Total knee replacement is the most common operation that we do.
It’s a great operation for those that have had worsening knee pain for several years and its starting to impact on your enjoyment of life. Your knee can wear out either just with normal ‘wear and tear’, following an injury, or from conditions such as rheumatoid arthritis.
Total Knee replacements are considered when knee pain is affecting your quality of life.
There are over 40 different knee replacements used in Australia. We use one of the most tried and tested implants with the triathlon knee, which is one of only 3 companies recommended by the Australian Orthopaedic Association as having the best 15 year results with the lowest revision rate ie the lowest rate of the knee replacement changing to be redone. The Stryker triathlon knee is the most commonly used knee in Australia due to its excellent long term results.
Implant positioning must be linked in with the ligament balance of the knee to get the best outcome. In years gone by we used to put knee replacements in a standard set position for everyone, but now we are putting knee replacements in patient customised positions based on what the individual knee looked like before arthritis set in. This more modern kinematic functionally balanced alignment seems to be giving better results and a more balanced knee, which leads to greater satisfaction and less pain.
To ensure this we use robotic technology with the Mako, which is arguably the best multi-platform orthopaedic robot in the world with the most robotically implanted joints. Prior to surgery we get a CT scan to ensure we know everything about the knee joint position and its relation to the centre of the hip and ankle, then we plan positioning of the implants looking at the bony anatomy. During surgery we look at the preoperative plan and adjust it slightly depending on how tight or loose the ligaments are within the knee at various positions. We then make sure that only the essential bone is removed and the implants are positioned perfectly with robotic guidance to give you the best outcome. The haptic boundaries also mean that the saw cuts are constrained to only take away the bone required for the implants, so there is less trauma and less pain. There is good evidence to support a higher satisfaction rate, less pain, shorter hospital stay, earlier rehabilitation and a longer average life span of the implants.
After surgery we would expect you to be in hospital 2-3 days, walking with crutches until weeks 2-3, a single stick for support until week 6, then walking without aids. Most of the discomfort and swelling will have resolved by week 4, but won’t completely settle until 3-4 months. Physio is important following a knee replacement to help you get your range of motion and for early reduction of swelling.