Total Knee Replacement

Total Knee replacement (TKR) surgery involves removing the damaged or worn ends of the femur and tibia which make up the knee joint and replacing them with metal components with a polyethylene (plastic) insert.  During total knee replacement surgery, the entire knee joint is replaced, often with resurfacing of the kneecap (patella). In partial knee replacement surgery, only part of the joint is replaced.

The Primary Goals of a Total Knee Replacement include:

  1. Pain relief – improving pain associated with the diseased joint.
  2. Improved function – optimising the range of motion and kinematics of the knee to optimise mobility. Knee kinematics refers to the way the knee moves, and knee replacements often do not quite replicate a patients own natural knee kinematics. When a normal knee flexes, the thigh bone (femur) rolls back and slides on the shin bone (tibia).  This is called the ‘roll back and slide’ phenomena. As the knee moves into full extension the tibia externally rotates on the femur (screw home kinematics).  Depending on the type of implant and the way the knee replacement has been put in, knee replacements, often, may not perfectly replicate the natural knee kinematics of the patient which may affect clinical outcome. During the surgery, balancing the soft tissues whilst optimising the range of motion and knee kinematics is crucial for optimising outcome.
  3. Balancing of the soft tissues – Balancing the soft tissues throughout the range of motion of the knee is important for enhancing the range of motion and kinematics of the knee whilst optimising outcome.
  4. Correction of deformities – correction of any underlying joint deformity to improve biomechanics.
  5. Restoring anatomy – restoring normal anatomy whilst balancing the soft tissues and is important at improving pain, function and overall knee biomechanics.
  6. Joint Durability – implanting a joint replacement which is durable and provides good function over a long period of time.
  7. Quality of life – improving the overall quality of life of the patient by improving pain and function enabling patients to return to their chosen activities.


Mr Griffiths has a specialist interest in the use of patient specific custom implants for patients with osteoarthritis associated with complex deformities to facilitate the accurate restoration of the patient’s anatomy and knee kinematics.

The Process of a Total Knee Replacement and What to Expect

Pre operatively

Prior to your surgery Mr Griffiths will meet with you at a consent appointment to discuss with you the risks of the surgery and the rehabilitation back to your normal activities. You will also have a separate pre assessment appointment whereby you are reviewed by the pre assessment teams to ensure you are fit for surgery. They will go through your medications with you and tell you what to stop and when to stop them.

It is very important to stay as fit and healthy as possible to speed up your recovery post operatively. Regular exercise preoperatively is important to strengthen your muscles and improve your overall cardiovascular health. Painkillers can be helpful to allow you to mobilise if pain is an issue.

It is important to prevent any cuts or grazes before your surgery as they could pose an increased risk of infection and could lead to a delay in your surgery.

On the day of surgery

Typically you will be asked not have any food for a minimum of 6 hours before your surgery.

Typically, you can continue to drink water up until your surgery.

You will be reviewed by Mr Griffiths and the anaesthetist before your surgery.

The surgery is usually undertaken either under spinal or general anaesthetic and this can be discussed with the anaesthetist prior to the surgery.

The surgery typically takes about an hour, but you’ll spend some time in recovery before going back to the ward. There will be a torniquet applied to your thigh in theatre though typically Mr Griffiths only inflates this while implanting the actual prosthesis. This reduces your post operative thigh pain and facilitates an enhanced recovery and early mobilisation. The torniquet will be removed before you leave theatre.

During the procedure, Mr Griffiths will ‘block’ the knee with a local anaesthetic block and this, along with the regional anaesthetic (if used) will act to make you feel more comfortable in the immediate few hours following your surgery. The local anaesthetic will, however, wear off several hours following the surgery. It is therefore important to keep on top of your pain killers following the surgery so that you have a good baseline level of pain relief for when the local anaesthetic wares off.

Mr Griffiths has a specialist interest in enhanced recovery with the aim of early mobilisation, typically within hours following your surgery, in order to optimise your pain and overall function while reducing your overall risks of complications. As such, unless otherwise stated, you will be mobilised, fully weight-bearing with crutches for confidence, either the same day or the next morning following your surgery.

Following Discharge

Upon discharge you will be mobilising with crutches and, unless stated, you can come off the crutches when confident. The physiotherapist teams will also guide you on this. You can drive when you can perform an emergency stop, and most people return to driving within 4-6 weeks following their surgery. Although the pain relating to the diseased joint disappears very quickly it can often take a period of time to get over the knee replacement surgery. The first 6 weeks involves intensive physiotherapy to strengthen the muscles around the joint whilst maintaining the range of motion.

The rehabilitation and physiotherapy is typically a little more challenging with knee replacement surgery compared to hip replacement surgery. Intra operatively the soft tissues will be balanced to allow the knee to fully flex and extend and it is very important to work hard to keep the knee achieving full flexion and extension following the surgery otherwise the tissues can scar back up and the knee replacement can become stiff. The more you put into the knee replacement rehabilitation the more you’ll get out in the long term.

