Learn more about the causes, symptoms and treatment options for knee pain with Mr Kumar Reddy.
(Please note that any discounts advertised in this video are exclusive to attendees and registrants of the live event)
Find out more: https://www.benendenhospital.org.uk/treatments-services/orthopaedics/total-knee-replacement-surgery/
good evening everybody and welcome to our webinar from benon hospital just allow a few seconds for you to join it’s excellent to see so many of you signed up tonight okay um a very warm welcome to our webinar this evening from benedon hospital uh tonight we are covering knee replacement surgery my name is Phil I’ll be your host for the session and I’m joined by our expert speaker our associate specialist surgeon Mr Kumar ready for those of you haven’t attended one of these webinars before the format is as follows Mr ready will conduct a presentation which will last around 25 minutes approximately and this will be followed by a question and answer session if you wish to submit a question to Mr ready you can do so during his presentation or following his presentation and you can do so by clicking the Q&A icon which you can find at the bottom of your screen now I should mention that you can do this anonymously or you can give your name uh but please bear in mind that we are recording this session if you do provide your name if you wish to book your consultation following this session we’ll be giving details at the end of the webinar that’s quite enough from me for the time being uh I will hand over to our expert speaker Mr Kum already hi good evening everyone thank you so much for taking your valuable time in joining this webinar uh I hope this webinar would be useful I’m going to talk to you about the knee replacement surgery and its indications um and also the post uh KNE replacement um the effects of knee replacement I hope you’ll enjoy this session and uh Phil thank you so much for the introduction my pleasure uh I’m one of the lower limb orthoplastic surgeons been um doing hip and knee replacements for the last 25 years uh my large NHS practice is at Kenton Canterbury and William har hospital where I do most of uh The Joint Replacements uh including revision total hips and total knee Replacements um we got um quite a team of um big team of Orthopedic Consultants working at benon hospital uh who perform loyal Lim surgery um I’ll be going through with you all with regard to definition of arthritis and its treatment and the surgeries what is going to be required and the types of knee Replacements and the surgical process in brief uh recovery process risk and also talk about the patient [Music] tools uh I’ve been an orthopedic surgeon and I’m currently the site lead at William har hospital and a member of Academy of orthopic Surgeons my clinical interest and surgical interests are mainly uh total hip replacements uh total knee Replacements partial knee Replacements um revision hip and knee Replacements arthroscopy AC reconstruction and menisectomy and meniscal repairs um you’ll all you’ll all be pleased to know that we the benan hospital is a leading provider of for private hip and knee orthoplast surgeries in Kent um with regard to Patient satisfaction rates we got very high satisfaction rate with when compared to other hospitals and trusts and we are also heavily involved in rapid recovery program here is our Orthopedic uh Consultants who are experts in loyal arop surgence uh who are Alex chipperfield William dunet Matthew Oliver Raman takur uh Omani Raj Shasta who just has retired Richard gard and Mark Jones who recently joined our team uh with regard to private KN replacement unit volumes you can see from the slide that the H Center which stands 305 Bon hospital is 225 from last year but this year we’ll be heading towards uh 450 a year next is Kims which was last year 175 there also increase in volume with regard to the replacement surgeries uh nfield temps and as food one so what is osteoarthrosis uh with regard to arthritis it’s a common disease affecting the joints of the body most commonly the knee and the hip uh The Joint surfaces which are smooth over a period of time they would get damaged and gradually the AR cartilage becomes thin and roughened and there’ll be loss of C cartilage as you can see in the slide on areas where the bare bone is exposed this would result in immense pain uh and this was also cause stiffness in the joint um pain on weightbearing and you’ll also find sensation of clicking and grinding sensation in the knee and there will be recurrent swellings and also effusions of the knee and the late symptoms you can see rest pain and also pain that wakes you up at night and you’ll also be noticing some deformity like the bone getting bowed and also sometimes the bone can go to other direction where you can develop a uh valgus knee resulting in a knock knee uh and your walking ability also will be getting reduced because of the pain you can see from the slide the normal knee on the left which shows a good preservation of the joint surface all throughout and you can see on the right side there’s complete obliteration of the joint space with ostop fides all around in the lateral compartment and also you can see the spines becoming quite prominent indicating that this is an arthritic joint with regard to treatment options of knee osteoarthrosis not that we all jump into doing a any replacement surgery