Answering the most pressing questions on joint replacement and orthopaedic surgery
Replacement Chris Evans, Consultant Orthopaedic Surgeon, and hip and knee replacement specialist, answers important questions on bones and joints.
Which activities can damage hips and knees?
There are many. In younger patients, problems can be due to sporting injuries or any activity where a fair amount of force is put through the joints. In middle-aged patients, a degree of early degeneration of soft tissues within the knee makes them more prone to problems: people come to see me after having knocked their knee on the corner of their desk, for example. And, in later life, degeneration in joints can be caused by arthritis.
What kind of symptoms might suggest that a patient needs a hip or knee replacement?
Pain that effects everything they do. In the hip, for example, that could include being woken from sleep by pain, limping, difficulties with stiffness, and 'start-up' pain that eases after a few minutes of walking, but which restricts movement and/or your activities. Knee symptoms are common and many episodes will resolve with rest, ice, pain-relief and physiotherapy. But if symptoms are ongoing for three months or more, then you should see a specialist. It depends on how intrusive the problem becomes.
Can keyhole surgery be performed on patients of any age?
In the over 50s, it is more challenging. That's because it's less effective when there is already wear and tear in the joints. It makes the outcome less predictable.
Can younger patients be suitable for replacement hip and knee surgery?
We would only recommend it if their quality of life is so impaired that the potential benefits outweigh the risks of surgical intervention. There is also a possibility that, in time, the replacement hip or knee will wear out and have to be replaced. It depends on the age of the patient and the activities they are involved in — but replacements should last for 10 – 15 years... and hopefully longer.
How long do hip and knee keyhole procedures and replacement operations take?
Keyhole surgery to the knee is typically performed under general anaesthetic as a day case procedure, and could take anything from 20 minutes to an hour depending on the quantum of surgery required. Keyhole surgery to the hip is an evolving field which is less commonly performed, takes longer and can be completed as a day case procedure or may require an overnight stay. A hip or a knee replacement operation generally takes anything from 45 minutes to two hours.
Have there been any advances in this field recently?
Yes. The way in which we manage patients requiring major joint replacement surgery has been transformed in the last 10-15 years. Advances in operative and anaesthetic techniques for hip and knee surgery means that, often, patients can be awake during their surgery if they wish. There are theoretical advantages of avoiding lengthy general anaesthetics, in terms of the risk of surgery and in terms of rehabilitation and mobilisation.
How long does recuperation take?
It depends on the condition being treated. If someone presents with symptoms of a torn cartilage, for example — and without any significant wear and tear or arthritis — they can be functioning at a fairly high level within 10 days to a fortnight. But it should be stressed that, after a keyhole procedure to the knee, improvements can take at least six – 12 weeks. Physiotherapy and rehabilitation is very important in this phase.
Post-procedure, if a joint hurts, the patient doesn't move it — but then it becomes stiff. Then when they try to move a stiff joint it hurts even more. Physiotherapy after reparative knee surgery and/or replacement surgery can therefore help break a vicious circle of pain and stiffness.
Are there things we can do to minimise our risk of knee and hip problems?
Yes: keep fit, keep moving and keep your weight down. A healthy joint is really down to the health of the 'stabilisers' that surround it. So if you have good hamstrings and good quadriceps around your knee, you are far less likely to suffer mechanical problems.