Knee Replacement

Diagnosis

We will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.

X-rays typically show a narrowing of the joint space in the arthritic knee.

• Our knees are vulnerable to wear and tear. Cartilage is the slippery lubricant that covers your joints and lets them glide smoothly. Over time, this cartilage can wear away, particularly in the knee and hip joints that support your body. Your age, your weight, and old injuries also matter. The result is that the bones of the joints rub against each other without enough cushioning. This is called osteoarthritis (OA).
• The first sign of knee OA is often pain and stiffness. Similar to hip OA, pain is typically worse in the morning. You may find that your knee locks or buckles when you walk. Eventually, you may feel pain and have trouble flexing your knee. Kneeling or climbing stairs may make the pain worse. The knee may feel tight and swollen, and hurt at the back of the joint.
• You can relieve OA at home. First, get enough rest. While it’s important to stay active, give your joints time off when they hurt. Second, ask us about taking chondroitin and glucosamine. These supplements may help ease pain and help you move more comfortably. You can try anti-inflammatory drugs like ibuprofen (Advil, Neurofen), Diclofenac (Voltaren rapid 25, Fenac) or Naproxen sodium (Naprogesic, Naprosyn) if we say these are safe for you. Panadol Osteo is also worth a try. They can provide fast relief for mild to moderate arthritis pain.
• Viscosupplementation Hyaluronic acid injected into an arthritic joint can afford symptomatic relief of pain and stiffness in about 70% of cases provided that the OA is not bone on bone. The injections can be repeated up to 3 times for maximal effect. We currently use “Durolane” (Bioventus) which is a stabilised single injection preloaded 60ml Hyaluronic acid in 3 ml. There is some evidence that Hyaluronic acid acts to heal early cartilage lesions and slow progression of disease.
• Stem Cell Therapy Currently there is no objective evidence that the results of stem cell therapy are any better than placebo in the treatment of osteoarthritis. There is anecdotal evidence but no randomised prospective blinded studies to support this therapy. St Vincent’s Bone & Joint do participate in ongoing evaluation of this therapy but accept that at this stage the treatment is experimental and requires more study.
• Losing weight reduces pain and stiffness. Being overweight puts extra stress on your knees and hips. You may be surprised to know that every 3 kg you lose can lower your arthritis pain by as much as 20% by decreasing the load in the joint.
• Exercise helps joints work better. Keep limber and start with stretching. Low-impact exercise, such as swimming or cycling, will strengthen your joints and increase their range of motion. A physio therapist can show you exercises to strengthen the muscles that support your knees or hips. Stronger muscles can reduce the stress on your joints during everyday activities, too.
• OA of the knee or hip can make it hard to walk. If there isn’t enough cartilage lining your joint, walking might hurt. Your joint may get so stiff that you can’t bend your knee or rotate your hip. People with severe OA of the knee or hip may need a cane to walk.
• Without treatment, OA usually gets worse. As the cartilage continues to wear away, the joint may become swollen and painful. In severe cases, bone rubs directly against bone, making any movement of the joint excruciating. Even at this point, you can still take steps to slow the damage.
• Joint replacement gets rid of pain. When other things don’t provide enough relief, your GP may recommend seeing us to discuss a hip or knee replacement. Often all the joint needs replacement, which is called a total joint replacement. In certain situations, only a partial joint replacement is necessary, especially in the knee. After recovering, most people can walk more easily and are pain-free.
• Rehabilitation is vital after joint replacement surgery. A rehab program includes vigorous exercises to make sure your new joint is flexible and to strengthen the muscles around it. People who stick to their rehab program have the greatest possible range of motion, meaning they can do more of the activities they used to do. All joint replacement patients continue to improve for at least 12 months, provided they keep up an exercise programme. Recovery normally takes 3 months until you are back to doing all your regular activities without discomfort.

What medications should I stop before operation?

Many tablets can cause excessive bleeding at operation so it is essential to cease taking the medication well beforehand. However, if you are taking such medication for problems with your heart or blood vessels, please ensure you discuss this us.

Stop the following one month (30 days) prior to admission:

• HRT (excluding Prednisone)
• Tamoxifen
• Arava
• Letrozole

Stop the following 5 days prior to admission:

• Alka-Seltzer, Chemgesic, Percoden
• Asasantin, Codiphen Forte, Persantin
• A.S.A. Aspirin, Cliopidogrel, Plavix
• Aspirin, Codis, Rheumat-ese
• Aspalgin, Codox, Rhusal
• Aspro Clear, Codral Forte, Solocode
• Asprodeine Soluble, Disprin, Solvin
• Astrix, Doloxene, Solprin
• Bex, Ectorin, Salicylamide
• Bufferin, Ensalate, SRA
• Cartia, Iscover, Vincents powder/tabs
• Cardiprin, Morphalgin, Winsprin
• Clusinol, Orthoxical Cold & Flu Tablets

Anti-Inflammatory Drugs

ACT-3, Clinoril, Inza, Priohexal, Aclin, Crysanal, Mefic, Prioxicam, Actiprofen, Dinac, Methotrexate, Proxen, Advil, Doloboid, Mobic, Rafen, Arthexin, Feldene, Naprogesic, Rheumacin, Arthrotec, Fenac, Naprosyn, Surgam, Brufen, Flexin, Nurofen, Tilcotil, Bugesic, Ibuprofen, Orudis, Toradol, Candyl, Indocid, Oruvail, Tri-profen, Celebrex, Inflam, Ponstan, Voltaren

Anticoagulants

Warafin/Coumarin/Marevan cease 5 days pre-op. The tablets will have to be withdrawn prior to surgery and CLEXANE injections are substituted up to the time of operation.

ANTICOAGULANT tablets will be resumed after surgery under the direction of A/Prof Neil.