Knee replacement surgery: getting it right first time

Knee replacement surgery is an excellent treatment option for individuals with severe knee pain and disability caused by degenerative joint conditions such as osteoarthritis.

Compare my Care spoke to Sam Rajaratnam, one of the leading knee replacement surgeons in the UK, about how one could improve the chances of achieving the best outcome from this surgery.

1. Choose your hospital and surgeon carefully

Generally, practice makes perfect. The more knee replacements your surgeon performs each year, the more experienced your surgeon and his team are. Moreover, if your knee replacement is performed in a dedicated hospital or unit specialising in orthopaedics, the more consistent the results they will generally achieve.

The National Joint Registry gives you an indication of how many knee replacements your surgeon has performed in the last year and in the last three years - and will act as a guide for their level of expertise.

Mr Rajaratnam performs over 450 knee replacements a year, putting him in the top 1% of surgeons in the UK.

2. Make sure you get an accurate diagnosis

Knee pain and deformity is variable and your symptoms may change from day to day and week to week. Depending on the pattern of osteoarthritis, the pain, deformity and loss of function will vary.

It is exceedingly important to diagnose where your knee pain is coming from. The knee pain can emanate from the worn articular surface, from degenerate meniscal tissue, debris in the joint, instability within a wearing knee, and very commonly from a leaking Baker’s cyst, which often gives you pain at the back of your knee.

The Baker’s cyst is often caused by excess synovial fluid caused by degeneration within the structure of your knee, so it is often treated as part of addressing the main issue.

3. Choose carefully between a partial and a complete knee replacement

The knee joint has three distinct compartments. The medial joint, the lateral joint, and the patellofemoral joint.

A careful history, thorough examination, X-rays and MRI scans will accurately be able to reveal whether your disease affects one, two, or all three compartments of the knee.

As a general principle, if only one compartment is affected (and the other two compartments are extremely well-preserved), a partial knee replacement - otherwise known as a uni-compartmental replacement -may well be suitable for you.

However, if more than one compartment is affected, you may be better off with a complete knee replacement.

Modern joint replacements are really a replacement of the surface of the knee, so are probably better described as a 'knee resurfacing'.

As a general principle, the best chance of getting a good outcome is to “get the decision and the technical aspects right the first time”.

4. Optimise your rehabilitation before and after surgery

Rehabilitation is exceedingly important to achieve an optimal outcome following knee replacement surgery.

Before you have surgery, an experienced physiotherapist will work on your pre-surgical knee deformity, improving the range of motion and the muscle function in the knee. This is called prehabilitation.

After surgery and discharge from hospital, it is extremely important to work closely with an expert physiotherapist. They will ensure that your knee moves well, you achieve early flexibility in the joint, and protect the healing tissues. Achieving a supple movement in the knee, whilst letting tissues settle and heal is key to achieving a fast functional recovery.

Strengthening of the muscles can be helpful so that a patient feels confident walking and climbing stairs after knee replacement, it is important not to overdo muscle strengthening exercises in the early phase of knee replacement recovery as this can increase pain in the healing tissue around the knee.

To find a great physiotherapist you can speak to Compare my Care on 020 8064 0875

Ultimately, your surgeon will guide you and help optimise your ideal “rapid recovery” programme.

5. Ask your surgeon about their failure and complication rates

Each surgeon and hospital in the United Kingdom will have their own specific outcomes recorded in the National Joint Registry (NJR).

Whilst this is not publicly visible, the NJR carries a wealth of information about failure or revision rates and normally covers your surgeon’s entire practice. Moreover, the NJR also collects Patient Reported Outcome measures (PROMS) specific to your surgeons practice.

You must feel free to openly discuss success rates, complication rates, failure rates and discuss all the possible complications that could occur during your episode of care.

Most leading surgeons welcome this approach of sharing information with patients so that one is fully informed prior to embarking on the surgical journey.

Most leading surgeons welcome this approach of sharing their information with patients.

6. Be patient during your recovery

Everyone has a knee story. You will have friends, family and acquaintances who have had unique experiences of knee surgery. Some will have recovered fast and others, more slowly.

Many hospitals claim to have a rapid recovery program in place but there is often a considerable variation in organisation and expertise.

Whilst most patients should be able to walk within a few hours of their knee replacement, and go up and down stairs independently within a day or two, the time it takes to return to normal function and activity can vary.

Most people are able to drive as soon as they can perform an emergency stop within two to three weeks.

Permanent recovery with all of the capsular pains settling can take a long time, and although it may take about six weeks to return to reasonably gentle sport, the knee can continue to recover for a whole year after joint replacement surgery.

A word from Compare my Care

Mr Sam Rajaratnam is one of the most respected knee replacement surgeons in the UK. He has performed over 5000 knee replacements and has amongst the lowest revision or failure rates on the National Joint Registry. He is the Director of Orthopaedics at the Schoen Clinic London based in Marylebone and also works at Horder Healthcare in Crowborough, East Sussex.

The team at Compare my Care are here to help you with your knee replacement journey. We can help you choose your surgeon and hospital, and can support you further through our insurance partner AIG’s virtual private GP service.

In the rare event of needing a further hospital admission for an inpatient procedure, our unique Protect my Care insurance package facilitates the refund of self-pay fees which can then go towards further care.

Please call Compare my Care on 020 8064 0875. We are very much here to help and guide you.