Mr Simon Ellis, Consultant Orthopaedic Knee Surgeon at One Ashford Hospital provides insight into knee arthritis and when to consider knee replacement surgery.
Suffering from knee arthritis can be an extremely limiting condition. In general, symptoms include gradually increasing knee pain and gradually deteriorating function. In the early stages, it is often possible to control symptoms using regular exercises particularly, those avoiding heavy weight bearing. Keeping the knee moving is important to promote longevity of your own joint. The ideal exercises are those involving the lowest weight going through the joint. These include exercise in water, particularly front and back crawl leg exercises, a cross trainer or an exercise bike. Simple supplements such as Glucosamine with Chondroitin or turmeric with black pepper tablets have been associated with an improvement in symptoms. The next stage tends to involve simple painkillers such as regular paracetamol or anti-inflammatories to control the symptoms. When these are no longer effective, injection treatments can give quite surprising long-term symptomatic relief. Sadly once the joint surface is damaged by arthritis the symptoms tend to increase further with time and for some patients eventually joint replacement is needed.
The idea of going forward with joint replacement is always very daunting. Overall up to 90% of patients are pleased with the outcome, however looking at the national statistics, 1% of patients will develop an infection which requires treatment with antibiotics and can require further surgery. Up to 5% of patients feel that the outcome has left them with significant ongoing symptoms. It is important to ensure that when talking to your surgeon, all the risks and benefits for you personally have been discussed and that you are given the opportunity to ask any pertinent questions and have the chance to ensure that your concerns are heard.
On the day of surgery it is important to keep as well hydrated as possible and as a result we encourage drinking as much water only up to 2 hours before your surgery. When you see the anaesthetist, you will have the chance to talk about the type of anaesthetic used but for most patients the safest way is to have a spinal anaesthetic which makes the legs numb. This is advantageous as it gives excellent post-operative pain control and certainly promotes early mobilisation which is known to reduce the risk of complication. One of the most difficult parts of knee replacement following surgery is to keep the pain under control. It is always better to take painkillers earlier rather than waiting for the pain to kick in. Certainly in the first 6 weeks following your surgery, the majority of patients require very regular painkillers. Keeping out of pain allows the knee to move better and also accelerates recovery. Routinely post-operative physiotherapy is required and it is very important to practice the exercises given. One of the potential complications is venous thromboembolism and because of this the Nice guidelines recommend that you have prophylaxis against this for 2 weeks.
It does take up to a year for your knee replacement to reach an endpoint in recovery, however in terms of milestones, most patients are able to walk unaided by the 6 week post operative stage and return to driving. The most rapid recovery occurs during that 6 week period. Returning to work is usually possible between 6 weeks and 3 months depending on the nature of your job. It is important to discuss your expectations with your surgeon before going forward.
Finally, having made the decision to go forward with knee replacement surgery based on the level of your symptoms versus the risks associated with surgery, engaging fully in rehabilitation and ensuring that you keep on top of the pain should give you the best possible chance of achieving a good or excellent outcome at the end of the day.
Mr Simon Ellis, Consultant Orthopaedic Knee Surgeon
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