Knee op that means you can WALK out of hospital the same day
On a warm afternoon six weeks ago, Roger north strolled into his local pub and ordered half a pint of Guinness. Unremarkable enough, perhaps. But this celebratory tipple with his partner, Theresa, marked t he end of an extraordinary day.
For just a few hours earlier, the father of four had been in surgery, having a full replacement performed on his right knee.
Thanks to a brand new type of prosthesis, together with innovations in surgery techniques and anaesthesia, Roger, 62, was able to leave — or, rather, walk out of — hospital the same day.
While other forms of knee replacement are sometimes performed as day surgery, it is unusual for people to be able to go home that day and typically they will use crutches when they leave. Roger walked out of hospital on his own two feet.
‘Four years before this, I’d had a standard knee replacement on my left knee and it had taken me months to become mobile again, let alone use the stairs,’ says Roger.
‘I had to learn to walk again. after the operation I was in an awful lot of pain. I’d thought that after the second operation at the very best I’d be hobbling on crutches. But there I was, walking out of the hospital unaided.’
More than 70,000 knee replacements are carried out in England and Wales each year, with the number rising, mainly because we’re getting heavier and l i ving l onger, placing greater demands on our knees.
and with the rise in knee ops, there’s a very large and growing number of knee replacements on offer. So how do you know which one is right for you? and is the newest BETWEEn necessarily the best?
10 and 15 per cent of patients are unhappy with t he result of knee replacement because of pain, stiffness or an i nability to regain a reasonable range of movement.
‘The key thing that the patient needs t o know i s how a replacement performs over a given period of time,’ says Mark Wilkinson, a professor of orthopaedics at Sheffield University and a spokesman for arthritis Research UK.
This information is available from the national Joint Registry, set up to collect information on all hip, knee, ankle, elbow and shoulder r eplacement operations and to monitor the performance of joint implants and the effectiveness of different types of surgery.
‘ The nHS has a menu of replacements, maybe two or three f or each trust,’ says Professor Wilkinson, but this menu can vary f rom trust to trust.
‘Implants can differ in terms of variety of sizes available or in shape and design.
‘Surgeons tend to stick to the range of implants they have experience with or the updated models. But a lot of implants are broadly the same, though techniques have i mproved. Small differences can have an effect on the way a knee replacement functions and survives.’
Roger was the first person in the United Kingdom to have the latest model of the ‘attune’ knee prosthesis.
as Professor Wilkinson explains: ‘The attune has been around for six years. But I’m not sure there has been enough time to see how much better the new attune will perform than other replacements.
‘If you have a new type of implant put in, you always take a risk and brand new innovations — or sometimes refinements of existing models — can have problems.’
Manufacturers periodically bring out new models, and surgeons will naturally be very enthusiastic about new products if they have had a role in their development, he explains.
‘But it is generally better to go for a prosthesis that has an established track record and proof of its longevity.
‘Innovations can sometimes be good, but often they can be of limited benefit. and in some cases — such as metal on metal hip replacement — they can be a disaster.’
Concerns have been raised over these hip implants, with some studies showing they may leak metal into the bloodstream. Professor Wilkinson adds that the success of a knee replacement also depends on many other factors, including age, weight, how active a person is and their attitude to post-rehabilitation therapy.
He suspects that in in the case of Roger north’s case, it was likely to be other factors — such as the physiotherapy plans put in place by the hospital, and the patient’s own expectations — that allowed him to walk out of hospital without crutches on the day of his operation, rather than because of the implant itself.
Roger’s surgery, which he had on the nHS, was performed at the private BMI Goring Hall Hospital in West Sussex.
according to his surgeon, James Lewis, the key feature of the new attune replacement is that it is more stable than other replacements so patients have the confidence to stand and walk on it straight away.
‘The knee replacement joints, including earlier versions of the attune, are usually made of a cobalt chrome metal, which covers the end of the thigh bone and shin bone,’ says Mr Lewis.
a piece of plastic-type material, known as a spacer, goes in between these bones to replace the cartilage.
‘With the new attune there is more chrome so more of the bone is covered; this reduces the risk of bleeding, which can cause pain,’ he says.
‘There is also less soft tissue tightness because of this, so mobility is increased.’
another f actor i n Roger’s recovery was the technical advances that mean many patients are able to have their knee ops done as day surgery.
For example, patients no l onger have to be ‘ starved’ before having the operation.
This has been traditionally done to avoid danger of vomiting and regurgitation which could get into the lungs and affect breathing during a general anaesthetic.
NOW instead, they can be given a specially formulated liquid meal so that the body isn’t in a stressed, starved state, before surgery.
‘The less stress to the body, the more relaxed the patient is, the more positive the outcome,’ says Mr Lewis.
advances i n anaesthesia mean no grogginess or nausea afterwards. Traditionally, a tourniquet is applied over the upper thigh during the operation to prevent any bleeding during surgery.
However, this can cause swelling and pain afterwards because of the pressure on the leg.
So surgeons use a smaller tourniquet only as the implant is ‘cemented’ in place.
other i nnovations i nclude using dissolvable stitches, which last 21 days — the metal clips traditionally used in this kind of surgery can cause pain.
The surgery for the replacement is fairly standard. after the operation, Roger was told to lie still for a couple of hours: ‘But I didn’t feel groggy from the anaesthetic,’ he says.
‘a physiotherapist asked me to lift my leg — and though I was a bit scared of doing so, I could. Then she asked if I could swing my legs out of bed. again, I could. and I could stand up.
‘By 1pm, I was walking down the corridor on my own. I left hospital about two hours later. Before the operation my knee was so painful I could hardly put any weight on it.’
The following morning, his knee did ache and there was quite a bit of bruising and swelling. But no serious pain.
‘I didn’t even need a stick, let alone crutches. and I could do things such as walk up stairs straight away,’ he says.