Surgery for Knee Osteoarthritis
Understanding risks, benefits and types of surgery for knee osteoarthritis
Surgery is suitable for ‘few‘ people with knee osteoarthritis. It is considered a last resort so it sits on top of the treatment pyramid.
Surgery may be beneficial if you have extensively tried the other types of treatment in order first.
There are different types of surgical approaches that are currently used to treat knee osteoarthritis.
It’s really important to note that even if you receive surgery, you need to continue with your core (and potentially second-line) treatments such as exercise, education and weight management.
Listen to Orthopaedic Consultant, Mr Finbarr Condon talk to a patient about the suitability of a knee replacement surgery.
How do I know if I need surgery for osteoarthritis?
There is no standard answer to this question. The decision to have surgery is one that needs much thought and discussion between yourself and your surgeon. If you have not tried the core recommended treatments (bottom of the pyramid) yet then this is where you should start your journey. You may also want to consider others (e.g. spouse or friends and family) in your decision.
This tool is an online decision-making tool from the U.K. National Joint Registry that provides the benefits and risks of surgery based upon you. The questions asked may help you facilitate a discussion and decision with your surgeon.
Some of these considerations may include:
The severity of your pain
How your symptoms are impacting on your daily life
How your symptoms are impacting on your sleep
To what extent you have tried other treatments
Any risks associated with other health conditions
How prepared you are for the recovery period
Is it possible to avoid surgery for osteoarthritis?
It is possible to avoid surgery by following the core recommended treatment options. Many people believe that all people with osteoarthritis will eventually need surgery or a total joint replacement, but this is a myth!
About half of people with a diagnosis of knee osteoarthritis end up getting a total knee replacement in their lifetime. Which means that half of people never have surgery and can manage their osteoarthritis without it.
It is certainly possible to avoid or at least delay the need for surgery with this condition.
What are the surgical options available for osteoarthritis?
There are a few surgical options to consider for someone with knee osteoarthritis:
- A total joint replacement (also known as arthroplasty) is the most common surgery for people with knee osteoarthritis. In this surgery, they replace the surfaces of the thigh bone (femur) and the shin bone (tibia). They are replaced by new joint surfaces made from metal and plastic.
- A partial knee replacement is where just half of the knee joint is replaced if the osteoarthritis disease is just on one side.
- A tibial osteotomy is a procedure to straighten a deformity of the knee. Usually this involves removing part of the shin bone (tibia), just underneath the joint surface.
Want to know more about what to expect if you are thinking about surgery?
Before surgery and during surgery
Your surgery will work better if you can be active, stop smoking (if you smoke) and are a healthy weight before surgery. During surgery, you will usually have a general anaesthetic. The surgeon makes a cut on your knee, takes out the damaged joint and fits a new one. Surgery takes between 1 – 3 hours. You will be in hospital between 1 – 5 days.
You will be given blood thinning medicine to stop you getting a blood clot in the leg or lung. You will see a physiotherapist who will give you exercises to do when you get home. These are vital to your recovery.
Recovery from joint replacement surgery
How quickly you recover depends on your age, general health and fitness, and how well you stick to the recommended exercises and guidance after surgery. You should be able to stop using crutches or a frame about 6 weeks after surgery.
It may take up to 3 months for pain and swelling to settle down. For some people recovery can take many months, and some may need further support from a physiotherapist.
Driving – most people can drive again after about 6 weeks if they feel safe to do so.
Return to work – it depends on the kind of work you do. You can usually do office work after 6 weeks, but for a more physical job it will be longer.
Replacement joints don’t last forever. It is a very difficult surgery to redo a replacement joint (have a joint replaced for a second time). This is why your consultant will wait for your osteoarthritis to be severe before they offer a first replacement.
DID YOU KNOW?
Keyhole surgery (arthroscopy) is not an effective treatment option for people with knee osteoarthritis. It was a very common procedure in the past but we now know that arthroscopy is no more effective than a placebo (fake surgery) in multiple studies of people with knee pain. It is now only recommended if people have a mechanical blocking of the knee.
What are the expected outcomes after surgery for osteoarthritis?
Although most people benefit from this procedure, not all do. Approximately 1 in 5 people (20%) are dissatisfied with their outcomes after a knee replacement. Research is still investigating why this is the case. It is important to have thoroughly researched the risks and benefits before deciding whether you want to undergo surgery.
Have a look at this tool again, which is an online decision-making tool from the UK. It provides you with the benefits and risks of surgery based upon you. The overall flow and questions asked might help inform your decision and facilitate a discussion with your surgeon.
What are the risks of surgery for osteoarthritis?
Total joint replacement is a major surgery that cannot be undone and, as with all types of surgery, it has side effects. Therefore, it seems wise to have fully explored and tried all other treatment options first.
Serious adverse events include blood clots or deep vein thrombosis, infection in the wound or joint, damage to nerves or tissue and death. Other complications include stiffness, urinary tract infection, bleeding, implant problems and complications from anaesthesia. About 6% will experience a serious adverse event and about 5% will be re-admitted to hospital within 30 days so these risks should be considered carefully.
Listen to Orthopaedic Consultant, Mr Finbarr Condon talk to a patient about potential complications of a knee replacement surgery.
Are exercise and other treatments needed after surgery?
YES!!!
It is essential that you undergo extensive rehabilitation after your knee surgery. This should be discussed in-depth with your physiotherapist or surgeon when deciding whether surgery is right for you.
What questions should I ask my orthopaedic surgeon/ consultant about my osteoarthritis?
If you have an appointment with an orthopaedic consultant, it can be helpful to be ready with some questions to get the most out of your appointment. Some examples are:
What are the benefits and the risks associated with surgery?
You may also wish to discuss the risks and benefits of prolonging a surgery or not getting the surgery.
What are the alternatives to surgery?
Have all other non-invasive or less invasive alternatives been adequately trialled?
Is it inevitable that I will eventually need surgery or is there anything I can do to prevent it?
How likely am I to have a complication from surgery?
If you have other factors or conditions that may increase surgical complications (for example older age, obesity or cardiac conditions), this should be included in the discussion.
If I undergo surgery, how long will the replacement last?
This also depends on individual factors and the materials used in the replacement.
How long will the recovery last?
How long will I be in hospital? What type of rehabilitation will I need to do and how will I be supported? When will I be able to drive? When will I be able to return to work / caring duties / activities and hobbies? What measures will need to be put in place at home so I can recover well.
How much improvement should I expect after surgery?
The consultant should be able to set your expectations for post-surgery. You should have an idea as to initial post-surgical pain and how much you will be able to do once you fully recover.
Listen to Orthopaedic Consultant, Mr Finbarr Condon talk about what to expect in the days and weeks after a knee replacement surgery.
Lived Experience of Decisions about Surgery for Knee Osteoarthritis
Listen to Matthew speak about his decision not to opt for surgery.
Go to the Tools & Resources section for more help on your journey where you can:
- Visit the Exercise Library,
- Find programmes on offer in your community
- Find a healthcare professional
- Find printable resources
- Or learn about another joint condition.