Knee Replacement Surgery
In patients with severe end stage knee arthritis, which limits their function, the main form of treatment may be a knee replacement surgery.
The goal of knee replacement surgery is to relieve pain and restore the alignment and function of your knee.
With a knee replacement the ends of the bones at the knee are removed and replaced with metal and plastic. This procedure has been found to be very effective at improving a patient’s function. However, it does have some limitations.
It is important to remember that a knee replacement should be the last option when treating an arthritic knee. All other treatment options should be considered before proceeding with this major surgery.
A knee replacement is an artificial knee; it is not a bionic knee! Despite advances in science and engineering an artificial knee is a long way behind being as good as a natural human knee. The best knee you will ever have is the one you were born with!
Some describe a knee replacement giving you the knee function of an average 70 year old. It functions well for low demand activities and very light sport (eg golf and cycling). However you will not be able to perform high demand activities (eg regular running and playing football). It is important to appreciate these facts when considering a knee replacement otherwise you may be disappointed and dissatisfied with your surgery.
Knee replacements are felt to last up to 15 years. The amount of time that they last can be dependent upon a patient’s size, alignment, and their age. Heavier and younger patients tend to wear out their replacements sooner. Thus, this has to be factored in when total knee replacement is recommended for a patient.
Studies have indicated that up to 20% of patients who have a knee replacement are dissatisfied with their knee. Thus, it is very important to try to exhaust all forms of non-operative treatment, including exercising, anti-inflammatories as needed, injections, bracing, as well as arthroscopic or realignment surgeries prior to performing a knee replacement in younger patients.
For the reasons outlined above, in patients that are less than 60 years old, Mr Sethi may suggest other treatment options rather than a knee replacement. However there will be occasions when in very young patients, the only treatment option is a knee replacement.
In addition, it is very important to evaluate the X-rays in these patients and to correlate them with the clinical symptoms. There are often times where patients may have “bad-looking X-rays,” but in fact they are still functioning quite well to the point where knee replacement surgery would not be indicated.
Overall 80% of patients are satisfied with their knee replacement.
In cases of severe deformity or previous fractures Mr Sethi uses computer navigated surgery or patient specific instrumentation for a more bespoke surgical procedure and a better outcome.
Partial and Total Knee Replacements
Depending on the pattern of knee arthritis patients may be suitable for a partial knee replacement.
Surgeons often divide the knee into 3 compartments. Treatment options depend on which compartments are affected.
If arthritis is limited to one of these compartments a partial knee replacement may be appropriate. The advantage of partial knee replacement surgery is that it is less invasive and it has been shown that patients can recover faster from this procedure with a better range of movement and reduced blood loss.
Not all patients are suitable for this form of surgery. The risk with a partial knee replacement is that if arthritis starts to effect the other compartments the partial knee will need to be changed to a total knee replacement. The long term results following partial knee replacement are good. Mr Sethi performs both partial and total knee replacement surgery and will be able to advice you which operation would be suitable for you.
Total Knee Replacement are commonly used when arthritis affects two or more compartments.
Partial Knee Replacement - Arthritis confined to one compartment
most commonly just the medial (inside of the knee) compartment is affected.
A partial knee replacement has the advantage of preserving more of the natural knee which has not worn away.
Knee replacement surgery will require physiotherapy and rehabilitation so that the knee joint can regain strength, motion, and overall mobility. It is important to follow the prescribed protocol and follow the instructions provided by your physiotherapist closely. Initial therapy focuses on improving the range of motion and increasing your mobility. After a recovery period of 2-3 months, patients typically are in less pain then they were before surgery and performing well with their normal activities. Function and symptoms will continue to improve up to a year after surgery.
Robotic Knee Replacement
Mr Sethi is fully trained in the use of Robotic Assisted Knee Replacement Surgery.
The NAVIO® Surgical System is designed to help the surgeon with the accurate placement of the knee implant, balancing of ligaments and preparing of bones.
These are key factors in helping a knee replacement survive and succeed. Patients who have been treated using this system have been able to resume driving and return to work and hobbies more quickly.
What are the risks of surgery?
Risks of knee replacement surgery include: Infection, Bleeding, Pain / Stiffness, Nerve and Vessel damage, Thrombosis (Blood clots - Leg / Lung), Fat Embolism, Fracture, Loosening / Wear, and anaesthetic risks.
What type of Anaesthetic will I get?
The majority of patients opt for a spinal anaesthetic (injection in back) which numbs the legs and the patient is “awake” during the operation. A spinal anaesthetic is considered much safer than a general anaesthetic and has an advantage of a quicker recovery with less “hang-over” affect from anaesthetic drugs. Spinal anaesthetic is part of the Enhanced Recovery programme that Mr Sethi uses.
Enhanced recovery’ allowing patients’ to start using their knee earlier and returning home faster. Rehabilitation begins immediately following the surgery.
What type of Knee Replacement will I get?
Orthopaedics is one of the most innovative and fast changing medical specialities. Whilst Mr Sethi keeps up to date with advances in surgery and knee replacement implants, his aim is to give his patients the best and most predictable outcome.
History has shown us that whilst some new designs of implants have often seem revolutionary and ground breaking they have not always fulfilled their promise over time. Unfortunately there have been some implants used with good intentions which have resulted in disastrous outcomes for patients resulting in long term pain, repeat surgery and disability.
For these reasons Mr Sethi only uses implant with an excellent long term track record and thus these implants have a more predictable outcome.
For more information about implant outcomes visit
How long will I be in Hospital?
The average length of stay for patients is:
Total Knee Replacement patients - 2 days
Partial Knee Replacement patients - 1 days
When Can I Drive a Car?
Generally most patients would be able to return to driving at 6 weeks. Mr Sethi would see you 6 weeks after your operation and you will have an opportunity to discuss this with him then.
When will the pain settle?
Knee replacement operations are very painful and for the first few days you are likely to be in more pain than your are before the operation. The good news is that the pain then quickly settles over the following days and weeks; most patients will see an improvement on a daily basis.
Though it will be painful to exercise your knee, it is very important to perform your exercises religiously on a daily basis. If necessary take pain killers prior to your exercises.
We know that patients who are more compliant with their rehabilitation programme will be more satisfied and have a better outcome in the long term. When it comes to rehabilitation from knee replacement surgery, it is a case of “No Pain - No Gain”!
At 6 weeks most patients are walking independently or at the very most using 1 stick to get about.
Between 2 - 3 months most patients are able to perform most functions of daily living independently.
Symptoms should continue to improve up to 1 year after surgery.
When will the Swelling Settle?
Knee replacements surgery is major surgery and it takes many weeks and months for the tissues around the knee to recover from the operation.
In the early days after surgery your knee (and whole leg from knee to ankle) will swell, especially after increased activity.
For the majority of patients swelling will remain long after the pain has gone. Symptoms of swelling alone is normal.
For many patients an “artificial Knee” will always remain a little “puffy”.
The front of my knee is numb - is there something wrong?
No - it is entirely normal.
Any surgery to the knee results in the damage to small nerve endings and therefore a numb patch of skin. The area of skin affected will get less over the first year but will not disappear completely.
Thankfully this does not result in any impairment of function.
Will I be able to Kneel after my Knee Replacement?
Many patients find it uncomfortable to kneel after a knee replacement (though some have no problems). If kneeling activities are very important to you, then you should carefully consider whether a knee replacement is the right choice for you.