Deciding whether or not to go ahead with knee replacement surgery is no small matter. Like surgery of any kind, it is an operation that carries certain risks and so should only be performed on patients who absolutely require it. With that the knee team at Wimbledon Clinics, have come up with seven essential questions that you should ask your knee specialist when you sit down with them for your knee replacement consultation.
1) What are the alternatives to having a knee replacement?
Before concluding that you should have replacement knee surgery, your knee specialist should discuss with you the non-operative options, such as medication, physiotherapy, injections, supplements and inserts to go in footwear. While these options are unlikely to be as effective as surgery, they need to be discussed regardless, given the serious nature of the osteotomy procedure. Osteotomy is an operation that changes the angle of the leg: the leg bone is reset at an angle that takes the weight off the sore part of the knee. Osteotomy is especially useful in younger people.
2) Is the knee your area of expertise?
Forgive us for stating the obvious, but a knee specialist will concentrate primarily on the knee. However, not all knee replacements are carried out by knee specialists – some surgeons do a bit of everything, and don’t specialise in any particular area. Then there are those surgeons who concentrate on just hip and knee replacement, sometimes called arthroplasty surgeons. Arthroplasty surgeons may be well practiced in performing replacement knee surgery, but may have less experience in some of the other surgical options for dealing with an arthritic knee. For instance, they may do little, or no, arthroscopy – or not offer osteotomy or partial knee replacement.
3) Can you describe what will happen to me both during the operation and afterwards during the recovery?
Having major surgery is a daunting prospect for anyone and should not be taken lightly. It is crucial that you prepare yourself as best as possible, which will help to control any anxiety you may have about the knee pain treatment. While you may not want to know about all the gory details of exactly what is done at the surgery, it can be useful to know what to expect in terms of pain, recovery time, and so on. Having an idea of how long you’ll have to use crutches for afterwards, when you can drive or even return to golf will help you plan the project and give friends and family the opportunity to put the relevant logistics in place and ensure that you will manage well post-op.
4) What are the risks of having my knee replaced?
There is an element of risk attached to all surgery. It is the duty of your surgeon to make you aware of the risks associated with having replacement knee surgery, as well as the positive potential outcomes. Things you should be informed of include: how many patients still have pain in spite of surgery; the chances of the procedure failing to do its job; the risks of heart problems, having a stroke/blood clot; the risks of not surviving the surgery. Of course you don’t want to dwell on the potential complications, but it is impossible to know whether you’re making the right decision without knowing at least something of the risks.
5) What kind of anaesthetic will I have?
Many knee replacements are carried out under epidural anaesthetic, but the thought of having an epidural often worries people. In our experience, the idea of having something injected the back is not what fazes people, but the fear that they will be expected to remain awake during surgery. While you can remain awake during surgery under epidural, 99% of our patients choose to have sedation. Epidurals are administered because they give extremely good post-operative pain relief and reduce the risk of clots in the leg. Again, being forewarned about knowing what to expect from the anaesthetic will reduce your nerves.
6) Is my knee bad enough to justify having a knee replacement?
To determine whether their swollen knee justifies knee replacement surgery, patients often ask if we would recommend the procedure to a relative in their position. This question usually comes from people who have come to me for a second opinion, having been advised to have a knee replacement when it seems that it might be a little bit early. They are right to make sure that their knee has deteriorated enough to require surgery. The results of a knee replacement – when the knee isn’t painful enough – tend not to be as good. There are some orthopaedic scores that can be done to help determine whether a knee is bad enough to require surgery, which often prove very helpful in reassuring people that they are making the correct decision and not just ‘making a fuss’.
7) What will happen if I leave it for longer and don’t have it done?
When your knee reaches a point where it is painful enough to justify surgery, there is a period of time that follows when the knee will become increasingly painful. Going beyond that point is detrimental because of continued loss of strength and balance. However, the knee will not just deteriorate overnight to the extent that it is in desperate need of surgery. In some cases, a knee can be left untreated for a year or more without it being harmful. So the operation is not urgent at the moment you reach the point that the knee has become painful enough to justify surgery. This is helpful in the sense that it gives you some time to prepare both mentally and physically for the procedure. You might be required to lose weight and become stronger through preoperative strengthening exercises, which are known to make things a bit easier post-operatively.
Free phone consultation
If you think you may need a knee replacement or have a knee injury – call Wimbledon Clinics for advice and specialist treatment.
We’ll take a look at your injury, make a specialist assessment and put together a clear strategy for your treatment and recovery. Our goal is to help you to get back to your best as soon as possible.
For a free phone consultation or to book an appointment, call Wimbledon Clinics now on 020 8629 1889 or visit www.wimbledonclinics.co.uk