Total Knee Replacement

What is Total Knee Replacement?

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with an artificial prosthesis.

Knee Arthritis

The knee is made up of the femur (thighbone), tibia (shinbone) and patella (kneecap). The two menisci, the soft cartilage between the femur and tibia, serve as a cushion and help absorb shock during motion. Arthritis (inflammation of the joints), injury or other diseases of the joint can damage this protective layer, causing extreme pain and difficulty in performing daily activities in an arthritic knee, the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. These factors can cause pain and restrict the range of motion in the joint.

Indications for Total Knee Replacement

Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is a type of arthritis. It is the most common form of knee arthritis in which the joint cartilage gradually wears away, and often affects the elderly. Mr Sakis Pollalis may advise total knee replacement if you have:

• Severe knee pain that limits your daily activities (such as walking, getting up from a chair or climbing stairs).
• Moderate-to-severe pain that occurs during rest or awakens you at night.
• Chronic knee inflammation and swelling that is not relieved with rest or medications.
• Failure to obtain pain relief from medications, injections, physical therapy or other conservative treatments.
• A bow-legged knee deformity.

Total Knee Replacement Procedure

The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.

• The surgery typically lasts about 1 hour. It is performed under regional (spinal) or general anaesthesia using a tailored RAPID RECOVERY PROTOCOLS to ensure you are comfortable and pain-free during the procedure.

• Mr Sakis Pollalis will make an incision in the skin over the affected knee to expose the knee joint. Then, the damaged portions of the femur bone are cut at appropriate angles using specialized jigs.
• Mr Pollalis then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached.
• Next, your knee is tested with trial implants to check the alignment, soft tissue balancing, and range of movement. After that, the final femoral and tibial components are attached to the end of the bone with bone cement. 
• Mr Pollalis will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia like the original meniscus cartilage. 
• To make sure the patella (kneecap) glides smoothly over the new artificial knee, its rear surface can sometimes be prepared to receive a plastic component if required. 
• With all the new components in place, the knee joint is tested again through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed with absorbable sutures and a sterile dressing is placed over the incision. Drains are generally avoided to enable early mobilisation and discharge.

Postoperative Care Following Total Knee Replacement

Rehabilitation begins immediately following the surgery. Initially, you will be taken to a recovery area where your pain levels will be monitored, and you will be encouraged to begin moving your knee. You will soon be moved to the ward where you will be assisted to get dressed and you will be offered a meal. You will be given pain medications to ease pain. Whilst in hospital you will have to wear stockings to prevent blood clots in your legs. Physical therapists will work with you to take your first steps using a walker or crutches. They will also provide you with a home exercise program to strengthen your thigh and calf muscles. You will have blood tests and an x-ray to check the positioning of the implants. Mr Sakis Pollalis will review you regularly whilst in hospital and after your discharge to make sure you are progressing well.

Risks and Complications of Total Knee Replacement

As with any major surgery, the possible risks and complications associated with total knee replacement surgery include:

• Infection
• Blood clots in the leg or lung
• Knee pain, stiffness, or limited mobility
• Numbness around the wound
• Ligament injuries
• Patella (kneecap) dislocation
• Bone fracture
• Nerve or Blood Vessel Injury
• Bleeding and Hematoma
• Prosthesis Failure or Loosening
• Requirement of additional surgery
• Cardiovascular risks, also leading to life-threatening complications
• Allergic reaction
• Anaesthetic risks

If you would like to have additional information on knee treatments or would like to learn more about total knee replacement, please contact Mr Sakis Pollalis, serving the communities of Buckinghamshire and Berkshire.