Knee replacement is a very common procedure. In England and Wales there are approximately 160,000 total hip and knee replacement procedures performed each year. Approximately the same number of hip and knee joints are replaced.

Knee replacement technology and techniques have advanced significantly over the last few decades, and knee replacement is usually a successful technique to restore quality of life and offer pain relief.

A traditional knee replacement usually takes around 60 to 90 minutes to complete. It is usually carried out under a spinal anaesthetic, whereby you are numbed from the waist down. Most people prefer to receive some sedation as well. Alternatively, sometimes a general anaesthetic can be used.
Once you’ve been anaesthetised, Mr Webb will make an incision over the front of your knee to remove and replace the damaged knee joint with artificial parts.

The prosthesis is made of metal, with a very hard wearing plastic (polyethylene) between the 2 pieces of metal to act as an artificial cartilage.

The artificial joint components can be held in place by being:

• cemented – the prosthesis is secured to healthy bone using a special tough cement. This is by far the commonest technique used in the UK.

• uncemented – the surfaces of the implants are roughened or specially treated to encourage the existing healthy bone to grow onto them and hold them in place.

If you have knee joint damage or disease with persistent pain symptoms that interfere with your daily activities then you may be a candidate for hip replacement surgery.

Mr Webb will discuss the best options of pain relief for you and if you should consider a knee replacement.

Some common reasons why a knee joint can become damaged include:

• osteoarthritis – known as “wear and tear arthritis”. The cartilage (a tough, flexible tissue that acts as a shock absorber and mould) inside a hip joint becomes worn away and causes the bones to rub against each other. Osteoarthritis is the most common cause of this type of damage. People who have had their knee cartilage (meniscus) removed or damaged in the past can go on to develop knee osteoarthritis

• rheumatoid arthritis- caused by the immune system. The body mistakenly attacks the lining of the joint whilst trying to defend the body against infection resulting in pain,stiffness and swelling

• hip fracture – a fall or similar accident can severely damage the knee joint so that a replacement is required.

Knee replacement surgery aims to increase your mobility and improve the function of your hip joint to relieve pain and ultimately improve the quality of your life. Many people find that their life is transformed as they regain their mobility and independence without the pain they suffered before their knee replacement.

The risk of serious complications during and after knee replacement surgery is low, estimated to be less than 1 in a 100. These include blood clots (deep vein thrombosis and pulmonary embolism) and infection. The most common complication of a knee replacement is that something goes wrong with the joint, which can include:

• loosening of your joint – caused by your prosthesis becoming loose or either the tibial or femoral side

• wear and tear – particles can wear off your artificial joint surfaces and be absorbed by surrounding tissue and cause loosening of your joint.

Further complications of a knee replacement can include injuries to the blood vessels or nerves, a fracture , ongoing pain, or future revision surgery. These are only generalised and it is important that you discuss with Mr Webb your own individual risk profile and concerns before you decide on surgery

There are some non-surgical options that can be effective in helping you to avoid or delay knee replacement surgery.

Pain killers, such as paracetamol and ibuprofen, can help control your pain. A walking stick can make walking easier. An exercise program can strengthen the muscles around the hip joint and help to reduce stiffness. A steroid injection into the hip joint can sometimes reduce pain and stiffness. However if your pain worsens and becomes unmanageable then hip replacement surgery may be the best option for you. It sis impoetant to discuss all the options before making a decision on the best way forward for you.

An artificial hip joint is designed to last for at least 15 years. 95% of the knee replacements that Mr Webb uses are shown to last at least 10 years prior to needing redo surgery. However it could wear out or go wrong in some way before this time and then further surgery is required to repair or replace the joint, known as revision surgery. Other knee joints can last a lot longer than 15 years.

In the past knee replacement surgery would primarily be offered to people over 60 years of age as they are typically less active, putting less stress on the artificial knee, than younger people.

More recently, with new technology that has improved the artificial parts so that they withstand more stress and strain and last longer, hip replacement surgery has proved to be successful in younger people.

Now a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. In general though the younger a person is, the greater the chances of them needing a redo knee replacement at some point in their life. Also in general, younger people will have higher expectations of what they want to do on a knee replacement so it is important to have a realistic discussion of what is and isn’t possible to do with a knee replacement.

Before you go into hospital there are some things you can put in place to make your recovery easier you return home. These include:

• Arrange for help. You will need a lift to and from the hospital. It is also beneficial to have someone to help you around the house for a week or two after coming home from hospital.

• Place items you use or will need and want every day when you return home within arm’s reach. These might include the TV remote control, books, telephone, and medicine.

• Stock up on food supplies especially easy to prepare foods such as frozen ready meals and tinned soups.