Total Knee Replacement in Perth

What’s involved?

Total knee replacement surgery (total knee arthroplasty) is a common choice for the treatment of osteoarthritis (knee arthritis). Unlike partial knee replacement, which involves replacing only the damaged sections of bone and cartilage in the knee, total knee replacement surgery involves replacing the entire knee joint.

“The areas of damaged cartilage are removed from the end of the bone and replaced with metal and high-density polyethene (plastic),” explains Dr Rhys Clark.

The plastic is placed between the pieces of metal to mimic your old joint and cartilage.

This comprehensive approach ensures effective relief for patients suffering from knee arthritis.

Am I a candidate?

Your knee is made up of three sections– the medial (inside), the lateral (outside), and the patellofemoral (kneecap). When two or more of these areas are damaged by osteoarthritis, a total knee replacement may be required. When osteoarthritis is at its worst, it can completely wear away your cartilage resulting in your bones rubbing against each other. This can mean a smaller range of movement and stiffness in your knee and can also cause issues such as bow-leg or knock-knee deformities. X-ray and CT/MRI imaging will be used to determine the extent of the damage in your knee.

“Once the cartilage in your knee becomes damaged it can cause you a considerable amount of pain. When that pain can’t be treated with medication, physical therapy, and/or injections, a total knee replacement may be required.”

Robotic assistance and a virtual pre-op

Rhys uses robotic assistance in total knee replacement surgeries. While Rhys is still in control of the procedure, the robot assists in the bone preparation and placement of the implant. You will be required to have an additional CT scan to help with the planning of your surgery. These images help Rhys to create an image of your knee that allows him to choose the correct size and location of your knee replacement.

“Before any surgery takes place, I use the images from your CT scan to complete a virtual pre-operation on a computer. When it comes to performing your surgery, the robotic arm helps guide me in making the bony cuts and implant placement.”

Robotic-assisted knee replacement covers this in full — what the robot does and does not do, how the CT planning works, and what the evidence currently supports.

What to expect from surgery

You can usually return home three to five days after your knee replacement in Perth. Rehabilitation exercises and further appointments will follow, but most patients are able to bear weight within six hours after surgery. You may be required to use crutches or a walking stick for the first four to six weeks depending on your stability. It is important for your post-op recovery that you continue to move your knee while also allowing your wound to heal. Keeping up your movement post-op will increase your range of motion and prevent blood clots and other complications.

The surgery is generally very successful both in patient satisfaction, reducing pain, and improving quality of life. In the rare case, something with your knee replacement goes wrong, knee revision surgery may be necessary. The chances of you needing another knee surgery later in life is lower than those that have partial knee replacements.

“Total knee replacement surgery is one of the most rewarding operations I do,” shares Dr Clark.

What is knee replacement surgery?

Knee replacement surgery, particularly Total Knee Replacement, is a complicated treatment that involves replacing an arthritis-affected knee joint with a high-quality prosthetic device.

Despite popular belief, the procedure usually entails removing about 5-7 mm from the ends of the bones, rather than substantial chunks of the thigh or shin bone.

The surgical procedure entails putting metal caps on the ends of the femur and tibia made of strong metal alloys such as cobalt-chrome or titanium, which ensure longevity and compatibility with the body. Specific bone cement is frequently used to fix the knee replacement, improving the prosthetic’s fit and stability. A polythene insert or plastic liner is inserted on the upper side of the tibial component to connect these metal components. This liner allows for easy mobility between the femur and tibia and is made of high-quality polythene for long-lasting wear and performance. Additionally, the undersurface of the patella is resurfaced with polythene to ensure consistency in the prosthetic materials utilised.

This comprehensive method not only attempts to alleviate pain but also to restore mobility to people suffering from the crippling consequences of severe knee arthritis. It is critical to understand that, while these prosthetic components are meant to last, their lifespan can vary depending on individual circumstances.

