Just like you look different in the mirror as you age each year, so too does the inside of our joints. To learn more about a knee replacement Bundaberg contact Dr. Anthony Murray, a Specialist Knee Replacement Orthopaedic Surgeon.
Just like you look different in the mirror as you age each year, so too does the inside of our joints. The knees take load walking, running, jumping, kneeling, climbing and everything else we throw at them over life – and they are not immune to the ageing process. The cartilage thins each year and the bone beneath begins to get exposed, the meniscus which act like shock absorbers in the knee get degenerative tears within them, and cruciate ligaments fatigue and fail. People often think only skin ages – but our bones, ligaments, muscles and tendons – in fact all organs of the body, age at the same rate. You will not ever know you need a knee replacement, you will just feel the effects of the wear and tear – pain, aching, reduced movement, reduced motion and activity, or any number of other symptoms. A specialist surgeon will determine the appropriate management for your condition – whether non surgical or surgical. There is no ‘right time’ for it to be done, but I like to tell my patients they will know and they will tell me when they have had enough of their existing arthritic joint.
Knee replacement surgery involves changing the bearing surface you walk on – removing a thin layer of wear and tear old cartilage and bone surface from the end of your femur (thigh) bone and top of your tibia (shin) bone, removing the meniscus and cruciate ligaments ACL and PCL – and replacing it with a metal surface attached by cement to the end of your femur and tibia. A polyethylene (hard plastic) liner is placed between these surfaces – the polyethylene is your new cartilage that you walk on.
A Knee replacement should last a lifetime in the vast majority of people. This is VERY different to the common held misconception by people in the community that they will only last 10 years or so. This is a historical old wives tale, and a classical question in consulting rooms.
We think of how long a knee replacement will ‘last’ based on its likely need to be revised – ie re-done with another operation. We collect data in Australia on every joint replacement ever done since 2001, and can look at this data to see how a knee replacement is performing over time by its need to be re-done. Any knee replacement being re-done will be recorded, and can be assessed to its ‘lifespan’.
So for all knee replacements done in Australia from 2001, the likelihood of it needing to be re-done at 24 years is only 7.8%. So you have a 92.2% likelihood at 24 years after your new knee goes in, of it still being in there without needing to be replaced. (Correct at January 2025)
This should comfort many people!
We do not judge how successful a knee replacement is by how long ‘it lasts’ though. A successful knee replacement operation is one in which you feel pain relief after your recovery, your arthritic pain is gone, and you have movement and function that you feel allows you to do the things you want to in life. All data suggests that rate of satisfaction after a total knee replacement to be around 80% in Australia. Higher volume subspecialty surgeons tend to cluster with more patients satisfied post surgery than lower volume surgeons.
A partial knee replacement or “unicompartmental” knee replacement replaces only one half of the inside of the knee. The surface of the end of the femur that is arthritic, and the accompanying tibia surface along with the meniscus that corresponds to that half of the knee are removed, and replaced by cementing metal to the two bone ends, and placing a hard plastic liner that is the new cartilage between them. These operations can have a quicker recovery than a full knee replacement, but if performed for the incorrect indications can often result in the individual needing it taken out, and a total knee replacement put in. They also have a higher risk of revision (re-do) surgery in the future and so a specialists opinion and skill is required. Always seeking information and opinion from a subspecialist knee surgeon is the best course of action to determine if you are appropriate for this specific surgery.
Recovery after a total knee replacement is variable from person to person, but generally speaking for patients aged 50 right through to 90 years old – the operation takes approximately 60 minutes for a routine knee replacement. Patients old or young will walk an hour or two after their operation for a few steps, and are out of hospital after 2 nights. You can shower as normal after the operation without concern. You will be able to walk up and down stairs before you even leave hospital. Patients need to use crutches for a week or two (often much sooner) to feel stable when walking.
Bilateral knee replacements or double knee replacements is having both knees replaced at once – and as you can imagine – is no small undertaking. The recovery is in general a little slower; 3-4 nights in hospital, 2-3 weeks on crutches, and 10-12 weeks to recover to a point similar to a single knee. People notice more (obviously) pain, similar swelling and symptoms – but the benefits of going through just one hospital stay, one recovery, one rehabilitation, and quick recovery times are clear. Not everyone is appropriate for bilateral knee replacements – generally you are not suitable if you are over 70 years old, have pre-existing major heart problems, or prior stroke. This is because the strain on your body and organs having a long operation and recovery increases the risk over these ages of having major problems such as stroke and heart attack at, or after the surgery.
A check of your wound occurs 2 weeks after the operation. I utilise an all dissolving stitch material buried under the skin so nothing needs to be removed, simply a waterproof dressing is peeled off and that is all. Some surgeons use metal staples, which will leave scars either side of your wound, and need removing with a staple remover 2 weeks after your surgery.
Physiotherapy starts at 2 weeks after the operation, and tends to be a visit a week for couple of weeks, once a fortnight for a couple of fortnights, then one or two further visits to get your strength and movement improving.
