Knee Replacement

The Knee is the largest and most complex joint in the body and knee pain can be caused by many conditions. When pain is caused by diseased joint surfaces, total or partial knee replacement can be an effective treatment to cure pain, restore function, and return you to the activities you want to do. Arthritis can be a debilitating condition and is becoming increasingly prevalent as our population ages. There are multiple ways to treat arthritis of the knee and our ability to devise and deliver patient specific surgical solutions has been markedly improved by modern technologies. Determining the appropriateness, timing, and type of surgery that is right for you is the focus of assessment and discussion with Dr Franks.

What is arthritis?

Arthritis is simply inflammation of the joint but this can caused by a number of diseases. The most common is osteoarthritis or wear and tear of the joint. The main symptoms of knee arthritis are pain and stiffness but patients may also experience clicking, locking, instability, and the sensation of the knee giving way. Despite seeing arthritis on x-rays, treatment is only required when your symptoms demand it. When these symptoms stop responding to non-surgical measures, and are debilitating enough, surgical measures should be discussed.

Determining when this is appropriate is the focus of assessment by Dr Franks and discussion with you.

What are the surgical options?

Broadly speaking, the definitive surgical treatment for advanced arthritis of the knee is partial or total knee replacement. The knee is made up of 3 compartments. Arthritis can occur in any one or all of these. When arthritis is restricted to only one compartment, a partial knee replacement can be considered. If there are 2 or 3 compartments affected a total knee replacement is needed. Keyhole surgery to ‘clean up the joint’ is not effective for sufficiently advanced arthritis and is only recommended in very specific circumstances. There are however many non-operative treatments for arthritis that should be undertaken prior to any surgical intervention.

What is a knee replacement?

Knee replacement is a surgical procedure in which the joint surfaces of the knee are replaced by an artificial surface. This is designed to remove the pain generating portions of a diseased joint. The artificial parts of the knee replacement are held onto the bone with either cement or special bone ingrowth surfaces. The knee replacement prostheses are combinations of stainless steel, titanium, and polyethylene.

Do I need surgery?

Just because you have arthritis, it does not necessarily mean you need an operation. In addition, nobody can simply tell you when you need a knee replacement. It is a decision you make in consultation with your surgeon. Knee replacement, like all surgery, has risks. Knee replacement should only be considered when the risks of surgery are outweighed by the benefits of pain relief and improved function.

What are the risks of surgery?

Like every surgical procedure, knee replacement has risks. The main risks are: ongoing pain or discomfort, infection, fracture, tendon/vessel/nerve damage, instability of the knee joint, blood clots, loosening of the prosthesis, tendonitis, bleeding, and the risks of undertaking an anaesthetic. The likelihood of any of these occurring remains very low but they are important for you to know about and Dr Franks will discuss these with you at your consultation.

What can I do to delay or prevent surgery?

There are many treatment modalities available to us that should be undertaken before considering surgery. In many cases, especially in early arthritis, these treatments can delay or even prevent the need for surgery. Non-operative measures include: weight loss, pain killers, joint injections, activity modification, physiotherapy, and job retraining. These treatments aim to reduce the symptoms you have from the arthritis rather than modifying or reversing the arthritis itself.

What is robotic knee surgery?

Robotic knee surgery is a technique whereby a normal knee replacement is inserted using a robotic arm and computer navigation. Currently the most common method of inserting knee replacement is with computer navigation alone. It remains to be seen whether robotic knee surgery has any benefit over conventional knee replacement. Dr Franks is fellowship trained in robotic knee surgery and routinely performs both robotic and conventional total knee replacement. Dr Franks can discuss this option further with you at your consultation.

What happens after I decide on surgery?

The next step is to organise a date for your surgery and this will be discussed at your consultation. You should plan for your family and other supports to be available around the time of your surgery to ease your return home after your operation.  We will need to do some planning scans to plan your prosthesis and fabricate your custom guides where necessary. You will also be required to perform some routine pre-operative tests, and to see our anaesthetists before your operation.  These appointments and tests will be arranged for you.

What to expect on the day of surgery?

On the day of surgery you will need to be fasted, this means you must not eat or drink from midnight the night before surgery. You will be given a time and a place to attend for admission to hospital and be checked in. Dr Franks will see you before the operation to answer any questions. You will see your anaesthetist to discuss the type of anaesthetic and pain relief plan with you again. After your surgery you go to the recovery ward for usually around 30 minutes and then to the ward where your family may visit.

What happens after surgery?

Immediately following your surgery the focus of care is to ensure that the effects of the anaesthetic wear off completely, and that your post-operative pain is well controlled. You will also get formal post-operative x-rays of your new knee and blood tests on the first day after surgery. Once you have recovered from the anaesthetic and your pain is well controlled, physiotherapy is the next important step. This will start in earnest as soon as possible, usually on the day of surgery or day following surgery. Your normal hospital stay will last as long as it takes for you to be comfortable on tablet pain killers only and to be safe to mobilise at home. This usually takes around 4 to 5 days. Occasionally some time in a rehab facility will be required and this will be determined by Dr Franks and your physiotherapists and arranged if necessary. Upon discharge you will be given your medications, including necessary pain relief, and you will be provided with details of your follow-up appointments.  You will be seen at 2 and 6 weeks after your operation to ensure you are progressing well.

Where can I get more Information?

Please bring any questions you may have about the procedure to your appointment with Dr Franks and they can be discussed in detail. If you would like more information, please see contact my rooms on 02 9998 8255.

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