in the beginning and everyone has to be sensible and go for the activity modification uh like if one is playing Impact Sports they need to reduce and be aware that uh um mostly impact activities can cause more pain and also one is um overly overweight then it would be reasonable for them to go for weight loss program and get the weight reduced so that one can offload the weight on the joint next is physiotherapy physiotherapy can be very beneficial uh with regard to strengthening of the quadriceps uh and also improve the extensive mechanism uh next is taking by simple painkillers and also taking some paracetamol neuropen or Naproxin and codol all these can help in relieving the pain there are some braces which are offloading braces you can have weight relieving braces for your knees and uh injections also in the early to moderate phase can significantly help in improving the symptoms one is steroid injections the other one are hyaluronic acid injections where we give them in bendon um and also there are um PRP injections that are aailable in the market if all the conservative methods of treatment which have stated just now fail to improve your symptoms then uh if one has got significant symptoms that are evidence on the radiological appearance that he got significant arthritis then it would be reasonable to offer surgical treatment which can be um osteotomies in the form of realignment surgery where we can correct the alignment of the knees by doing a high otomies in genu varum knes that would help in relieving the symptoms as your offloading the medial compartment and transmitting the load evenly uh the other techniques are orthoscopic techniques where if there is an isolated condal defects one can do a micr ing uh of the compartment to encourage the new cartilage to form um and there are also in young patients where one can consider cartilage transplantation where we are not doing here at the moment um it can be done in the tertial ref refal centers like in stanu or UCL and eventually one can consider a knee replacement surgery provided all these failed to give reasonable uh pain relief with regard to knee Replacements uh surgery it is now a common operation approximately 100,000 are performed in a year average age of the patient is between 68 to 17 majority of the patients um 56.5% of female patients and um 95 94 nearly 95% patient report Health Improvement in symptoms 80% of the knee Replacements can lost and their survivorship is between 20 to 25 years and one need to understand do I need a knee replacement surgery if the pain is the limiting factor and if it is significant ly affecting your sleep and quality of life and provided there is radiological evidence of um arthritis in the form of narrowing of the joint space significantly and provided all the conservative methods of treatment like physiotherapy steroid injections um and braces fail to improve the symptoms it would be reasonable for one to be considered for a knee replacement and the common conditions that one can come across is osteoarthrosis romatoid arthritis and postraumatic arthritis where one had fractures of the tibial plateau uh and if there are inar fractures in the long term this may go on for osteoarthrosis um and there are other conditions like like gout uh psorasis also can contribute to arthritis with regard to Aims of knee replacement surgery improve in pain relief um there’ be tremendous amount of pain reduction following a knee replacement surgery uh increase in Mobility restoration of function and U we realignment of the mechanical axis in anger patients it is a high function demands such as work and sports um some of the patients would have gone back to non-impact activities like cycling and swimming and also higher Impact Sports like getting back to football or tennis um it is not advisable as this these are artificial joints and these artificial joints are subjected to wear and tear it would be best avoided any impact activities but most of the patients can return back to golf and other activities what are the types of re knee Replacements that one can offer at Ben so there’s a partial knee replacement which we call it medial uni compartmental or lateral uni compartment with medial uni compartmental you have Oxford uni compartmental need replacement uh which are again is a mobile bearing and whereas zuk unic compartmental knee Replacements or a fixed bearing and uh both are doing extremely well in the National joint registry and the second one is a lateral unicompartmental knee Replacements which I do when uh individuals have got isolated lateral compartment osteoarthrosis um these are mainly done as a fixed bearing needes as mobile bearings will have increased risk of dislocation um if the arthritis is spread to all of the compartments including petal and other compartments then it will be reasonable for one to consider for a total knee replacement you also have got a petal joint replacement where some patients we see have got isolated petal pain mainly when they coming downstairs they struggle to come downstairs and they have difficulty in crouching and kneeling um they have to hold on to banisters and do one step at a time when there is isolated petal arthritis it would be reasonable to offer them petal replacement then with regard to the partial knee I can show you here where you can see see only part of the knee which is the on the medial side have