The knee is one of the commonest joints to develop arthritis. Most patients describe symptoms of pain located around front or back of the knee, swelling, stiffness, a sensation of giving way and difficulty in kneeling.
There are generally two types, either ‘bow leg’ (varus) arthritis or ‘knocked knee’ (valgus) arthritis. With ‘bow leg’ arthritis there is no urgency for an operation but ‘knocked knee’ arthritis preferably needs to be assessed sooner by an expert because the ligaments around the knee are at higher risk of stretching or in the worst case scenario tear completely. This requires a much more complex procedure and implants to rectify.
The only patients I want – happy patients!
Just as with arthritis of the hip if you are having disturbed sleep due to pain, or need to increase your pain-killers or are finding a significant impact upon your quality of life it is time to seek an expert opinion and consider knee surgery.
Non-operative Treatment of Knee Pain
Hip and knee arthritis are not of course life threatening conditions. In the majority of cases there is no need to rush into an operation. It is always better to try various non-operative strategies to manage your symptoms in the first instance. These steps will also help you immensely during your recovery if you need an operation in future.
How to help yourself
- Weight reduction: Unfortunately easier said than done! Yet even moderate weight reduction will improve your hip and knee pain immensely. Not only that, it will reduce your risk of complications after knee replacement surgery should you need it in the future. It may not be a bad idea to seek an expert help for weight management. It will be worth it!
- Light exercise & Aqua-therapy: It is important to keep yourself mobile with at least light walks whenever possible. It will prevent deconditioning. Avoid the treadmill though! You should do non-impact exercises like cycling, static bike, pilates, cross-trainer and yoga if possible. Gentle exercises in the swimming pool to tone and strengthen your muscles will be of great help even if you can’t swim.
- Balanced diet: Adequate nutrition is essential for healing. Your diet should involve healthy portions of fruit, vegetables, meat and oily fish. You can get expert advice from a good dietician as well.
- Stop Smoking: ALWAYS a good idea!
Help from Your GP
Your GP should be your first point of contact if you need further help. They can advise you regarding appropriate painkillers based on your medical condition. They can also refer you to a very successful ‘Lifestyle Management’ program if you need it.
Expert Advice and Treatment – How I Can Help
Based on my assessment of your condition, I may offer an injection of steroid and local anaesthetics if you are not yet ready or do not want an operation. Many patients achieve significant pain relief for some time but length of pain relief is not guaranteed. I also do not tend to operate within 3 months of joint injection.
Knee Replacement
If your symptoms haven’t resolved with pain killers and physiotherapy, I may recommend a knee replacement to treat your symptoms and improve your quality of life. The recent advances backed by extensive research has made this operation very reliable and successful. The long term success of knee replacement depends on ‘Getting It Right First Time’ and this requires meticulous pre-operative planning and perfect execution of this plan during surgery. I perform between 100-150 successful knee replacement procedures per year.
A knee replacement can best be described as having a dental cap fitted in your knee! I will remove the arthritic bone ends, shape it perfectly according to your needs and replace it with new knee implants. The operation will take approximately 60-90 minutes to complete. Your expected length of stay in hospital is between 2-3 days.
One of the most important elements of achieving a good result after surgery is to ‘manage your expectations’ and it is your surgeon’s responsibility to give you sufficient time and advice to achieve realistic targets. It can be a challenging operation both for surgeon and patients to get it right. We will have to work as a team both before and after the operation to achieve the best results.
On the left is the arthritic knee before surgery,on the right you can see the same knee after surgery
My Approach
Thanks to my extensive national and international experience, I perform knee replacement without tourniquet (thigh cuff) and using ‘Computer Navigation’ to get perfect alignment and balance. This is followed by ‘Enhanced Recovery’ rehab regime to achieve best results and this has a very favourable impact on reduced post-operative pain, swelling, a reduced likelihood of blood transfusion and also allows quicker recovery.
Implants I Use
I use a Stryker Triathlon system which is the most widely used implant in the world with excellent results recorded in all joint registries around the world. I also use fully un-cemented StrykerÒimplants for suitable young patients.
My Results
I am delighted to say that (to my knowledge) none of my patients on whom I have performed a knee replacement have required revision surgery.
What to Expect During Your Knee Replacement
Pre-operative Assessment
Once you have decided to proceed to surgery the first step is to assess your fitness for surgery. Our very experienced pre-op team, under supervision of our consultant anaesthetist will perform a thorough physical assessment of you. This includes various blood tests, ECG, (chest x-rays if necessary) and screening swabs for MRSA. They will also assess your home circumstances to make sure that it will be safe for you to go back to your home after your operation.
They will also give you detailed information about the whole process of the operation and management of your medication around the time of surgery. Some medicines will need to be stopped before your operation but restarted afterwards and the pre-op staff will advise you accordingly.
Very rarely, it is not appropriate to perform your opertaion privately because it may be better to have support from other specialists or high dependency unit backup. Remember, your safety is our prime concern and if this occurs I will carry over your care to the NHS.
On the Day of Surgery
You will need to be at the hospital 60-90 minutes before the operation.
You will be greeted by our pleasant staff on arrival and they will get you settled in one of our suites with en-suite facilities. They will then go through your notes and investigations and get you ready for surgery. Additionally one of our junior doctors will assess you once again to make sure that nothing has changed since your last pre-operative assessment and take a final blood test.
The Consultant Anaesthetist responsible for your operation will advise you regarding which type of anaesthesia you should have. This can be either an Epidural/Spinal anaesthetic (which means you will be awake but numb below the waist) or General Anaesthesia (i.e. you will be asleep). You will take the final decision on what anaesthesia to have but I recommend you follow the experts advice!
I will visit you prior to surgery and ask you to sign the consent form before marking the side & site of the operation and answer any outstanding questions you may have.
Once the operation has been completed you will return to your suite after spending a brief period in the operating theatre recovery room and start your rehabilitation.
Post-Operative Care and Rehabilitation
Attention to detail during surgery and commitment to rehabilitation afterwards is the what makes for the best possible outcome.
The biggest game-changer in how we manage your care after surgery is the introduction of our ‘Enhanced Recovery After Surgery’ protocol. This includes excellent post-operative pain management, better control of sedation, nausea and any sickness and intensive physiotherapy to get you going sooner after surgery. It has a huge role in making your recovery quicker and improving satisfaction. I work with an excellent team of consultant anaesthetists, ward staff, physiotherapists & occupational therapist to achieve this. It is one of my main interests of research and I take a huge effort to make this protocol personalised according to each patient’s needs, expectations and lifestyle. I am a firm believer of this approach and have successfully implemented ‘Day-Case’ and ‘Fast-track’ (Overnight stay) pathways for suitable patients helping them recover quicker after these life changing operations.
You will also have a calf compression device during your hospital stay as well as a blood thinning injection (Clexane) for a few weeks after your operation to minimise the risk of clots in legs or lungs.
Once your pain is under control and you are safe on your cutches, you will be discharged home. This is usually within a couple of days and you will continue your recovery under the supervision of our experienced physiotherapy team. There will be some precautions to observe for four to six weeks after joint replacement to make sure everything heals fully. I will tailor these according to your needs and see you in clinic two weeks after the operation to review your recovery.
In the case of knee replacement, success also depends upon adequate pain control and intensive physiotherapy to regain as much mobility for the future. I cannot over-emphasize the importance of strict adherence to expert input from myself and our physiotherapy team.
Most of my patients start to walk unaided by four to six weeks and continue their recovery in a predictable manner over the following months.
Case Studies
