Knee

Total and Partial Knee Replacement

Revision Total Knee Replacement

A total or partial knee replacement is replacement of an arthritic tibia, femur and patella at the knee joint with an artificial joint. The artificial joint consists of polyethylene between metal surfaces. A knee replacement is most commonly done for severe osteoarthritis of the knee.

Knee replacement technology has evolved significantly over the years and your surgery may involve the use of newer technologies such as robotics.

A knee replacement can be total or partial. Total knee replacement involves replacing both the femur and tibia and patella (not always) while a partial knee replacement involves replacing only the arthritic side of the knee joint. During the consultation we can discuss whether a total or partial knee replacement is more suitable for you.

A knee replacement is generally a very successful and life changing operation but as with any major surgery there are risks with surgery and anaesthetic. Below is a list of some of the more serious but rarer risks with knee replacement and I can discuss this further with you at the time of consultation.

Total or Partial Knee Replacement

1. Infection

An infection of the knee replacement can be a serious and challenging problem to solve. A superficial infection not involving the knee replacement can usually be cured with surgery and antibiotics. A deep infection involving the knee replacement will likely require removal and revision of the knee replacement. This is a rare complication.

2. Stiffness/Laxity

After surgery a knee replacement can be stiff or loose (lax) and this may require further surgery or therapy. This a rare complication.

3. Fracture

A fracture can occur in surgery or any time after if there is significant trauma to the leg. If a fracture occurs it may need fixation with a metal plate and screws or revision of the knee replacement. This is a rare complication.

4. Loosening

A knee replacement can become loose over time for multiple reasons. We would expect your knee replacement to last 20-30 years before it became loose. If it becomes loose and is causing you pain or interfering with your function it may need to be revised.

5. Blood clots

Due to surgery your body forms clots and this may lead to clot formation in the veins of your leg (DVT - deep vein thrombosis). This may cause swelling, pain or cramping of the calf of your leg. This is an uncommon complication. Rarely, a clot in the veins of your leg can dislodge and travel to your lungs (pulmonary embolism). This is a very rare but serious complication and requires immediate treatment. We try to reduce the risk of DVT with mechanical devices and medications.

The anterior cruciate ligament is important for knee stability especially for any pivoting activity or sport. An ACL Reconstruction is an operation that involves using a tendon from around the knee to reconstruct the torn ACL. These tendons may include your hamstring, patella or quadriceps tendon. In rare instances it may be required to use a tendon that has been donated by a deceased person (allograft). We will discuss different options during the consultation.

During an ACL reconstruction we may need to repair meniscal tears and we may need to add further stability to the knee by performing a lateral extra-articular tenodesis.

It is extremely important to follow the rehabilitation protocol to ensure the best possible outcome possible.

ACL Reconstruction and Meniscal Surgery

The patella can dislocate after trauma or injury to the knee. When it dislocates certain structures such as ligaments tear and may lead to further dislocations. This may be exacerbated by underlying anatomic or soft tissue factors. The first line of treatment generally is physiotherapy unless there is a significant injury including any fractures.

If you have recurrent patella dislocations then patella stabilisation surgery can be performed and this may include repair or reconstruction of ligaments, re-aligning the limb or moving certain bony structures to improve the tracking of the patella.

Patella Stabilisation

A mal-aligned leg may overload a certain part of the knee and lead to the development of arthritis. For certain patients it may be beneficial to re-align the limb to a more neutral position to distribute the load more evenly in the joint and delay the progression of arthritis. This involves cutting the bone and moving to a more favourable position with fixation with a metal plate and screws.

Some patients may be better off with a partial knee replacement. We will discuss all the options in the consultation.