been replaced uh and you can see the on the tibial side you can see a metal back tiia along with the plastic which is moving this is what a partial knees and uh the other compartments are well left alone as you do not see any arthritis in the lateral or petal compartments and with regard to total knee replacement this is how a total knee looks all you need to do is shave the articular surfaces of the arthritic bones at the end of your thigh bone called the femur and then you shape the femur for the knee replacement process and you put the femur in uh which is like a Vanguard knee replacement and also on the ti side again you resurface the the tibia and shave the articular surface off and then put in a TBL component so at the end of the thone you have the metal component which articulates with the plastic so this is how a KNE replacement looks again you have got a cruet retaining where the cruet ligaments are being uh the posterior cruet liament is retained uh when you call it a cruet retaining and if the crusades have gone if there’s an increased posterior slope in the tibia then one one can consider a posterior stabilized total knee replacement um and there is also Replacements that are available um and it’ll be soon available at benenden with regard to robotic KN replacement surgery which AIDS surgeon in performing an replacement with the robotic assistance um it’ll be here and my colleagues are are going to give another webinar with regard to robotic knee replacement surgery um in January uh you’re all welcome to join for this um robotic uh knee replacement surgery uh which is coming soon then you got constraint totaling Replacements and you got revision where we put the stems in to the thigh bone and the shin bone and make it stabilized um and in severe deformities these are useful and also when the ligaments have failed like mainly the medial collateral ligament which is the chief stabilizer if they fail then one can consider a constrained totally replacement you can see the Vanguard knee replacement this is the one that we use at bendon this is um I got good Survivor ship and the AEP rating of the Vanguard KN Replacements is 15a would operating and um it the 10year survivorship is about 97% um these are basically cemented totally replacement and you can resurface the petal if there is arthritis in the pet or they can be done without the pet res serving we again have got cruciate retaining and poster stabilized Vanguard Total knee Replacements so with regard to surgical process what happens during the knee replacement surgery so one have one would have a midline longitudinal incision and the disease joint is been replaced with the your bony cuts and once you have resurfaced the cuts then you can plan your replacement as I’ve just shown you by putting the femal component in into the thigh bone and at the end of the shin bone where it is tibian fibula you can insert the Tiel component into this so this is how the knee Replacements are performed so uh with regard to coming to recovery from a replacement surgery though on my slide it stays two to three days in hospital majority of the patients um are discharged within uh a day or two uh especially the unic compartmental knee Replacements uh they are getting discharged within a day um as the recovery is quicker and the patients prefer to be at home rather than hospital we encourage that um and you’ll have a large protective dressing on the knee uh and pain will be controlled with the regular pain medications and also patients do get uh um in addition to spinal an electric Canal block to help with the pain um and you’ll be soon vised by our physiotherapist team and we’ve got an excellent team of physiotherapists who will uh help you regain your Mobility uh range of motions and function we also have got excellent uh highly skilled uh Team of nursing staff who looks after the impatients on the Ws that provide you all the information that you need and help you regain your Mobility with regard to recovery from knee replacement surgery we only let you leave the hospital once everyone is happy that it is safe for you to do so and you are mobilizing independently with the help of crutch or frame that you’ve been provided with and you’ll be shown how to safely go up and downstairs if you got stairs at home um and after about a week most people can walk independently with sticks we encourage all our patients to take pain clears on a regular basis uh to help with the pain and uh uh there’ll be some bruising around the Staples um if you do not wish to have Staples and we can use dissolvable stitches uh following knee replacement surgery and regular excis are quite important before and after surgery um majority of the patients do complain of some numbness which is not uncommon after knee replacement on the outer aspect of your knee and uh some of them have got some medial pain around the top of the shin bone which is again not uncommon after 6 weeks one can resume driving short distances and you will have your appointment to be seen by the respective Consultants who has performed your surgery at 6ek interval and you any questions or concerns that you may have he will be addressing all those issues at 6 we interval um one would um assume for patients who had need replacement to return to normal activity after 3 months with regard to potential risks that one can anticipate there is um risk of blood