What’s new in knee replacements?

A number of our patients have recently told us how much better their most recent joint replacement has been since their contra lateral joint replacement completed a few years previously. So we thought we would ask an expert in joint replacements why this may be. So Mr Veysi – a very well respected hip and knee surgeon based in Leeds kindly shed some light on the matter for us.

Introduction

Knee replacements have been successfully used to treat arthritis of the knee since the 1970’s. Since then, there have been many developments that have resulted in knee replacements lasting longer and performing better, and currently there are over 100,000 implanted in the United Kingdom every year.

Over 85% of patients who have a knee replacement report that the result of their operation was excellent, very good or good. Interestingly, over 90% also report that they feel generally better after a knee replacement. Further improvements in such good results require advancements in all aspects of the procedure and these are considered below.

Before surgery

It is undoubtedly the case that preparation for surgery has a very large influence on the overall outcome of knee replacements. Weight loss will reduce the likelihood of complications and make post-operative rehabilitation easier. Remaining active and doing extra exercises under the supervision of a physiotherapist will improve the condition of the muscles and make recovery quicker and the overall outcome more certain.

Anaesthetic techniques

The majority of patients have their knee replacement under a spinal anaesthetic. This technique is very safe and has many benefits for patients. There is less post-operative pain and reduced reliance on morphine-based pain killers following surgery. This not only allows early mobilisation but also reduces risks of bleeding and developing dangerous blood clots in legs (Deep Vein Thrombosis) and lungs (Pulmonary Embolus)

The procedure

There have been some significant recent developments in how knee replacements are performed as well as the design of the prosthesis used.

There is increasing recognition that the characteristics of a person’s knee is individual to them and that knee replacement results can be significantly improved by taking this into account during surgery. So called “Kinematic Alignment” allows the surgeon to place the knee replacement implants such that the patient’s muscles and ligaments work in the best possible way. This should speed up recovery, and improve short and long term outcomes.

Implants have also evolved to meet the needs of modern-day patients who demand not only simple pain relief and long-lasting implants, but also better function and ability to partake in leisure activities. Changes in the polyethylene (plastic) have meant that wear and therefore loosening have become very rare. Components have been developed which allow better range of motion. A greater range of sizes has made the implants more appropriate for a given patient. Furthermore, there are knee replacement designs which allow more personalisation of the implants used. Robotic assisted surgery is the latest development in knee surgery which is expected to make further improvements in results. This technique allows more accurate placement of the implants, thus allowing the benefits of the other developments to be better realized.

After surgery

Enhanced recovery is an increasingly important part of recovering from any surgery and is particularly important in knee replacements as it has a big impact on the long-term success of the procedure. Most patients are able to stand and walk a short distance on the day of their surgery. Such early and appropriate mobilisation is important in achieving the best results following knee replacements.

Conclusion

There are numerous multi-faceted reasons why patients may report that their knee replacement feels better and the rehabilitation feels easier than a previous joint replacement years previously. We’ll continue to keep abreast of developments to keep you informed as any new developments take place.

If you have an issue that doesn’t seem to be settling then you can simply fill in our free online form and let us clinically review whether we feel you may need an assessment from an expert clinician like Mr Veysi.