Two bad knees, two surgeons operating at the SAME TIME

Pioneering practice cuts recovery time — and means new knee joints match better

MORE than 90,000 Britons a year undergo a knee replacement. Martin Walsh, 58, a sales assistant from Bracknell, Berkshire, had a pioneering op where two surgeons worked simultaneously to replace both his damaged joints, as he tells ANGELA EPSTEIN.

THE PATIENT

AS A sports fanatic who played squash three to four times a week, I suppose knee problems were bound to catch up with me.

The pain first started to bother me about 15 years ago — made worse after I tore the cartilage in my right knee while doing DIY. The discomfort in both knees got steadily more painful, so my gP referred me to a specialist who said I had osteoarthritis, probably from wear and tear.

Over the next ten years, I had three arthroscopies — a keyhole procedure where they ‘clear out’ the joint, removing any torn cartilage or chipped fragments of bone that might be causing pain.

After each one I’d get some relief for up to a couple of years, but the pain always came back and got progressively worse.

I was lucky that I had a sedentary job as a manager for a freight company, but my usual games of squash and running became impossible. I liked keeping fit, so I took up cycling and went on walks instead.

However, two years ago it got so bad I could barely hobble 100 yards without excruciating pain.

I reconciled myself to replacement knee surgery, but then I had a terrible cycling accident in August 2015. I came off my bike at around 23 mph, fracturing my shoulder and breaking ribs and bones in my neck and back.

It was an awful time; I was immobile in a neck brace for three months and had two metal pins put in my back. WHen

I finally felt fit again, nearly a year later, I decided I wanted my knees sorting out — there was no point in getting over that kind of trauma and then not being able to walk because of worn-out knees.

When I went to see my surgeon, around April last year, he told me that rather than having replacement work done separately on each knee a few months apart, or doing one knee after the other in the same operation, he worked with a colleague to operate on both knees simultaneously. Surgery would be shorter and recovery quicker, he said.

I was a little daunted. It seemed a lot to do in one operation, but after my recent long hospital stay, less recuperation time was a very attractive thought. I had the surgery last August and was astonished by how little pain I felt. I was out of bed the day after the operation and within a week, I’d discarded my crutches.

Within two weeks, I was walking a quarter of a mile down our lane and after two months, I was walking three to four miles a couple of times a week.

I took early retirement from work after my accident and now have a local part-time job as a sales assistant. I am on my feet for eight hours a day, a few days a week, but it doesn’t bother me. I can walk ten miles and not feel a thing, and I play golf. life is great.

THE SURGEONS

hENrY BoUrKE is a consultant orthopaedic surgeon who performed the surgery with his colleague, rakesh Kucheria, at the BMI The Princess Margaret hospital, Windsor. They both also work at Wexham Park hospital in Berkshire. Mr Bourke says: WHen Martin came to see me, his scans revealed he had advanced osteoarthritis, or damage on both knee joints.

As a result, the cushioning cartilage between the lower end of his thigh bone (femur) and the upper end of his shin bone (tibia) had gone and the bone surfaces were rubbing against one another, causing a lot of pain and discomfort. He had more or less equal damage in both knees.

In replacement surgery, the roughened ends of the bone are ‘resurfaced’ with metal and a plastic disc sits in between to replace the lost cartilage.

Because only part of Martin’s joints were damaged, he needed only a partial knee replacement.

Traditionally, double knee replacements are done on different days, months apart — which means going through major surgery and the recovery process and then having to do it all over again. Alternatively, patients can have a long operation to have them done one after the other.

My colleague, Rakesh Kucheria, and I had discussed the possibility of doing simultaneous bilateral knee replacement procedures together, since we could see what a massive benefit they could be for patients. And we have been doing this for a few years now.

With two surgeons operating at the same time for 60 to 90 minutes, both knees are replaced in one go. If one surgeon were to do two knees sequentially, it would take up to three hours and I think the patient takes longer to recover. THeRe

is also less time under anaesthesia as well as less exposure to infection in the shorter surgery. The cost to the patient or health service is cheaper, as there’s only one hospital visit and the stay is shorter.

To begin the operation, we each apply a tourniquet to the thigh we are working on to stop blood flowing to the knee joint, making it easier to see.

We then make a 10cm curved incision down the front of the knees (we work at roughly the same pace) and move the knee cap to one side so we can access the joint.

We make incisions of around 10cm to 12cm into the ends of the femur and tibia and press the small pieces of metal replacement into the bone. The bone will grow around these pieces of metal, allowing the knee to regain its original function.

A very hard-wearing plastic, polyethylene, is then fitted between the metal surfaces and this acts as the new cartilage.

Another advantage of working simultaneously is that between us, we can agree the ‘balance’ of the two knees — that is, the positioning of the two ligaments surrounding the joint on each side — to make sure they don’t feel too loose or tight. essentially, we check each other’s work, ensuring optimal balance within the joints.

In an unbalanced knee, increased stresses occur on other parts of the joint, particularly the cartilage, so early failure of the replacement joint is more likely.

The idea of working simultaneously is relatively new, but essentially, any consultant can do this with another qualified specialist, and I would encourage patients to ask their doctors about it. ThE surgery costs £14,000 both privately and to the NhS.