transfusion when there is increased blood loss and there can be little fracture one can come across and there can be slight damage to the nerve of the vessel um and the ligament or tendon can be injured at the time of surgery with regard to recovery wound problems infection um which is uh [Music] uh and I’m very pleased to let all of you know that infection rates in this particular Hospital have been time and again proved to be less than the national average um and the other one is a DVT one can develop clots in the veins of your leg uh that can sometimes migrate into the lung and cause a PE that’s why everybody is given blood thinning tablets or injections for a period of 14 days you will also have Cal pumps in the form of flotron till your mobile uh from your inpatient bed another one is stiffness and swelling of the knee which is not uncommon and um one has to do regular exercises to get rid of the stiffness and improve the swelling late um complications which include infection again plant failure with regard to aseptic loosening uh where the poly plastic which is being put in between the components can wear off and there can be delamination of the poly which can contribute to loosening um and which may well require revision surgery if the symptoms are getting worse uh the others are fracture and dislocation which is again very rare uh following KNE Replacements with regard to patients de support tools it’s an ngr surgeon’s uh profile um it is in the public domain any one of you can look into the surgeons how many a surgeon has performed or has performed over the years with regard to the knee Replacements or hip replacement surgery um and there outcomes and the results so if is an outlayer it would highlight in the ngr this is mainly not only to give you enough guidance um and also it will also monitor the surgeons and also the implants uh that we’re putting in nowadays uh if an implant is failing soon it would highlight that these implants are um not very good and they would abandon these implants uh for further use so it is a tool that gives us Guidance with regard to choosing the implants and also with regard to long-term how the surgeons are performing with the regard to their joint replacement surgeries and lastly with regard to knee replacement robotic surgical assistance so it is um everybody is catching catching up on robotic knee replacement surgeries and as you all know about 3 million Replacements are being done in a year throughout worldwide and um out of which about 11% or being done with robotic assistance um this at the end of the day your surgeon is still in charge and um this robotic uh robots will help the consultant perform total need replacement surgery with an improved precision and uh it gives a better alignment and U Precision when undertaking the knee replacement surgery we do not know still the long-term outcomes but um we hope the long-term survivorship and the outcomes can sign significantly improved by doing this robotic KN replacement surgery you will have a very detailed webinar with regard to the surgeries uh on which is coming up soon which is scheduled to be on the 9th of January at 6 p.m. thank you all for listening to me now I would uh pass on to Paul Phillip um for his thank you Mr readyy for that insight into the patient Journey um we can now take some questions from our attendees so this person asks would having a partial knee replacement be better for younger patients I’m in my early 50s and would need a revision later in life yes the answer to that question is certainly yes if your 50 or anger I believe and if you got isolated unic compartmental arthritis mainly in the middle compartment as evidenced on the x-rays and the and with regard to prerequisites uh it is ideal one should have a anterior cruciate ligament being intact and there should not be any arthritic changes in the uh lateral compartment of the knee and also your knee should not have a fixed flection of more than 10° and the knee flexion should be more than 100° in case of unic compartmental knee Replacements if one were to consider uh and also the surgery in the long term because you distribute several milon seconds of stress when compared to a 75 year old uh it would also be it would certainly be reasonable to consider for any replacement as um with the distribution of load and millions of cycles of stress the joint replacement would wear off and doing a knee replacement later on is a much easier way to do uh rather than doing a revision in a total knee where we need to put stems into both th bone and the shin bone okay thank thank you this person asks is it advisable to build up the knee muscles before surgery yes 100% you need to because your knee is defunctioned because of the pain so it is uh and wasting you get if you don’t use the knee is quite a mark at wasting of the muscles uh and this is quite vital and it’s a very important question that youve asked so all patients before knee replacement surgery I would encourage them to do strengthening exercises within pain limits so that they would have a better function following surgery thank you thank you um next question is on average how long does the operation last for a total knee replacement by and large most of us um uh we do KN Replacements with less than an hour uh um I have not been using T Cas for the knees for the last 20 years so it is uh proved to be better uh pain relief