Total knee replacement

If you are considering knee replacement surgery, or have knee replacement surgery planned, it is important to know all you can about it. This includes:

• why you need knee replacement surgery

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out knee replacement surgery, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your knee replacement surgery choices with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You have arthritis of your knee joint. This is causing you pain in the joint. You may have reduced movement of the joint.

What is a knee joint?

The knee is quite a complex hinge joint. It is formed by the ends of the thighbone (femur) and the shinbone (tibia). The kneecap (patella) moves over and protects the joint at the front.

The thighbone has 2 smooth, rounded joint surfaces. They move on the nearby flat joint surfaces of the shinbone.

Normally, to reduce friction, the surfaces of each bone are covered with a layer of cartilage that allows the bones to move smoothly on each other. Cartilage is the white glistening layer that you see on the end of a lamb or chicken bone where it forms a joint.

What has gone wrong?

The cartilage in your knee joint has worn away. The underlying bone surfaces are now rubbing against each other. This is why your knee is stiff and painful.

The aims

The aim is to replace your knee joint with an artificial joint. This is called a total knee replacement or TKR for short.

The benefits

The operation should stop the pain in your knee. The range of movement in your knee may improve. As a result you will be able to walk further and climb stairs more easily.

Are there any alternatives?

We can inject steroid or other medicines into the knee joint. If the arthritis is not too severe, injections may relieve some of your pain. The effect of the injections usually only lasts a few months. Physiotherapy can help reduce the pain if your arthritis is not too advanced.

What if you do nothing?  

The condition is not dangerous in itself. However, without an operation your knee will get more painful and less mobile.

Who should have it done?

You should have your knee replaced if:

• The pain in your knee interferes with your life
• Tablets do not make the pain bearable
• X-rays show that your joint is severely damaged by arthritis

Who should not have it done?

You should not have knee replacement surgery if you have angina (chest pains) or shortness of breath that limits your walking more than your knee pain. You should not have a knee replacement if you have a urinary infection (UTI). This may result in infection of your new knee. We will test your urine. If it is infected, we will give you antibiotics before your operation. You should not have a knee replacement if you are a man with prostate problems. If you have poor urinary flow, it is better to have this investigated and treated before your knee is replaced.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in orthopaedics & trauma.

© Dumas Ltd 2006

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