Knee Replacement

When you have knee replacement surgery, (knee arthroplasty), your surgeon will replace the damaged, worn or diseased cartliage and bone in your knee joint with a prosthetic joint made of 'plastic' and a metal alloy or ceramic sandwich.

The surgery is offered in order to reduce your disability and allow your return to enjoyable activities without debilitating pain. 

There are two main types of knee replacement:

• Total knee replacement (TKR) surgery – the whole of your existing knee joint is replaced with out without the undersurface of the patella (knee cap).

• Partial knee replacement (PKR) – also called unicompartmental or "half-knee" replacement as only one compartment (of the 3) in your knee is replaced. This surgery is used when knee arthritis is confined to one compartment of your knee.

Your knee surgeon will discuss the best surgery for your knee anatomy needs.

Knee replacement surgery can be carried out under general anaesthetic or under spinal anaesthetic. Your surgeon and anaesthetist will discuss the best option for you.

Your surgeon will make a longitudinal cut down the front of your knee and move your kneecap to one side to reach your joint. 

They will remove worn or damaged surfaces from the end of your thigh bone and the top of your shin bone and shape them to fit the artificial implant which is sized to best fit for your bone size. Medical cement impregnates with antibiotics is usually used to bond the new joint to your bones. Once the new joint is in place they will close your incision.

Knee replacement surgery is often recommended if you have:

• debilitating pain from yout knee artritis or injury that results in severely painful joints which is holding your life back. This may be down to mobility impairment, or ability to perform everyday tasks which is impacting your quality of life and quality of sleep.

• tried non-surgical treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), physiotherapy and injections but these have failed to make an impact in relieving your pain and help your movement.

Initially, you might visit your GP if you are experiencing persistent pain in your knee or you are finding it difficult to do normal things because of stiffness or loss of mobility. They may carry out a physical examination, and order X rays and blood tests to diagnose the underlying problem. Your GP may recommend non-surgical treatment options or refer you to a consultant orthopaedic surgeon to discuss other options including a knee replacement operation. If you are overweight, you may be asked to lose weight as this will reduce the strain on your knee.

The usual reason for a knee replacement is arthritis, with the most common type being osteoarthritis. This is the gradual wear and tear of your knee joint that results in damage to your cartilage covering the surface of your joint and the bone underneath and is very painful. 

It is extremely important that you keep your knees healthy to prolong a knee replacement, there may come a time when knee replacement surgery might be something you have to consider, but in the meantime there are things you can do to keep your knees moving to reduce the risk, read more here.

An operation can take up to two hours depending on the type of replacement surgery.

You can expect your knee replacement to last at least ten years and up to twenty years. Most people enjoy less pain and improved mobility following their knee replacement.

Total knee replacements are not ideally indicated in the "working age group". However, if you are in a position to require one the length of time you are out of work following a knee replacement is dependent on your individual circumstances including: your health, how you respond to knee surgery, how you heal and, the type of activity you wish to return to.

If you have a desk job, you may return to work around six to eight weeks after your knee replacement. If your job is more physically demanding and involves a lot of heavy lifting, standing up or walking for long periods of time you may need to take up to 12 weeks off work after knee surgery. 

When considering your return to work you will also need to think about your ability to get to and from work and, the amount of painkiller you are taking as this can cause drowsiness.
It may be that you agree a phased return to work with your employer.

Getting back to your normal work routine sooner rather than later can help you to recover more quickly. Too much time may be detrimental to your health as you could become isolated and depressed.

The time it takes to walk after a procedure can vary from person to person. 

You will be encouraged to stand and walk whilst you are in hospital, usually from day one.

Most people are able to walk on their own using crutches or sticks within a week or less after their procedure. These walking aids support you whilst your muscles are weak and help prevent falls that could damage your joint.

You will gradually build up your strength in your knee after a knee replacement by keeping active and doing the exercises advised by your physiotherapist.

Six weeks after your knee surgery, you should be able to stop using walking aids and resume your normal leisure activities, by three months you should be able to return to longer walks and activities such as a round of golf but this may vary from person to person.

You will be sent home from hospital once you meet criteria in your range of motion and can handle stairs (especially if your house has stairs to negotiate).

You can kneel down after a knee replacement but the timeframe can vary between individuals. You should get confirmation from your surgeon prior to doing so. This is usually around three months after your knee surgery when the scar tissue has healed enough.

Many people can kneel without any discomfort once they have fully recovered from a knee replacement but others may find it uncomfortable to do so due to pressure being exerted onto the scar. As time passes you should find it easier to kneel. Using a pillow, a cushion or knee pads can make kneeling more comfortable.

Some people avoid kneeling after their surgery as they have the misconception or uncertainty that it may be harmful to their knee following knee surgery. You should talk through any worries you have about your knee replacement in detail with your knee surgeon.

Expect a numb patch at the oustside area of your scar, this may reduce in size but may never go away completely.

At Ramsay, we are very conscious that a speedy recovery is important after the procedure. Aftercare is a valuable part of our care and we aim to get you back to normal life, as soon as possible.

