When all other options and non-operative measures – such as weight loss, anti-inflamatories and physiotherapy – no longer control the pain, it may well be time for knee replacement surgery. Osteoarthritis of the knee joint causes huge discomfort but with the minimally invasive techniques offered by Professor Ali Ghoz, knee replacement surgery can soon give patients back their active lives.
It is never too late for knee replacement so patients can choose to opt for modern knee replacement surgery once the pain becomes too uncomfortable – and when they want to rediscover their vitality.
Knee Replacement Surgery
Although unicompartmental – or ‘half knee’ replacements - are available, arthritic knees usually require a total knee replacement. This surgery resurfaces the femur, tibia and patella and introduces a layer of polyethylene between the femur and tibia as a plastic shock absorber to eliminate the pain of osteoarthritis.
Studies have shown that a well aligned and functioning knee replacement should last between 25-30 years. Using computer navigated, patient specific instruments Professor Ali Ghoz can treat the knee and help patients become pain free.
Professor Ali Ghoz tends to cement the replacement onto the bone rather than allow for the bone to grow onto the prosthesis, as patients tend to recover a little quicker and experience less pain and discomfort.
It has been found that over 85% of knee replacements will achieve a good, pain-free functional result allowing patients to live a full and active life.
Types of Knee Replacement
Total Knee Replacement
A total knee replacement (TKR) or total knee arthroplasty is a surgery that resurfaces an arthritic knee joint with an artificial metal or plastic replacement called the prosthesis.
Unicondylar Knee Replacement
Surgery in which only part of the knee joint is replaced through a smaller incision than would normally be used for a TKR. The knee joint is made up of three compartments – the patellofemoral and medial and lateral compartments between the femur and tibia. Often only one of these compartments wears out.
Revision Knee Replacement
This is when part or all of a previous knee replacement needs to be revised. These operations can vary from very minor adjustments to massive procedures replacing significant amounts of bone.
With robotic assistance, we can achieve better alignment with our implants, and this is clear on the X-rays we look at. All procedures are carried out by a surgeon who is trained in performing knee replacements using the robot.
Generally, robot-assisted surgery results in less postoperative pain and an earlier return home. However, as with the use of 3-D printed knee replacements, there is still no clear evidence that the outcomes of this change in the long term.
The Surgery – What You Need to Know
Prior to starting the procedure, we give Intravenous Antibiotics to protect you from infection. Professor Ali Ghoz’s minimally invasive procedures are usually carried out under General Anaesthesia. Sometimes the surgery can be performed under a combined spinal anaesthetic and a light general sedation. This is entirely safe and is proven to reduce any possible complications during joint replacement surgery.
A urinary catheter is used as the morphine given for pain relief invariably results in patients finding it difficult to pass urine for 12-18 hours. Removing the catheter is a very straightforward process and not painful at all. If we do use a urinary catheter, we give antibiotics before insertion of the catheter and at the time of removal of the catheter.
Pain relief after the surgery is down to the individual patients’ needs in accordance to the anaesthetist’s direction.
Recovery – What You Need to Know
Preventing thrombosis is the priority after hip and knee replacement surgery. Mobilisation and exercise are vital. To aid this every patient is fitted with a calf compressor that promotes blood flow and prevents clots. Every patient will be prescribed oral blood thinning medication following surgery to guard against the risk of Deep Vein Thrombosis.
The sooner a patient gets out of bed and walks the less the risk of thrombosis so Professor Ali Ghoz encourages his patients to walk twice a day whilst in the hospital. The more exercise the better but patients are warned not to overdo things.
Although there may be some discomfort the keys to a successful recovery after replacement surgery – even the minimally invasive techniques offered by Professor Ali Ghoz – are mobilisation and hydration.
Physiotherapists will be able to show patients exercises to help recovery and ensure that surgery is just the start of a new way of life.
Knee Replacements – Things to Note
All knee replacement procedures leave some numbness on the outer side of the wound. This is unavoidable as there is a skin nerve that goes directly across the skin incision that is purposefully cut in order to open up the knee joint. It is a minor nerve and the numbness will tend to lighten up over time but is never completely eliminated.
All knee replacements click – this is entirely normal. The noise is just the metal and polyethylene parts touching each other and is no cause for alarm. It is how the joint functions and will get quieter over time.
What happens next?
As this surgery is minimally invasive recovery is relatively quick and patients will only need to go back to their room for a short period – and will be allowed home after some evidence of mobilisation. After only around our to six hours the patient should be able to move independently but this will be assessed by medical staff.
Once the patient is home it is advised that the knee is iced regularly over the next week or so. Pain relief and anti-inflammatories will be prescribed and patients will be required to be seen again around 10-14 days after the surgery to see how everything is progressing .