You can swim in a pool after a knee replacement once the wound is fully healed over, normally around 3 weeks.
You can drive after your knee replacement depending on which side is operated on, and what type of car you have. Right knee/automatic car for instance you’ll need to be able to bend and straighten the knee safely, not be on any strong pain relief medication, and be able to press the brake quickly if something runs out in front of you. This tends to be around 3-4 weeks after your surgery. Left knee for the same (no clutch to push) can be quicker, often around 2-3 weeks.
The left knee for a manual is an effort pressing the clutch repeatedly, and you will feel sore and fatigued early – this tends to be 6 weeks after surgery to be safe but can be a little quicker if you’re doing well.
There is no written clearance necessary to drive, it is based on your progress and capability.
Another common expectation is walking distances after knee surgery. Most people around 8 weeks after their surgery can walk 1.5 kilometres in a burst, often 2-3 times a day, OR can walk 5km’s or thereabouts in a single go. Some people can climb mountains – yes climb a mountain – at this time. Some people may still be in agony and barely walking 500 metres. This is highly dependent on your motivation, perception of pain, capacity to complete tasks, supports at home etc. Do not be concerned if you feel slower than others, it is all a spectrum of healing and it is not a race. I prefer my patients to be the tortoise, not the hare.
Knee replacement surgery is a painful process. Those surgeons advertising anything different are lying. Irrespective of having a minimally invasive muscle sparing knee replacement like I provide, or the old school knee replacement, you will feel like a horse has kicked you, lots. Pain is managed during and after your operation by the Anaesthetist. Your surgeon and his physician will manage this for you in the days and weeks that follow. Ice over the area, pain tablets, physiotherapy, and activity will be your friends to improvement over time. It is the most painful joint to replace, and the biggest joint in size to replace.
Total recovery after a knee replacement varies by age and pre-operative health status. If you are a 60 year old having a knee replacement, I expect the same timeframe for recovery as a 70 year old overall. This being around 8 weeks before you’re getting around quite freely without too many lingering symptoms. You may find some niggling pains around the knee, and difficulty sleeping in the evening as your “major” issues at that time – but it will be vastly different to what you experienced before you had your knee replaced. An 80 year old with some background health problems may find it a little slower going early, sometimes needing 3 nights in hospital – but the wound will heal in the same time frame, physiotherapy occurs at the same time frame, and recovery at 8 weeks still roughly equivalent to that of a 60 year old. Our bodies go through healing phases, and inflammation is a key in this, which you cannot speed up or improve – irrespective of your age. This is why patients, young or old, if appropriate for the operation, and in skilled surgeons hands, tend to do well after a total knee replacement.
The cost of knee replacement surgery in Australia is largely determined by your private health fund. A public patient in a public hospital is covered under Medicare with no cost. A Veteran under Department Veterans Affairs incurs no cost also. A self funding patient with no insurance getting a knee replacement in a private hospital will generally be out of pocket approximately $30,000 dollars. A private patient will have out of pocket expenses that vary from health fund to health fund. Not all funds are the same – you may think they are just cheaper for you with less out of pocket and the same refunds and returns but this is most certainly not true. The cheapest premium cost insurers (eg NIB) will give you back the lowest returns on the surgery costs. So whilst you pay less year to year on your insurance premiums, the surgery out of pocket costs will be much higher if and when you do need to see a specialist. The major insurers (BUPA/Medibank Private/HCF) all cover similar middle range costs but there are still out of pocket expenses. So whilst you think you have “top cover” – you indeed do not and that is just a term these companies create to enhance their client numbers. These are big businesses – they are not in the interest of providing top level care to their customers. They are about profits – a recent Australian Medical Association press release spoke to the fact that patients are receiving less in rebates as a proportion of premiums each year. Your costs you will likely incur are your private insurance ‘gap’, and a gap for the anaesthetist and surgeon.
Overall the out of pocket amount varies but is generally a few thousand dollars for a high volume top surgeon. Your costs are provided to you with a full breakdown after the decision you need a joint replacement is made, and you receive this as an independent financial consent to allow you to make clear decisions when money matters.
Beware of fly in-fly out surgery. Like cosmetic tourism in Thailand and Turkey that have been popularised in recent years, seldom do you hear of the good outcomes. A surgeon who meets you only via phone, and does not ever follow you up in person, is a dangerous road. What happens if you require regular review, have a complication, or major issue necessitating surgery and long stays in hospital? These things happen everyday all around Australia – be wary of things too good to be true (anything “free” is never free). Be aware there will be cost cutting everywhere along your journey to maximise profit to some surgeons and insurers. They aren’t in the business of being charitable.
Like all big decisions and especially for knee replacement surgery – ensure you research your surgeon before your appointment, and choose someone that you are comfortable with after meeting, and consulting on your problem. Speak to your GP, or contact a different surgeons consulting rooms directly if you don’t feel comfortable, after all you are the most important person in this decision tree.
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