when compared to people who use T case but in the long term it should not make any significant difference uh so major by and large most of the knee Replacements or partial knees are done less than an hour okay thank you this person asks would I be able to go back to work on my feet most of the day after I’ve fully recovered um normally takes about we say about 3 months is the ideal time for one to go back to work uh so up to 3 months um if it’s a sedentary job you can go back after 6 weeks um if you’re standing up all day long up to 3 to 4 months we should be allowed yeah uh to accommodate uh your symptoms thank you thank you um this is quite a long question I’m happy to repeat bits of it um it’s it’s sort of two questions rolled into one um this person asks um I have recently had a cortisone injection into my knee for my osteoarthritis um an MRI scan showed I have severe patellofemoral osteoarthritis an osteochondral defect and meniscus meniscal tearing is there a minimum time after a cortisone injection before a knee replacement can be carried [Music] out um ideally one should not recommend because cortisone is an anti-inflammatory uh and ideally one should not be rushing into doing a knee replacement surgery for a minimum period of I would not do any replacement if one had an injection for a minimum period of um 3 to 4 months so I think one has to be aware of this so if he has significant relief then it indicates that he definitely has got severe arthritis which has given some pain relief but these steroid injections one need to think that these are temporary and they’re not a permanent cure thank you they say that they say they’re 74 years old um and is it too soon to consider a knee replacement how bad should one’s knee be before considering knee replacement I would always ask the patient how bad the pain is if the pain is severe and if it is affecting his sleep and quality of life and if has tried physiotherapy some pain killers because one cannot take keep on taking pain painkillers uh the rest of their lives because it can affect their kidneys and stomach so it would be reasonable for one to be considered because 74 year old um it would if the pain is immense it would be reasonable to offer any replacement provided there is xray evidence of severe arthritis he thanks uh the next attendee asks um do I understand correctly that the Vanguard has only a 10year validity period um the the slide of shown was for 10 years but vanguards have been in the market for the last 25 years or more and uh about 85 to 90% of these knee replacement they’ve got a 20 year survivorship thank you um the next person asks are all knee replacements conducted on the spinal block majority of the patients are recommended to have a spinal and a block but again at the end of the day our anestis we have got excellent team of anestis who can um talk to the patients at the time of surgery so some of the patients are very apprehensive in having spinal they would like to be put to sleep not hear any noises but uh our team of excellent anesis can give some sedation for them to sleep and they also regard that this is safer in having a a spinal and a block that’s how majority of the knee Replacements are and hip replacements are being done at end but it’s again it is down to patients Choice One always respects patients wish what they prefer to and then they go along with the patients great thank you thank you um this person asks is bilateral knee surgery done in the same sitting and how effective are injections and do they affect the surgery um bilateral total Replacements it is not a thing that um it is that we have inherited in um uh in United Kingdom uh we always uh do one replace M at a time the reason being of the risks outweigh the benefits because the risks being one will be in significant amount of pain and also the risks of DVT and Pulmonary emuls are higher uh it is done in States and in Asian countries like in Singapore and India but uh we are evidencebased so it is in the best interest of the patients that we do not do or carry out uh Replacements at the same setting so if you had steroid injections it would certainly help temporarily so one could have a knee replacement and also an injection into the other knee which is affected and you can defer the surgery for a minimum period of four to 6 months before we considered on the other side thank you thank you um this person asks um and I cycle after surgery so they’re they’re asking how how flexible would their knee joint be can I cycle after surgery and yeah it is a good question so again with regard to cycling one would encourage people to do exercises and one you got good range of movements your knee is flexing to about nearly 120 so it is is reasonable for you to get back to cycling but I would um go uh with the physiotherapist on their assessment and also speak to the respective consultant who has performed the surgery and uh they can measure how much flexion you have got and if you got good flexion then I see why not you should not be cycling so most of my patients they go back to cycling after a period of 3 months um so so I would recommend uh the person to ask uh to engage a dialogue with the physiotherapist and the respective surgeon who has performed their replacement surgery thank you thank you um we have got a few sporty people on tonight it looks um so somebody asking what’s the possibility of playing