Knee replacement : a Guide

Making the choice – when is surgery right for me?

Dr Ellis will consider your need for surgery based on your level of pain, your functional capacity, your medical history and physical capability. Your decision to go ahead with surgery should be considered when you feel fully informed. Knee replacement surgery is a major procedure, and it’s important that you consider both its risks and benefits.

You should have exhausted all other effective treatment before choosing surgery.

 

A healthy knee:

The knee is one of your body’s largest weight-bearing joints. Nearly normal knee function is required to perform routine everyday activities.

The knee joint consists of the lower end of the thigh bone (femur) which rotates on the upper end of the shin bone (tibia) and the knee cap (patella) which slides in a groove on the end of the femur. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength.

 

Why do I need my knee replaced?

In a healthy knee, abutting joint surfaces are covered with articular cartilage, a smooth substance that cushions the bones and enables them to move easily. All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane.

This membrane releases a special fluid that lubricates the knee which reduces friction to nearly zero in a healthy knee. Normally, all components work in harmony. Disease and injury can disrupt this, resulting in pain, muscle weakness and inhibited function.

Dance Knee Dr-andrew-f
Knee walking

What can I expect from knee replacement?

Knee replacement is a major procedure and requires effort and commitment to your recovery, both by you and your surgeon, Dr Ellis.

 

Most people who have knee replacement surgery feel a dramatic reduction of pain and a major improvement in their ability to achieve everyday activities of daily living. After surgery, you can expect that your knee pain will be improved, that your range of motion increases with physiotherapy as you strengthen any muscles that might have deconditioned, and return to most activities and exercises that you enjoy.

 

However, it’s important to know that you will be advised to avoid certain activities for the rest of your life, like long distance jogging and high impact sports. Kneeling can often be difficult after knee replacement and you might need to adapt your normal habits and sitting postures around your new replacement.

 

Even with normal use and activities, an artificial joint develops some wear over time. High impact sports accelerate wear and may cause the prosthesis to loosen prematurely or become painful, leading to further surgery in the long term.

Getting fit and ready for surgery

Keeping fit with low impact exercise or physiotherapy (prehab), stopping smoking, and maintaining a healthy weight are simple methods to personally improve your outcome. Keep an eye on  your skin’s condition: avoid cuts and abrasions to prevent infection.

 

Take a look at the Arthritis Foundation of Australia for some suggestions on exercising with arthritis.

What are the risks?

Knee replacement is considered a highly predictable and safe procedure but its risks are real and should be carefully considered by prospective candidates.

 

Most patients are highly satisfied with their outcomes, but some can be disappointed with their choice or result.

 

You should be aware that serious complications do occur and may necessitate further surgery and/or treatment slowing your recovery.

 

These include:

 

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Both you and Dr Ellis will work together to avoid adverse results from surgery. You can help by informing Dr Ellis of your other health conditions, regular medication or concerns that you have prior to surgery. Blood thinners, arthritis and diabetes medications are examples.

My pathway through knee replacement

Once you’ve made the choice to proceed with knee replacement, let Dr Ellis and his staff know and we’ll get the ball rolling!  You can expect to have your surgery in four to six weeks, pending your health issues.

STEP

01

Imaging

Recent x-rays of your knee (within the last six months) will be required to plan for your procedure. Ensure that you have the x-ray films printed, ready to take to the hospital on your day of surgery.

STEP

02

Preadmission

It’s important to attend preadmission at North Shore Private Hospital to assess your fitness for surgery. Any health issues that might affect your recovery should be discussed with the team, and a general health assessment will take place to make sure your pathway is a smooth one!

Please complete a NSPH online booking form prior to this appointment. Dr Ellis’ staff will arrange a time for you to attend.

STEP

03

Preoperative Check

You’ll see Dr Ellis for a last check-up roughly a week before your date of surgery. You will review together the results of your readmission and your radiology, and make sure everything is ready to go.

Now is a good time to ask further questions.

STEP

04

Surgery

Admission is usually on the day of surgery.
Dr Ellis and his anaesthetist will see you before your operation to check your condition and answer any last questions.

