Revolutionary knee replacement treatment to speed up recovery

Knee replacement – also known as knee arthroplasty – is a surgical procedure that involves replacing the damaged knee joint with a prosthetic implant made from ceramic, metal or plastic. It relieves pain and disability, as well as increasing mobility and improving quality of life.

In a standard knee replacement this essentially ‘resurfaces’ the end of the bone, by removing very small amounts of bone and the remaining joint surface cartilage, and resurfacing them with metal and plastic.

Osteoarthritis causes the parts of the knee that slide over each other as you move to become damaged which may result in the joint becoming inflamed or sticking, or the bones rubbing together. It is a degenerative disease and you will normally only be considered for knee replacement surgery if it has reached the stage where you are in persistent, disabling pain and other less-invasive treatments, such as painkilling injections or physiotherapy, are failing to provide adequate pain relief. You may need a partial or a total knee replacement, depending how extensively damaged the knee joint is.

You might need knee replacement surgery if you have a worn or damaged knee joint that is causing severe pain and loss of mobility. Osteoarthritis is the most common reason to undergo knee replacement surgery, but you might also have the procedure if you have other knee diseases such as rheumatoid arthritis, psoriatic arthritis, or severe injury to the knee. When the knee joint becomes damaged, it may no longer function smoothly, which can result in reduced mobility and worsening pain. If you are experiencing severe pain, even when resting, you may benefit from knee replacement surgery.

During knee replacement surgery, the damaged, worn or diseased cartilage and bone in your knee joint is cut away and replaced with an artificial joint made of metal, ceramic or plastic. The artificial joint functions in the same way as the natural joint, restoring movement and flexibility to the knee. Once you have fully healed after surgery, you will normally be able to resume most of your normal activities although you may need to avoid certain movements or high impact activities, which your surgeon will discuss with you prior to surgery.

Our specialist knee surgeons work with all the major insurance companies, so you will usually be able to have your knee replacement operation paid for by your private medical insurance.

A partial knee replacement is also often called a unicompartmental knee replacement.

The knee is considered to have three areas where the bones articulate (or move against one another), and these are called compartments: the medial compartment (which is the inside part of the knee), the lateral compartment (the outside of the knee) and the patellofemoral compartment (the front of the knee). In some people, only one compartment of the knee is affected by osteoarthritis, usually the medial compartment. The lateral compartment can be affected, but this is less common.

In a partial or unicompartmental knee replacement the worn surfaces of the compartment that is affected are resurfaced as for a total knee replacement with metal and plastic, but the advantage is that it is just one part of the knee that is being replaced. The remainder of the joint is retained including the ligaments both inside the knee – the cruciate ligaments – and the collateral ligaments on the outer side (which are retained in total knee replacement as well).

One of the advantages of partial knee replacement surgery – as well as being functionally much better than a total knee replacement, is that when they wear out it is relatively easy to convert them to a total knee replacement. So, for a younger patient who has arthritis it is preferable to have a partial knee replacement initially, as opposed to a total knee replacement, as you then have increased options in the future.

Recovery can vary, depending on the extent of surgery, your age and general state of health. However, most patients can care for themselves and resume normal daily activities within six weeks. Your consultant will advise when you are able to drive, but for most people it is within three to six weeks of surgery. It can take six months or, in some cases, up to a year to recover completely and experience the full benefits of knee replacement surgery.

Knee replacement surgery provides almost immediate relief from the pain of osteoarthritis, however, in the immediate post-surgery period you will experience a certain amount of pain, swelling, and bruising. This is a natural part of the recovery process and can be managed with pain killing medication.

At Orthopaedic Specialists, all knee replacement patients will have the use of a new cryotherapy device, Physiolab®. This has given excellent results for knee replacement patients such as Ryan and John.

You may be able to reduce post-surgical pain by preparing yourself in the weeks leading up to surgery. Your consultant can advise you on exercises that you may be able to do to prepare your body and the muscles that support the affected joint, as well as techniques for managing pain.

Most people who undergo knee replacement surgery say they have little or no pain from around three months onwards. High levels of anxiety about pain or holding onto “old pain” after surgery can slow your recovery. Talk to your consultant if you are concerned about post-operative pain.

