Knee replacement surgeon London

Medically reviewed by Sam Rajaratnam FRCS (Tr. & Ortho).

Knee Replacements for Osteoarthritis of the Knee

“The outcome of the procedure exceeded my very high expectations. I was able to walk unaided on the 3rd day and have not experienced more than soreness since. The post operative support and care was of the highest standard. I am indebted to the surgeon and his anaesthetist, who have succeeded in raising the quality of my life on the last lap to a level I could not possibly have envisaged.”

Patient – April 2023

A talk on enhanced recovery in joint replacement surgery

Osteoarthritis of the knee is a very common cause of knee pain, often bringing with it the feeling of the knee giving way and swelling.

Whilst conservative treatment, including painkillers, steroid or cartilage protein injections and physiotherapy, can be helpful in the early stages, most people with osteoarthritis of the knee will eventually require knee replacement surgery.

Depending which part of the knee is worn will determine the types of symptoms an individual will feel, be that pain, locking, giving way or stiffness.

What does knee replacement surgery involve?

Knee replacement surgery has advanced tremendously over the last 30 years. It is now one of the most successful operations performed throughout the world. The National Joint Registry recorded over 80,000 primary knee joint replacement procedures performed in England in 2021.

In years gone by, the replacement itself formed a hinge to the knee joint, but modern knee replacements are surface replacements only. They work by removing the arthritic surface of the knee and capping it with an artificial surface. It is custom-fitted to the patient’s anatomy by an expert surgeon.

Modern high flexion knee replacements allow a pain free and active life
Modern high flexion knee replacements allow a pain free and active life

Modern high-flexion knee replacements allow a pain-free and active life and its design allows an excellent range of motion once the patient fully recovers. Most patients can mobilise safely and be discharged home within a couple of days of their joint replacement.

After your operation, you must continue to exercise your knee after being discharged home. The overall patient satisfaction rate of a successful joint replacement with a rapid recovery programme is around 94%, with the majority of patients being able to walk long distances, play golf, cycle, swim and lead an active lifestyle and a life without pain. Knee replacements also last longer, with the National Joint Registry reporting that most knee replacements last for over 15 – 20 years.

Partial vs total knee replacement surgery

Osteoarthritis can affect either one part of the knee or multiple areas within the joint. Sometimes your surgeon may recommend a partial knee replacement as a solution for your knee pain and condition.

As implant technology has developed, and the designs and results of full knee resurfacing have improved, many patients choose to have the whole joint resurfaced as the outcomes and function post knee replacement/resurfacing give them an excellent result.

Computer Assisted Alignment vs Conventional Alignment

Computer assisted alignment
Computer-assisted alignment

The accurate alignment of a joint replacement is vital to achieving excellent function post-knee replacement surgery. Even slightly incorrect positioning of knee replacement components can lead to early failure of the knee, leading to revision surgery.

Conventional knee replacement surgery, without the aid of computer technology, uses analogue measuring devices and x-ray (radiography) imaging before the operation to help in making sure knee replacement components are sized correctly and helps with making decisions on the cuts to the bone and the positioning of implants during the operation.

Several instruments are used to position guides so that the damaged bone and cartilage can be removed from the joint. Sometimes instruments are located inside the femur and/or the tibia bones to help with the positioning and alignment of the implant. Since the alignments and bone cuts must be made in a three-dimensional plane, the two-dimensional radiographs must be interpreted accurately. These conventional alignment methods have significantly improved with the use and improvements of mechanical alignment instruments and are still widely used for knee replacement surgery.

Computer imaging has been used to produce customised patient instrumentation. This makes use of MRI (magnetic resonance imaging) or CT (computed tomography) technology to obtain unique positioning guides for knee replacement surgery, the so-called ‘Patient Specific Instrumentation’ (PSI). The Zimmer Biomet version of PSI is called ‘Signature’. It can be used with the ‘Persona’ and ‘Vanguard’ knee replacement systems. The MRI scan, which only takes about 20 minutes, will only include your hip, knee and ankle. The scan is done so that your knee joint and leg alignment can be studied in precise detail. The reason for this is to further help the surgeon with the alignment process and the positioning of the implants. With computer-assisted knee replacement surgery, there is less need for invasive procedures to the femoral and tibial medullary canal for insertion of guides, and fewer instruments are needed.

Several scientific studies have found that computer-assisted alignment is the more accurate method for aligning implants. MRI scans produce a three-dimensional image unique to your anatomy, allowing the surgeon to plan your operation very effectively. Computers can manipulate MRI scans in a software programme to make a virtual three-dimensional image of your knee and leg alignment.

