Orthopaedic Surgery for Shoulder, Knee and Sports Injuries in the Midlands
Mark Hamlet FRCS (Orth)
Shoulder knee and sports injuries specialist
​Tel: 01543  481929
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Unicompartmental Knee Replacement


PROCEDURE: 
The knee is an important hinge joint and as it is weight-bearing can be prone to “wearing out”. Arthritis is painful and disabling and you and your surgeon may have decided that a partial knee replacement may be your best option.

A knee replacement is a surgical procedure, in which the injured or damaged running surfaces of the knee are replaced with artificial parts which are secured to the bone.

If your knee joint is only worn on the inside surface then you may be suitable for a half replacement, or Unicompartmental Knee replacement.

An advantage of this is quicker recovery and a knee that feels more like a normal knee than after a total knee replacement. There are reasons that you may not be suitable for this and your surgeon should be happy to explain this were it to be the case

If you have any X-rays of your own please remember to bring them with you to the hospital.


Medial Joint Arthritis- Note the narrow joint space
Pre Op planning
Post Op X-Ray. Note joint line is now corrected
You will be seen by the surgeon before the operation. They will take this opportunity to draw (mark with a pen) on your leg. This is to make sure the correct leg is operated on. If you have any questions, this might be a good time to ask them.

An anaesthetic will be given in theatre. This may be a general anaesthetic (where you will be asleep) or a spinal block (e.g. where you are awake but the area to be operated is completely numbed). You will have the opportunity to discuss this with the anaesthetist. 

A tight inflatable band (a tourniquet) is not usually required by Mr Hamlet to do this operation. Your skin will be cleaned with anti-septic solution and covered with clean towels (drapes). The surgeon will make a short incision (a cut) just to the inner side of the knee. The knee capsule (the tough, gristle-like tissue around the knee) which is then visible can be cut and the knee cap (patella) pushed to one side. From here, the surgeon can trim the ends of the thigh bone (femur) and leg bone (tibia) using a special bone saw. At this stage an assessment of the other parts of the knee may show that a total knee replacement is required

Using measuring devices, the new artificial knee joints are fitted into position. The implants have an outer alloy metal casing with a “polyethylene” bearing which sits on the tibia.

When the surgeon is happy with the position and movements of the knee, the tissue and skin can be closed. This may be done with stitches (sutures) . The  stitches will need to be removed around 10 to 14 days after the operation.

Drains are not usually used.

When you wake up, you will have a padded bandage around the knee. If you are in pain, please ask for pain killers. If you have pain, it is important that you tell somebody.

You will be encouraged to stand and take a few steps within hours of the operation .
You may go for an X-ray the day after the operation.

Many people  can expect to be going home the same day, or the day after surgery.

Whilst in hospital you will be visited by the physiotherapy team, who will suggest exercises for you. It is important to do these (as pain allows).


***please be assured that as a private patient of Mr Hamlet you will see him at every step of the way and he will perform the   operation***


Alternative Procedures:


Knee replacements are usually performed on patients suffering from severe arthritis (although there are other reasons). Most patients are above the age of 55yrs.


Other alternatives include – Losing weight,

                                              Stopping strenuous exercises or work,       

                                              Physiotherapy and gentle exercises,

   Medicines such as antiinflammatory drugs

                                            (e.g. ibuprofen or steroids),

                                              Using a stick or a crutch, 

                                              Arthroscopy

                                              Using a knee brace,

                                              Cartilage transplant,

                                              Knee fusion (arthrodesis)

Some of the above are not appropriate if you want to regain as much physical activity as possible, but you should discuss all possibilities with your surgeon.

  

Risks and Complications of Operation

RISKS

As with all procedures, this carries some risks and complications.



COMMON: (2-5%)     

         Pain: the knee will be sore after the operation. If you are in pain, it’s

                        important to tell staff so that medicines can be given. Pain will

                        improve with time. Rarely, pain will be a chronic problem & may be   

                        due to any of the other complications listed below, or, for no obvious

                        reason. Rarely, some replaced knees can remain painful.

       Bleeding: A blood transfusion or iron tablets may occasionally be required.

                        Rarely, the bleeding may form a blood clot or large bruise within the

                        knee which may become painful  and require an operation to remove it.



              DVT:(deep vein thrombosis) is a blood clot in a vein. The risks of 

                        developing a DVT are greater after any surgery (and especially bone

                        surgery). DVT can pass in the blood stream and be deposited in the

                        lungs (a pulmonary embolism –  PE). This is a very serious condition

                        which affects your breathing. Your surgeon may give you medication

                        to try and limit the risk of DVTs from forming. Some centres will also

                        ask you to wear stockings on your legs, while others may use foot

                        pumps to keep blood circulating around the leg. Starting to walk and

                        moving early is one of the best ways to prevent blood clots from

                        forming

Knee stiffness: may occur after the operation, especially if the knee is stiff before the

                        surgery. Manipulation of the joint (under general anaesthetic) may be

                        necessary

Prosthesis wear: With modern operating techniques and new implants, knee

                       replacements last many years. In some cases, they fail earlier. The

                        reason is often unknown. The plastic bearing is the most commonlyworn away part. With a unicompartmental knee replacement there is also the risk that the side that was not replaced wears and causes pain. This may necessitate a conversion to a total knee replacement

LESS COMMON: (1-2%)

     Infection: You will be given antibiotics at the time of the operation and the

                        procedure will also be performed in sterile conditions (theatre) with

                        sterile equipment. Despite this infections still occur (1 to 2%). The

                        wound site may become red, hot and painful. There may also be a

                        discharge of fluid or pus. This is usually treated with antibiotics and an

                        operation to washout the joint may be necessary. In rare cases, the

                        prostheses may be removed and replaced at a later date. The infection

                        can sometimes lead to sepsis (blood infection) and strong antibiotics

                        are required.

RARE: (<1%)              



                PE: a Pulmonary embolism is the spread of a blood clot to the lungs and can



                        affect your breathing. This can be fatal. 



Altered leg length: the leg which has been operated upon, may appear shorter or   

                        longer than the other.



Altered wound healing: the wound may become red, thickened and painful (keloid

                        scar) especially in Afro-Caribbeans.

Joint dislocation: if this occurs, the joint can usually be put back into place without        

                        the need for surgery. Sometimes this is not possible, and an operation

                        is required, followed by application of a knee brace      

Nerve Damage: efforts are made to prevent this, however damage to the small nerves

                        of the knee is a risk. This may cause temporary or permanent altered

                        sensation around the knee. There may also be damage to the Peroneal     

                        Nerve, this may cause temporary or permanent weakness or altered

                        sensation of the lower leg. Changed sensation to the outer half of the

                        knee may be normal.

Bone Damage: bone may be broken when the prosthesis (false joint) is inserted. This

                        may require fixation, either at time or at a later operation.

Blood vessel damage: the vessels at the back of the knee may rarely be damaged. may

                        require further surgery

            Death: This very rare complication may occur after any major surgery and

                        from any of the above.
Patient Information Booklet (NHS)
unicompartmental_knee_replacement-patient_information_booklet-version2.pdf
File Size: 496 kb
File Type: pdf
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