Knee replacement surgery is generally a highly successful operation that improves pain, mobility and quality of life in people with advanced osteoarthritis of the knee joint. Your consultant will discuss the specifics of the procedure with you as outcomes may vary depending on factors such as your age and general state of health.

In terms of the quality of life that can be expected after a knee replacement, one of the best indications of how well the knee will move after the knee replacement surgery is how well the knee moves before surgery. Someone who is particularly stiff will get an improvement, but not as great as a person who has a good range of motion before undergoing knee replacement surgery.

There are also other considerations such as the quality of the bone and the design of the implant, as there are many different types. The newer designs allow better flexion and have better wear characteristics – in other words have been designed to last longer. With the newer designs there are now also an increased number of sizes that are more specific to the patient and also how much soft tissue contraction the person has around the knee, as these tissues will need to be released to get the knee moving again, and this can slow things down in terms of the postoperative recovery.

Recent studies have found that around 8o% of total knee replacements last 25 years. Prosthetic implants that wear out may be replaced using a procedure called revision knee replacement surgery.

Knee replacement surgery normally takes around 1.5 to 2 hours.

Knee replacement is a major surgical procedure and other, less invasive techniques will always be recommended first in the treatment of knee pain. It is important to have a proper diagnosis to determine what is causing your pain. Once this has been established, you may be offered one of a range of treatments to help you manage your symptoms, including:

• Physiotherapy – A physiotherapist can recommend exercises to help reduce pain and strengthen the muscles that support your knee. They will show you how to do the exercises correctly and may apply ice or heat to reduce pain and inflammation. Electrical stimulation, ultrasound therapy, or other procedures may also be used to increase blood flow to the skin, helping to reduce pain.
• Orthotics – If you have flat feet, a shoe orthotic may be helpful in the short term.
• Unloader Braces – An unloader brace is designed to prevent the knee thrust during walking. The knee can still bend and straighten normally, but as weight is borne and the knee goes into full extension, straps act like ligament stays and limit the collapse of the joint space on the affected side. These braces need to be the correct size and properly fitted for best effect.
• Steroid injections – Steroids act to control swelling and inflammatory pain for approximately 6-8 weeks. If the knee suddenly swells as a result of an injury or even following surgery, then it can be very effective. For chronic pain, it can offer some great pain relief. It is quite safe to have up to 3 steroid injections into any one area of the body without any negative issue.
• Viscosupplementation injections – this is an “orthobiological” treatment, which uses growth factors, proteins that promote cell growth, to control inflammation and promote healing. One injection is given which can last 2-3 months. It can work well with other treatments such as fat derived stem cells which are discussed in more detail below.
• Platelet-Rich Plasma (PRP) Therapy – This is a non-surgical procedure that is used to reduce joint pain and improve mobility. It uses a concentration of platelets extracted and prepared from your own blood and re-injected into the site of joint pain. PRP injections are used to repair damaged cartilage, tendons, ligaments, muscle and bone. Patients usually see their symptoms improve in one to two weeks of having the injections.
• Stem cell injections – Stem cells have been used for more than 10 years, and there are different types. More recently, fat has been shown to be the best source of stem cells, as there are a hundredfold more stem cells in fat than there are in bone. They don’t deteriorate with the person’s age and can be harvested easily. A small amount can be manipulated and washed to provide stem cells in high numbers, then be injected into painful joints and areas where there is muscle and tendon damage.The fat is harvested with a liposuction technique under local anaesthetic and takes only a few minutes. They are then washed and treated and injected. The procedure is very low risk but extremely promising although there is still a lot of work to be done to assess the evidence of this form of treatment which is still relatively new, but in the future it is likely that it will be performed on a regular basis.
• Knee osteotomy – A knee osteotomy may be suitable for people with knee deformity or damage to only one side of their knee. It is a surgical procedure that removes a wedge-shaped section of bone to shift the weight-bearing load away from damaged areas of the knee. The procedure is not suitable for everyone and is normally recommended for younger people with limited knee damage.