.
The risks and complications associated with any form of surgery can be discussed with Mr Drabu at the time of consultation. He will explain and discuss his experience and answer any questions you have in detail .
Treatment by Mr Drabu and his Team
Mr Drabu and his team are experienced in their fields. They are supported and fully backed up by staff who have knowledge and experience in such surgery. The theatre facilities are those required for the individual patient.
Your Surgeon and the Operation
Although a knee replacement operation is quite a common operation you should always ensure that your surgeon is sufficiently experienced in such surgery. Mr Drabu will discuss details of his expertise and experience and results in this field and answer any questions or concerns you have.