Although most people are back to their normal day to day activities around the 3 month mark it can take 6-12 months to fully recover from a total knee replacement.

If your aim is to get back to social sports, typically patients return to sports around the 3 – 6 months with a phased approach, though this can be discussed at the time of your follow up appointment.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

The Process of a Total Knee Replacement and What to Expect

Pre operatively

Prior to your surgery Mr Griffiths will meet with you at a consent appointment to discuss with you the risks of the surgery and the rehabilitation back to your normal activities. You will also have a separate pre assessment appointment whereby you are reviewed by the pre assessment teams to ensure you are fit for surgery. They will go through your medications with you and tell you what to stop and when to stop them.

It is very important to stay as fit and healthy as possible to speed up your recovery post operatively. Regular exercise preoperatively is important to strengthen your muscles and improve your overall cardiovascular health. Painkillers can be helpful to allow you to mobilise if pain is an issue.

It is important to prevent any cuts or grazes before your surgery as they could pose an increased risk of infection and could lead to a delay in your surgery.

On the day of surgery

Typically you will be asked not have any food for a minimum of 6 hours before your surgery.

Typically, you can continue to drink water up until your surgery.

You will be reviewed by Mr Griffiths and the anaesthetist before your surgery.

The surgery is usually undertaken either under spinal or general anaesthetic and this can be discussed with the anaesthetist prior to the surgery.

The surgery typically takes about an hour, but you’ll spend some time in recovery before going back to the ward. There will be a torniquet applied to your thigh in theatre though typically Mr Griffiths only inflates this while implanting the actual prosthesis. This reduces your post operative thigh pain and facilitates an enhanced recovery and early mobilisation. The torniquet will be removed before you leave theatre.

During the procedure, Mr Griffiths will ‘block’ the knee with a local anaesthetic block and this, along with the regional anaesthetic (if used) will act to make you feel more comfortable in the immediate few hours following your surgery. The local anaesthetic will, however, wear off several hours following the surgery. It is therefore important to keep on top of your pain killers following the surgery so that you have a good baseline level of pain relief for when the local anaesthetic wares off.

Mr Griffiths has a specialist interest in enhanced recovery with the aim of early mobilisation, typically within hours following your surgery, in order to optimise your pain and overall function while reducing your overall risks of complications. As such, unless otherwise stated, you will be mobilised, fully weight-bearing with crutches for confidence, either the same day or the next morning following your surgery.

Following Discharge

Upon discharge you will be mobilising with crutches and, unless stated, you can come off the crutches when confident. The physiotherapist teams will also guide you on this. You can drive when you can perform an emergency stop, and most people return to driving within 4-6 weeks following their surgery. Although the pain relating to the diseased joint disappears very quickly it can often take a period of time to get over the knee replacement surgery. The first 6 weeks involves intensive physiotherapy to strengthen the muscles around the joint whilst maintaining the range of motion.

The rehabilitation and physiotherapy is typically a little more challenging with knee replacement surgery compared to hip replacement surgery. Intra operatively the soft tissues will be balanced to allow the knee to fully flex and extend and it is very important to work hard to keep the knee achieving full flexion and extension following the surgery otherwise the tissues can scar back up and the knee replacement can become stiff. The more you put into the knee replacement rehabilitation the more you’ll get out in the long term.

Although most people are back to their normal day to day activities around the 3 month mark it can take 6-12 months to fully recover from a total knee replacement.

If your aim is to get back to social sports, typically patients return to sports around the 3 – 6 months with a phased approach, though this can be discussed at the time of your follow up appointment.

You will be followed up closely by Mr Griffiths and a member of the rehab team to ensure your expectations are met and your outcomes are fully optimised.

Risks

  1. Bleeding – you may require a blood transfusion, although this is very rare.
  2. Damage to blood vessels.
  3. Infection – the risk of infection is extremely low. (<0.5%) You will have antibiotics at the time of surgery to help prevent against this. Early mobilisation is important to help reduce infection risk.
  4. Wound problems.
  5. Nerve injury. The risk of nerve injury is very low. It can cause weakness and numbness in the leg which would usually resolve but in rare circumstances can be long lasting.
  6. Pain and stiffness – early mobilisation is important to improve pain and stiffness.  If the range of motion is not optimum at 3 months, occasionally patients require a manipulation under anaesthetic, though the risk of this is low.
  7. Malalignment of the implant.
  8. Malrotation of the implant.
  9. Fracture.
  10. Loosening of the implant.
  11. Failure of the implant.
  12. Revision surgery.
  13. Deep vein thrombosis / Pulmonary embolism – you will be risk assessed for your blood clot risk and will receive blood thinners (anticoagulation) after your knee replacement. The type of blood thinner will depend on your individual risk factors, and this will be discussed at the time of your consent appointment.
  14. Anaesthetic complications – The anaesthetist will review you on the day of your surgery and discuss the anaesthetic options and risks of the anaesthetic with you at that stage.

Other Knee Treatments