What causes knee wear and tear?
The joint surface of the tibia and/or the femur become seriously worn, due to previous trauma or general, age-related deterioration. Some illnesses can cause this to happen prematurely (osteoarthritis, rheumatoid arthritis, gout), as can a lifetime of knee-pounding sports activities.
Feeling a twinge after your early morning jog? R.I.C.E – rest, ice, compression, elevation.
8 surprising remedies to relieve knee pain
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When will I get my knee replaced?
Knee replacement is the last option and will only be offered after non-invasive treatment has been exhausted – physiotherapy, behaviour modification, weight loss, injection (steroids to reduce inflammation or knee lubricant can help, if the joint isn’t too badly damaged).
The key factor is: how much is your knee problem affecting your everyday life. Is it stopping you exercising, seeing friends or disrupting your work? Does the pain regularly wake you up at night?
Most knee-replacement operations are carried out on people aged 60 to 80, but the procedure is becoming increasingly common for younger people. While it’s important to remember that your new knee won’t last forever, you should enjoy 10-15 years of knee happiness… provided you look after it!
Learn more about knee pain
Will I lose the whole knee?
Depending on the state of your knee, you may need a TKR (total knee replacement) or a PKR (partial knee replacement: only half of the knee joint is replaced). With a TKR, you’ll probably be looking at a longer stay in hospital and increased recovery time.
Your new knee will be measured and designed to fit your body so that it lasts as long as possible.
As you’d expect, a knee-replacement operation involves the removal of your old worn-out knee and replacing it with a nice, shiny new knee made of metal (titanium or cobalt-chromium alloy) and plastic (polyethylene).
Implants can also be ceramic or a combination of ceramic and metal. They weight around 15-20 ounces… about three or four decent-sized tomatoes.
The whole thing is held in place by fast-curing bone cement or your surgeon may use a ‘cementless’ implant, where your bone is encouraged to grow into the surface of your new knee.
What are the surgical alternatives to knee replacement?
Depending on how badly damaged your knee is, there may be different solutions, but, long-term, they’re not always as effective.
Arthroscopic washout. With the help of a tiny, fibre-optic telescope and cannula (a tube inserted into the knee), the knee joint is ‘washed out’ with saline solution. This helps remove any loose debris that may be causing pain. Debridement is often performed at the same time, removing any damaged cartilage or bone.
Osteotomy. If a knee joint is damaged, the weight can be unevenly distributed throughout the joint, leading to excessive wear and tear on one side. Osteotomy involves cutting the shin bone, allowing the surgeon to realign it, shifting the weight more towards a part of the knee that isn’t damaged.
Mosaicplasty. In basic terms, you take away some of the damaged bits of your knee joint (bone and hard cartilage) and replace them with some good bits. Tunnels are drilled into the weight-bearing part of the knee and those holes are filled with plugs harvested from the areas that bear less weight, such as the side of the knee.
Steroid injections for knee arthritis
Risk and recovery for knee replacement surgery
Like all operations – there is a risk of infection, failure or poor response. That’s why replacement is the last resort. Having said that, most people respond very well and are pain free.
- Six weeks is the regularly quoted recovery period, but it can take up to three for pain to settle and any swelling to disappear.
- Physiotherapy and hydrotherapy are a must, as are a positive mental attitude and dedication to rehabilitation when at home – don’t rely on your physio to do all the work!
- Check with your physio and/or doctor about when they think it is safe for you to start driving. Obviously, you’ll need to be able to control the car properly without risk of damage to your knee.
- Watch out for those seemingly everyday tasks – vacuuming, bending down to pick up the TV remote, getting in and out of the car – that can easily aggravate a partially healed knee.
- According to the NHS, you may find that having the operation gives your sex life a boost – and you can normally resume bedtime activities six to eight weeks after the operation. Vigorous sex and kneeling positions are to be avoided, however!
- The arthritic pain that patients had before the operation will disappear immediately because the damaged knee is removed. Six to nine months down the line, if everything goes according to plan, the knee should not even be on your mind.
Knee replacement recovery tips
For one woman’s story of having knee-replacement surgery, see the September issue of Saga Magazine.
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