The MRI scan, because it provides a significant level of detail about your knee joint, gives the surgeon more information about the component sizing, alignment and positioning that is right for you. Sometimes it will be used to provide information about the way the custom-fitted implant will be formed and the instruments to be used.

SIGNATURE PERSONA & VANGUARD KNEE REPLACEMENT

Early knee joint replacement implants were hinges, but these tended to fail because they didn’t consider the knee joint’s rotation. Modern designs are not hinged and are designed to replace only the damaged surfaces of the joint’s bones rather than the whole joint.

Several commercial companies make knee replacement implants and systems, including DePuy, Stryker, Zimmer Biomet, Smith & Nephew and ConforMIS, and these are manufactured in different styles, options, and materials.

Mr Rajaratnam can talk you through the pros and cons of each design.

Knowing an implant company’s manufacturing track record is essential before choosing an implant. There are approximately 100 different knee replacement systems on the world market. Still, a few giant companies manufacture most of the implants and generally provide reliable and long-lasting products.

Mr Rajaratnam generally favours the ‘Persona’ and ‘Vanguard’ knee system (from Zimmer Biomet) with the potential additional use of the 3D printed MRI-assisted ‘Signature’ jigs (based on MRI modelling of your own anatomy). However, in many instances, patients may choose to use the conventional alignment methods, which will still give them an excellent outcome.

Zimmer Biomet produces almost half of all the knee replacement implants made in the world and have an excellent manufacturing history over the last 40 years in knee replacement design. The ‘Persona’ is their latest high flexion knee design and is possibly the most comprehensive knee replacement system on the market today.

Knee Replacement Surgery Recovery – Enhanced Recovery Programme

As techniques and processes have developed, expert centres throughout the UK have seen improved results of modern knee replacement through the enhanced recovery programme. 

Best results are gained by careful surgery and a streamlined approach to pre and postoperative rehabilitation.

This involves:

  • A comprehensive preoperative meeting with a consultant who specialises in knee surgery to help with your understanding of the process.
  • Excellent verbal and written information to ensure you are fully prepared.
  • Optimising your health and fitness before surgery, i.e. looking at your nutrition, how much you exercise and minimising the impact of any other medical conditions you may have.
  • Use of the latest high-flexion knee implants during surgery which have a proven track record.
  • Care from an expert theatre team who implant hundreds of knee replacements annually with excellent results.
  • Use of an advanced spinal and local anaesthetic technique to optimise pain control after surgery.
  • A co-ordinated postoperative early rehabilitation programme involving the surgeon, nurses and physiotherapists.
  • Most importantly, you! A motivated patient keen to exercise their knee, following a knee resurfacing/replacement procedure will give the best outcome after surgery.

Knee Exercises after Knee Replacement Surgery

Mr Rajaratnam focuses on achieving excellent function after knee replacement surgery. The keys to achieving full functional recovery are accelerated rehabilitation and targeted physiotherapy.

The surgeon, anaesthetist, surgical care practitioners, physiotherapists and dedicated nurses work as a team to make patients comfortable post-surgery.

Generally, you can move your knee as early as 30 minutes following joint replacement surgery. We encourage our patients to walk with our highly trained physiotherapists and nurses within 3-4 hours.

Patients are encouraged to walk with our highly trained physiotherapists and nurses within 3-4 hours.

Joint replacement patients usually remain in the hospital for 2-3 days. We will ensure you have safely walked up and down stairs before being discharged home.

Over the next 2 weeks, achieving an excellent range of movement in the knee is vital, and you will be taught how to bend and straighten your knee to achieve this.

You will be seen 2 weeks post-surgery for a follow-up appointment. Once the wound has healed and a full range of movement has been achieved, it is important to strengthen the muscles around the knee. These exercises aim to increase muscle tone around the new knee joint.

We are happy to recommend a specialist knee physiotherapist who will arrange to see you as an outpatient, oversee your strengthening programme and monitor your progress over the next few weeks.

If you already have a good physiotherapist, we are happy to work collaboratively with them during your rehabilitation.

Ultimately a full pain-free range of movement in your knee with good muscular recovery will enable you to return to an active lifestyle.

FAQs about Knee Replacement Surgery

Should I be worried if my replacement knee is clicking?

If you have had a knee replacement before and it is now clicking, you may first want to read our article here: https://www.thechelseakneeclinic.com/blog/clicking-noise-knee-replacement/