The operation lasts about two hours and you will stay in the operating room for 4 -5 hours. Dr Ellis will ring your nominated contact at this time to let them know all is well. You will begin to walk with the hospital physio on the day of surgery or the next day.

STEP

05

Discharge

Your hospital stay will last roughly two to five days. Once fit to leave, you have several options. Rehabilitation as an inpatient is one choice, but you can also recover well with physio at home or by attending an organised outpatient program.

There are many options for home-based rehab, you are welcome to discuss these with Dr Ellis’ staff and your insurer to find out more.

PDF Knee Replacement with Dr Ellis - A Guide

How can I improve my recovery?

Being diligent about rehabilitation about physiotherapy in the first weeks will hugely improve your outcomes.

 

Home-based rehab: A popular solution, these programs are usually covered in the majority by your health fund. If you chose not to go to rehab, they offer in home supported care, physiotherapy and online consultations, often with prehabilitation before your surgery. Check with your insurer if you are eligible. Options include 360med.care and Ramsay Connect.

 

Avoiding problems after surgery:

 

Avoiding Falls: A fall during the first few weeks after surgery can damage your new knee and may result in a need for more surgery. Listen to your physiotherapist and keep using your walking stick, frame, crutches and handrails until your flexibility and strength are improved

 

Blood clot prevention: Follow the advice of Dr Ellis carefully to reduce the possibility of blood clots, which can occur in the first weeks of recovery. Take the prescribed medication and wear your TED stockings for six weeks.

Look out for:

  • Pain in your calf and leg, unrelated to the incision.
  • Tenderness or redness of your calf.
  • Swelling of the thigh, calf, ankle or foot.
  • Warning signs that a clot has travelled to your lung include shortness of breath and chest pain, particularly with breathing.

 

Notify Dr Ellis immediately if you develop any of these signs. If it’s an emergency, call an ambulance or go to the nearest hospital.

 

 

Week 1-6: Recover and rehabilitate

This is the time to work hard with your physio and rehab team. Some movements will be restricted in the first six weeks to protect the surgical wound and your new knee as it heals but you will be working hard at bending and straightening your knee. You will be on crutches, a frame or using a stick to walk for the first few weeks.

 

Whether you’re at home, attending a day program, an inpatient or working with private physiotherapy, keep active and moving!

 

Be prepared to be in some pain but as time passes, you’ll wean from your pain medication.

 

Dr Ellis will see you at 6 weeks post-op with an x-ray, but is always available if you have any worries.

Crutches

Week 6-12: Normalise and strengthen

During this time, you can expect to start to recommence your normal recreation, exercise and social activities. As you regain your strength, your new knee should allow you to do most of the things that you might have stopped because of pain.

 

Just keep in mind that your prosthesis and bone are healing. Kneeling after knee replacement is usually difficult for most patients to achieve and in some cases not possible. This is a limitation that you should discuss with Dr Ellis before surgery, as it can affect your ability to do certain tasks or recreations.

 

Dr Ellis will see you again at the 12 week mark, making sure that you’ve achieved your goals for the first three months. Most people will return to full time work early in this period.

PDF - Total Knee Replacement with Dr Ellis PDF - Anaesthesia and Total Knee Replacement

How much does knee replacement cost?

Your private health insurance should cover the majority of your care. Check your level of cover to ensure that the stay in hospital, the prosthesis and rehabilitation are all covered.

 

Dr Ellis will discuss his fees with you. Well before surgery, you will be provided with a quotation for surgery for informed financial consent. Dr Ellis uses the AMA schedule of fees as the basis of his part of the professional costs of the operation. He works closely with a specialist anaesthetist of great experience who will charge separately and whose likely fees can be confirmed preoperatively.

 

Your surgical fee will cover postoperative follow-up appointments for a period of five months.

Unicondylar versus total knee replacement

Dr Ellis will discuss the type of knee replacement that you require before surgery. Depending on your degree of arthritis and its pattern through your knee joint, he will choose an implant that gives you the best outcome. Usually, total knee replacement is indicated but in disease that is very concentrated in one location sometimes unicondylar (partial) knee replacement is a choice.