Total Knee replacement

Right, so you're coming in to have your knee replacement today. I just want to talk to you a bit about what it's like. It's a procedure to get rid of the pain, the arthritis, the wear and tear that's in your knee joint. We do that by cutting down the front of the knee. The incision is right down the middle, about that long. We go down and find the ends of the bones that are worn out and we shave the ends of the bones off and we replace it with metal. In between the two metal ends you've got a layer of plastic so you don't have the worry of metal rubbing against metal. The idea of doing it is to get rid of the pain and hopefully it will be able to get you to walk again. One thing to say is that some people when before the operation they find the leg doesn't go completely straight and can't bend as well as the other side and I'm afraid most of the time we can't improve on that but we hope to at least get your pain much improved. In the UK at the moment, if 100 people take the knee operation, 75 of them, so 75% of people would generally have a really good outcome and they're glad they've done it, but I have to say there's about 25% of people, so 25 out of 100 who have a poor outcome or at least no difference. The procedure itself will take about an hour to an hour and a half to do and you won't feel any pain for any of it. The option would be either a general anaesthetic where you're completely knocked out asleep or the anaesthetic doctor will put an injection in your back and then your legs will be numb. So either way you don't feel any pain. If you're slightly awake for it when you're not feeling any pain, you'll be hearing a lot of banging and a lot of chiseling and that's completely normal. You won't feel pain but you may still feel pressure. So you could feel us pulling and tugging on your leg and again that's completely normal so don't worry about that. When we do the operation, we put a tourniquet, so it's like a blood pressure cuff, around the top of your thigh to reduce the bleeding, and so you may feel a bit of tightness for the whole operation, and also at the end of the procedure, you may notice you've got some redness around the top of the thigh. So don't worry about that, just go like normal, and it will fade into the eyes. The recovery from the operation is usually about four days. We'd like to get you out of bed from the next day straight away. What keeps you in hospital is learning how to walk again and getting your confidence back. Most of the time when patients are discharged from the physiotherapy team because they're able to walk and they can do stairs, then you go home. We see you back in the clinic in about six weeks' time just to check that everything's absolutely fine. In terms of the things you need to know before you sign your consent form, the risks of the procedure, as with any operation anywhere in the body, the generic risks are bleeding, infection and damage to the surrounding structures of blood vessels, nerves, tendons and ligaments. For the knee operation, because there's not much give in the tissues, everybody's got quite a skinny knee, but one thing we worry about is the wound infection. Now from your perspective we'd ask you not to soak your leg in a pool or in a bath for the first two weeks and to keep it up, keep your leg up as much as you can to allow for the swelling to go down. We'll be giving you antibiotics at the beginning of the operation and at the end to try and prevent the infection. And like I mentioned, occasionally people don't find that the range of movement is any better. I'm afraid most of the time we can't do much about that, but hopefully the pain will be better. Other minor things to note is that there is a very small chance that if you knock your knee afterwards, the knee could come out of joint. It could dislocate and that may require further procedure or even another operation to put it back. In the middle of the procedure, there is a lot of banging and drilling and chiseling. You can feel some of this and occasionally we can create breaks or fractures in either your femur or your shin bone. If that happens, and it is very rare, but if it does happen and we need to do something about it, then we'll go ahead and fix it and tell you about it afterwards because that's the quickest and safest thing to do. After the operation, the next day you'll have a blood test to make sure that we haven't made you anemic, and an x-ray of your knee, and that's just for our record purposes. Everybody has its routine procedure. After the procedure, when you go home, we ask you to walk on it as much as you can, not needing crutches or wheelchairs or anything, but we do ask you not to drive for the first six weeks. We'll be seeing you in the clinic first at six weeks, and then usually for the first few years with x-rays periodically to make sure that everything's going in the right direction.