tennis after a new replacement I assum the answer would be similar to previous yeah I me Impact Sports I always tell them uh that this is um an artificial joint which is subjected to wear and tear the more you stress it out the poly will wear and it is it creates a poly debris which contributes to loosening so idly we I I do not recommend but some of my patients have gone back to playing tennis and they also has gone back to playing golf within 6 weeks so ideally I mean I would not Al recommend but if one were to play gentle tennis not a very high impact or high intense tennis it’s absolutely fine after 3 months okay thank you um this person asks and excuse my pronunciation on this one do you do injections of arid we do we have hyaluronic acid injections which is a type 1 collagen these benefit the patients with the arthritis and when then patients are allowed to have when they called the membership they’re allowed one injection on their membership and also NHS patients also we can give um they need to get a e referral for these injections as and they can give steroid injection but not THX or PRP injections we have not been giving it pen right than this person says I had my knee replaced at the beginning of August I am pretty mobile but uh my knee and lower K not sure what they’re referring to there lower K is still a little bit swollen and I still get odd aches will my knee eventually get back to normal so first of August is only about uh 3 months down the line um so oh yeah so ideally want to get an Optimum benefit it can take up to 6 months in certain individuals and majority of the patients though they recover between 6 weeks 3 months the optimum benefit one could get is about 6 months so I would recommend this person to continue with exercises with a view to strengthen the quadriceps muscle which is the extensor muscle with a view to improve his extensor mechanism and quadriceps function so idly if you still have got major issues then um I would certainly get in with the surgeon who has performed the surgery thank you next attender he says I’m 74 years old and had a total knee replacement in 2012 I have rheumat to arthritis and lately this knee is feeling stiff and starting to cause me pain does this mean I may need a revision uh no it’s only very short period of time so one need to have a diagnosis uh it is important that he’s assessed thoroughly um and uh one need to have a diagnosis after an assessment why this is causing him severe pain stiffness and whether there is something loose mechanically that is happening he should have a plain radiographs uh to see whether there’s loosening or not and people can then get on and do CT scans and and also he should have routine blood test as a standard routine practice because some can be secondary to low grade infections so one need to rule out all these things and if all these measures failed to improve the symptoms it would be reasonable to for him to be considered for an orthoscopic surgery with the view to see whether there is any delamination of poly or not before one can embark on revision surgery you need to have a specific diagnosis before we put patients through a revision major total replacement that’s what I would sincerely recommend Mr tendi asks what would recovery be from patellofemoral joint replacement I mean though the this is isolated joint which is a petal replacement and the recovery can vary from 6 weeks to 3 months so for any knee including partial though the recovery is quicker when compared to standard total knees so I would still say between 6 weeks to 3 months okay um the final question I think this you may probably refer back to um earlier answers but this person says I’m I was a keen Walker will I be able to resume walking a distance of say five miles uh following knee replacement surgery yes you can walk up to uh five miles but listen to the knee if the knee is not liking it I think you should reduce a bit of mes but people who had knee Replacements after period of 6 months they resume their normal activity levels okay thank you very much um thank you we have come to the end of our attendees questions so um Mr readyy please can you move on to the last slide in the presentation if you don’t mind yeah thank you so um as a thank you for uh joining this session we’re offering uh as listed on the screen there 50% off the value of your consultation Accord back from your dedicated private patient advisor and an email tomorrow with the recording of this session and further information and also updates on news and future events if you would like to book your consultation following this webinar our private patient team can take your call until 8:00 pm tonight or you can call back between 800 a.m and 6:00 pm Monday to Friday using the number listed on your screen to the right of your screen there and following this webinar you’ll receive a survey and we’d appreciate it very much if you could fill that survey out when this session closes to um improve our future events with your feedback our next webinar we have scheduled is treatment for enlarged prostate and you can sign up to that via our website I realize that we are finishing a little bit early today um but All That Remains for me to say on behalf of Mr readyy and the team here at benon hospital I’d like to say thank you for tuning in this evening and we hope to hear from you very soon thank you and goodbye thank you