Do you need a knee replacement?

What goes wrong?

Several conditions can cause damage and pain to your knees, including osteoarthritis and rheumatoid arthritis. Our younger knee replacement patients often have damaged knees resulting from sports injuries in which they’ve strained ligaments or torn the meniscus – the cartilage that acts as a cushion between the bones in the knee.

These are some of the signs that you might notice if you have one of the above conditions:

• Your knee pain is severe and limits your daily activities.
• Your knee pain persists or recurs over time.
• Your knee is painful, stiff, or swollen.
• You can’t sleep because of your knee pain.
• Your motion or degree to which you can move your knee has decreased.
• Your leg bows in or out (deformity).
• You find climbing stairs, walking, and getting in and out of chairs difficult.
• Using medication or a walking aid no longer provides relief.
• You can feel your knee joint ‘grating’.
• You have previously injured the ligaments in your knee.

How we make a diagnosis

The above symptoms could be caused by several things and it’s difficult to know what type of treatment you need without a consultation. It’s worth booking an appointment with a specialist if your knee-related symptoms have severely affected your daily activities, or caused a decrease in your quality of life. Perhaps you avoid walking or using stairs, you can’t carry groceries, and you can’t sleep at night because of the pain. These are symptoms that need medical attention.

These are the things we consider when diagnosing your knee:

History: An orthopaedic specialist will go through your past medical and surgical history to determine if your knee symptoms are a result of a previous injury or medical procedure. Looking at your family history might also be useful in determining if your condition (such as osteoarthritis) is genetic.

Examination: When examining your knee, we will look at your range of movement, swelling, and where and when exactly you experience pain. We will also evaluate your overall lower leg alignment to see if your knee condition may have changed the alignment of your leg. The examination will include a look at your hip and spine to make sure that your knee pain isn’t referred pain from a different part of your body.

X-rays: X-rays will help us to clearly see the extent of damage in your knee is and whether there have been changes to the shape or size of the joint and surrounding cartilage.

Expectations: A critical part of my patient consultations relates to their expectations. Many patients regard knee replacement surgery as a golden bullet and are disappointed afterward when they can’t immediately bend their knee fully or jog around the block. I discuss in detail what the outcome of the surgery is likely to be and what the risks and limitations are, so that patients go into surgery with realistic expectations.

When assessing whether you’re a candidate for knee surgery we take all the above factors into consideration. Our approach is individualised based on what your unique needs are. In some cases, a partial knee replacement will do the job, while other patients might benefit more from a total knee replacement.

Surgery versus other treatments

Performing major surgery on a patient generally isn’t the first step we take. If you have knee-related symptoms but your joint function is normal, or if you have pain with function, we start with conservative treatment. This may include medication, corticosteroid injections, splints or braces, and physiotherapy. In some cases, your doctor might recommend losing weight to prevent further damage to the joint.

However, knee replacement surgery (total or partial) will help if you fall into one of the following categories:

• You are in pain, your function is impaired and you are dependent on medication to be able to continue with daily activities.
• You are in pain, stiff, disabled, and/or other joints are compromised.
• Your knee is grossly damaged or deformed.

In these extreme cases, surgery will provide relief, help the patient to regain movement, and restore function.

Surgery and recovery

In my practice, patients are typically admitted on the day of their procedure. The operation takes approximately two hours, depending on the type of implant we are using and the extent of damage to the knee.

Patients spend two to three days in hospital and a physiotherapist will visit you during this time to assess your progress and schedule appointments for the rehabilitation process. Most patients experience some discomfort after surgery, but no pain.

You will have to use crutches for four weeks post-surgery and during this time you will have a follow-up appointment with the surgeon who performed your knee replacement.

Full recovery from the surgery is a long process that can take up to a year. However, the good news is that the knee replacement should last between 15 – 20 years.