Understanding minimal invasive surgery (MIS) for knee replacements

When considering minimally invasive surgery (MIS) for knee replacements, it is crucial to remember that the size and shape of the knee prosthesis have some limits. Specifically, the replacement’s size makes it impractical to implant into a very small incision; it just won’t fit. Rhys continuously strives to reduce the size of each patient’s incision, but this effort can be influenced by a variety of factors, including the size of your knee, the extent of arthritis and any existing deformity, as well as pre-surgery stiffness levels.

In debates on minimally invasive surgery for total knee replacements, a modified surgical method is frequently mentioned. This alternative method changes how the surgeon approaches the knee, intending to minimise the effect on the quadriceps tendon. While this procedure has its own set of advantages and disadvantages, Rhys is committed to offering thorough explanations and determining whether this approach is appropriate for your specific needs and surgical goals.

Your operation day: what to expect

On the day of your knee replacement in Perth, you will be admitted to the hospital, usually in the morning. The nursing team will assist you in changing into surgical clothes and making the required preparations for the surgery. Rhys will meet with you in the preoperative holding area to answer any last-minute questions and mark the knee to be operated on, assuring clarity and precision before moving to the operating room. Additionally, the anaesthetists will introduce themselves and perform final tests to assure your safety and comfort.

Following these preparations, you will be brought to the operating theatre, where the surgical team will be waiting for you. The anaesthetist will implant a cannula into your arm to administer medicine and perform a spinal block while you are positioned sitting up with your legs dangling over the side of the bed. This is followed by the administration of a sleep drug. To properly control post-operative pain, your leg will receive a specific nerve block with a local anaesthetic while you sleep.

The knee replacement treatment is carried out under sterile conditions. Following surgery, your leg will be wrapped and an ice pack applied to reduce swelling. You will then be sent to the recovery room, where you will be monitored by a specialised nurse until you are completely awake and ready to be transferred to the ward.

Once on the ward, our team of orthopaedic nurses will continuously monitor your development. Due to spinal anaesthesia, it is usual to experience numbness in your legs for the first few hours after surgery. As the anaesthetic wears off, the sensation will return to your legs, but you may experience some discomfort. With the assistance of physical therapists and nurses, you will be urged to stand and take your first steps with your new knee as soon as it is safe to do so.

Post-operative care and recovery

The journey to recovery begins on the first day after your knee replacement in Perth. A physiotherapist will teach you particular exercises that you may practise from the comfort of your own bed. The morning after your knee replacement, most – or all – of the drugs from your surgery will have worn off, leaving you to rely on pain relievers taken orally to manage your discomfort. The morning after the catheter is withdrawn from your bladder, you will shower and be expected to return to “normal” loose-fitting clothes. Rhys also prefers that you sit outside in a chair for your meals and try to get back into your regular pattern. An X-ray of your knee will be done to ensure that everything is in order and that your new prosthesis is properly placed. The bandages surrounding your knee will be decreased, and the dressing Rhys applied in theatre will normally last for two weeks before being examined in Rhys’ clinic.

Daily physiotherapy sessions will be part of your routine until you are discharged; nevertheless, while it is crucial to exercise, you should do so in moderation and within your pain tolerance at first. Before discharge, the physical therapist will confirm that you are mobile and capable of going up and down stairs.

Discharge from the hospital is dependent on a few crucial milestones, including safe mobility, adequate knee motion, and controllable pain with oral medication. If you require more in-patient treatment to complete your recovery, we can arrange for a transfer to a rehabilitation unit.

Continued rehabilitation after returning home

After being discharged from the hospital, usually two to three days after surgery, you can continue your journey to complete recovery and therapy from the comfort of your own home. Initially, you will require crutches for mobility, usually for two to four weeks. You will also be given a prescription for appropriate pain management drugs, which should be taken regularly as indicated.

For a full week-by-week account of what to expect — the first fortnight at home, when driving becomes possible, and what the first year realistically looks like — see Knee Replacement Recovery.

The primary goal at home should be to rest. It is vital to pace yourself and avoid overexertion during this critical healing period. Rhys will organise a follow-up appointment around two weeks following your surgery to evaluate your wound, review your pain management needs, and make sure you have enough medicine. Around this time, your physiotherapy routine may be increased to help you heal even further.