You will need to stay in hospital with us  until we are confident you are ready to go home, this is typically one to two days.. One of our physiotherapists will explain and demonstrate exercises to do at home to help strengthen your knee and they will offer advice about everyday living and what you should and shouldn’t do. Initially you’ll be given crutches or a frame to help you walk. Physiotherapy is often advised for a number of weeks after knee replacement or until you achieve the minimum range of motion required.

In the immediate period following your return from hospital, you may need help in the house and with your usual activities. Gradually, you will be able to move around more and start driving and doing housework, and return to work. You may need painkillers for this initial period.

We will offer you a follow up appointment with your consultant to check on your progress.

Your knee replacement recovery is individual to you. It can take up to 12 weeks or more for pain and swelling to go down, but many patients will recover quicker than this. You should follow your knee surgeon’s post-operative advice. 

Our staff will be able to answer any questions you have about your recovery and what you can expect over the weeks after your operation.

Before your total knee replacement, you will be given an anaesthetic to prevent you from feeling pain during the surgery. This may be a general anaesthetic that puts you into a deep sleep, spinal anaesthetic, or an epidural when you are awake but takes away any feeling from the waist down.

After total knee replacement surgery, you can expect pain, swelling and bruising as part of the natural recovery process. Every patient is different but you can expect it to take up to three months for the pain and swelling to settle down.

If you experience intractale pain or "new" pain weeks following surgery you should inform your surgeon or your GP.

Knee replacement is the most common joint replacement procedure. However, it is a major operation and is normally only recommended if other conservative treatments, such as physiotherapy or injections, have not worked in reducing your pain and improving your mobility.

When you leave hospital after your surgery you can stay home alone, but you should prepare your home before going into hospital for your surgery.

You should have a bedroom set up with easy access to a bathroom and kitchen so that you can navigate your way around easily, and place items you will need and use regularly at table-top height so you do not have to reach up or bend down. Make sure you have the food provisions you need.

You may want to arrange for someone to help you for the first week or two. You may feel very tired at first, and your muscles and tissues around your knee replacement will take time to heal.

Make sure you follow your surgeon or your care team’s post-operative advice and call us or your GP if you are worried about anything.

You will be provided with more detailed information during your pre-assessment from our physiotherapists and occupational therapists.

You should take extra care in the first few weeks after your knee replacement and avoid some movements, such as twisting at your knee and crossing your legs, to prevent injury. You should also avoid

• slippery floors without non-slip socks or shoes.
• getting up at night without a night light on.

Once you have recovered from your procedure surgery you can return to your normal daily activities and certain more vigorous physical activities. You may be advised to avoid some high-impact sports or aerobics that involve jumping, twisting, jerking, pulling or running as these movements may compromise your new knee.

Your surgeon or physiotherapist will advise you specifically on what to avoid in the first few weeks after your knee surgery and beyond. The following is a helpful checklist.

Do:

• use crutches to walk around with
• try walking without an aid after around six weeks if you feel ready 
• walk around for five minutes every hour to prevent blood clots
• stay well hydrated 
• wait at least six weeks until you drive after a total knee replacement or three weeks for a partial knee replacement
• keep your leg raised to avoid swelling
• avoid twisting, bending down and reaching up
• refrain from flying for a minimum of 6 weeks prior and post surgery

Don't:

• sit with your legs crossed for the first six weeks
• sleep with a pillow under your knee
• kneel on your new knee until the doctor says you can 
• do household tasks that involve lifting or moving heavy objects for the first three montjs
• stand for long periods of time, as this can cause swelling
• go on a flight for 6 weeks

Mr Marcus Cope, Consultant Orthopaedic Surgeon answers some additional questions around what you can do after knee replacement surgery here. 

If you decide to pay for your treatment, Ramsay offer an all-inclusive Total Care package, where a single one-off payment at a pre-agreed price, delivering direct access to all the treatment you need for complete reassurance. You can also spread the cost of your treatment with finance options available. The knee replacement (knee arthroplasty) cost depends on your local Ramsay facility, to find out more information around knee replacement surgery cost click here.

The procedure may be covered by your medical insurance policy. We advise you to check directly with your insurance provider and get written confirmation before commencing treatment.

One of the major advantages of seeing a knee surgeon privately is that your appointments and treatment are arranged at times to suit you and without any unnecessary waiting. This is especially important if you are in a lot of pain or if you want to avoid particular dates for surgery.

You will be treated by an experienced orthopaedic surgeon with a special interest in knee surgery who will be able to discuss your individual needs and select the best prosthesis for you.

Additional benefits of being a Ramsay Private patient include:

• choice of consultant, where possible
• rapid access to expert opinion on the best treatment for you
• fast track admission and discharge
• single bedded rooms with en suite bathroom and flat screen TV
• choice from our a la carte menu as an inpatient

This content has been reviewed by Mr Ionnis Pengas, Consultant Orthopaedic Surgeon at Duchy hospital in March 2024.