Posted: 13/04/2022
The knee is one of the most complex joints in the body, and it is also the largest. It is made up of four bones: the femur (the thigh bone), tibia (large shin bone), fibula (smaller shin bone) and patella (the knee cap). The surfaces of these bones can wear with age or other conditions, resulting in pain and discomfort, restricting mobility, and affecting quality of life.
Once pain can no longer be controlled with conservative measures such as painkillers and physiotherapy, or with alternative surgery, knee replacement surgery may be offered. The condition which most commonly results in a need for knee replacement is osteoarthritis – this is where the cartilage on the ends of the bones breaks down, causing pain, often with swelling and reduced movement in the joint.
Other conditions causing damage to the surfaces of the knee joint and resulting in the need for knee replacement are haemophilia, gout, and traumatic knee injury. The median age of patients undergoing knee replacement surgery is 70[1].
Knee replacement surgery involves inserting an artificial implant to replace the damaged components within the joint. There are three main types of knee replacement surgery:
Total knee replacement is the most common type of replacement. Partial replacement tends to be more common in younger patients, between 55-64 years old; in part this is because any prosthetic replacement has a finite life span and will need replacing after a number of years. Replacement is therefore more likely to be required by younger patients, and a partial knee replacement is easier to revise by conversion to a total knee replacement, than it is to entirely replace a total knee replacement.
Total knee replacement begins with an incision made down the front of the knee to expose the kneecap. The damaged end of the femur and the tibia are cut away, and the ends are measured and shaped to fit the prosthetic implant. A dummy joint is then positioned to test the joint working properly. Adjustments are made and the final prosthesis is fitted. The end of the femur is replaced with a curved piece of metal, while the end of the tibia is replaced by a flat metal plate; these are often fixed using bone cement. A plastic spacer is fitted, which acts like cartilage between the pieces of metal to reduce friction. The wound is then closed with stitches or clips. In some cases, a splint is used to immobilise the leg, but more often movement is encouraged as soon as possible after surgery to improve recovery.
A partial knee replacement is a simpler operation, involving a smaller cut, with less bone removed. A shorter hospital stay tends to be required, and the post-operative recovery is quicker.
As with any surgical procedure, knee replacement carries with it certain risks. As well as the complications associated with surgery in general, specific risks of knee replacement surgery include: stiffness, infection of the wound or joint replacement, unexpected bleeding into the joint, ligament, artery or nerve damage, deep vein thrombosis (DVT), persistent knee pain, and bone fracture[2].
For a total knee replacement, patients commonly spend two to three days in hospital, before being discharged with a walking frame or crutches. Patients who have a partial knee replacement tend to have a shorter hospital stay. It may be possible to walk without aids at around six weeks post-operatively, and drive within six to eight weeks. Targeted physiotherapy will assist in increasing mobility and the range of movement in the knee joint. It may take up to three months for pain and swelling to subside, and, depending on a patient’s occupation, they may be able to return to work within 6 to 12 weeks. Full recovery can take up to two years while scar tissue heals.
Alternative surgical procedures are available, including:
Long term results from these surgeries do not tend to be as good as with knee replacements, and knee replacement surgery may ultimately be required.
Over time, implants wear out, loosen and can break and require revision. According to National Joint Registry data, 1 in 20 patients needs further surgery after 12 years, depending on type. Total knee replacements usually last longer than partial knee replacements.
Rosie Nelson, associate in the clinical negligence team at Penningtons Manches Cooper comments: “Knee replacement can offer patients fantastic results and can hugely assist in allowing them to regain their independence and quality of life. Though the majority of patients are satisfied with the results, we continue to see cases where surgical treatment has fallen below a reasonable standard. Examples of cases where we have successfully acted to obtain compensation for our clients include:
“Where surgery is negligently performed, the impact can be profound. We know from our clients that pain and very substantially reduced mobility are common complaints where knee replacement surgery has failed to deliver the expected benefits and, sadly, these may not always be corrected even by revision surgery. The effect on daily life can be devastating, drastically reducing physical function and causing considerable emotional distress.”
If you have any concerns about orthopaedic treatment you have received, please get in touch with our specialist orthopaedic team for a no-obligation discussion.
[1] National Joint Registry, 18th annual report, 2021
[2] https://www.nhs.uk/conditions/knee-replacement/risks/
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