Knee Replacement

Relieving pain and restoring function with personalised, evidence-based knee replacement surgery.

Knee Replacement – Key Points

• Knee replacement is used to treat advanced arthritis causing significant pain and reduced quality of life
• It is considered when non-operative treatments are no longer effective
• Options include partial and total knee replacement, depending on the pattern of arthritis
• Partial knee replacement can offer faster recovery and more natural movement in selected patients
• Most knee replacements last 15–20 years or longer
• Recovery typically takes 3 months for daily activities and up to 12 months for full recovery

What is a knee replacement?

A knee replacement is a surgical procedure in which the damaged surfaces of the knee joint are replaced with artificial components made of metal and plastic.

It is most commonly performed for osteoarthritis, which causes pain, swelling, stiffness, and reduced function.

Why might you need a knee replacement?

Common causes include:

• Osteoarthritis – the most common cause
• Rheumatoid arthritis – inflammatory joint damage
• Post-traumatic arthritis – following previous injury

Knee replacement is usually considered when:

• Pain significantly affects your quality of life
• Walking, stairs, or daily activities are difficult
• Non-surgical treatments have not provided sufficient relief

Non-surgical treatment (first-line management)

Before considering surgery, all patients should undergo appropriate non-operative treatment in line with NICE guidance.

This includes:

• Physiotherapy and exercise (strengthening and aerobic fitness)
• Weight management (even small reductions can improve symptoms)
• Pain relief (topical or oral anti-inflammatories where appropriate)
• Walking aids (e.g. stick)
• Steroid injections (short-term relief in selected cases)

These measures can significantly improve symptoms and may delay or avoid the need for surgery.

Types of knee replacement

Total Knee Replacement (TKR)

Used when arthritis affects most or all of the knee.

• Replaces the entire joint surface
• Provides reliable pain relief and function
• Best option for widespread arthritis

Partial Knee Replacement (PKR)

Suitable when arthritis affects only one part of the knee (most commonly the inner side).

Benefits of partial knee replacement:

• More natural feeling knee
• Better range of movement
• Faster recovery and return to activities
• Lower risk of major medical complications
• Reduced need for blood transfusion
• Higher patient satisfaction in some studies

Considerations:

• Slightly higher lifetime risk of needing further surgery compared to total knee replacement

Patellofemoral Knee Replacement

A form of partial knee replacement used for isolated arthritis under the kneecap.

• Smaller operation than total knee replacement
• Faster recovery
• Requires careful patient selection

Partial vs Total Knee Replacement

If you have arthritis in only one part of the knee, both options may be discussed.

• Partial knee replacement prioritises quicker recovery and more natural movement
• Total knee replacement offers durability and treats the whole joint

The choice depends on:

• The pattern of arthritis
• Your symptoms and expectations
• Your priorities and lifestyle

Benefits of knee replacement

• Pain relief – often significant improvement in pain
• Improved mobility – walking, stairs, and daily activities become easier
• Improved quality of life
• Correction of deformity and alignment
• Long-term durability – most implants last 15–20 years or longer

Risks of knee replacement

Knee replacement is generally very successful, but potential risks include:

• Infection
• Blood clots (DVT or pulmonary embolism)
• Bleeding or need for transfusion
• Implant-related problems (loosening, wear)
• Stiffness or reduced movement
• Nerve or blood vessel injury (rare)
• Persistent pain
• Fracture around the implant
• Anaesthetic or medical complications

These risks are uncommon and will be discussed in detail based on your individual health and circumstances.

The day of surgery

Knee replacement is typically performed as a planned procedure.

• You will arrive a few hours before surgery
• You will meet your surgeon and anaesthetist
• Surgery usually takes 1–2 hours
• Anaesthesia may be general or spinal

After surgery:

• You will be monitored in recovery
• Pain relief will be provided
• Physiotherapy usually begins the same day or next day

Recovery and rehabilitation

Recovery is gradual and structured.

Early phase (0–2 weeks)

• Walking with crutches or a frame
• Pain and swelling management
• Early physiotherapy exercises

Intermediate phase (3–6 weeks)

• Increasing walking distance
• Improving movement and strength
• Transition away from walking aids

Later recovery (6–12 weeks)

• Return to most daily activities
• Driving (typically 4–8 weeks)
• Return to work depending on job type

Long-term (3–12 months)

• Continued strengthening
• Return to low-impact activities (e.g. cycling, swimming, golf)
• Ongoing improvement in strength and function

Long-term outcomes

• Most patients experience significant pain relief and improved function
• Implants typically last 15–20 years or longer
• The risk of needing revision surgery is approximately 2.5–3% at 10 years

Maintaining a healthy weight and staying active helps maximise the lifespan of your knee replacement.

Evidence and research

The TOPKAT trial (UK) compared partial and total knee replacement for medial compartment arthritis.

Key findings:

• Partial knee replacement was more clinically and cost-effective
• Shorter hospital stay
• Similar patient-reported outcomes
• Modest clinical advantages in selected patients

This supports the use of partial knee replacement in appropriately selected patients.

Why choose Mr Smith?

Mr Smith is a leading UK knee surgeon with expertise in both partial and total knee replacement. His approach focuses on careful patient selection, ensuring that each patient receives the most appropriate type of replacement based on their arthritis, anatomy, and goals.

His practice combines high-volume surgical expertise with a strong research background, ensuring treatment is personalised and evidence-based.