Consider the following scenario:
You are a fit and active 65-year-old man; you play golf once a week and tennis twice a week. Your right knee has been creaking for a few years, and during the previous few weeks has become very sore, swollen and stiff. Your knee is now slowing you down, affecting your enjoyment of sport and exercise. You are waking with pain in the mornings and finding it slower to get up and going.
You consult an experienced chartered physiotherapist who, following a thorough clinical assessment, diagnoses you with medial compartmental knee osteoarthritis. Your physiotherapist provides a course of treatment which reduces your pain levels by 60% and improves the mobility and strength of your knee. A good result, but not quite enough to get you back to playing golf and tennis comfortably. What next?
Your physiotherapist refers you to a good orthopaedic consultant for and opinion. At this stage, the consultant arranges for an MRI scan which confirms the physiotherapist's diagnoses of knee osteoarthritis, which appears moderate to advanced. The consultant administers a series of injections to the knee, which results in temporary improvements. After further assessment, the consultant recommends considering knee replacement surgery.
According to orthopaedic consultant Gavin McHugh, a total knee (the whole joint) or partial knee (most affected half) replacement may be considered. If deemed suitable for both and given the option, he would recommend a partial knee replacement. Total knee replacements are good at relieving pain, but patients may struggle to achieve full knee mobility and function post-surgery. For example, the flexion (bending) movement usually reaches around 100-110 degrees at full range post-surgery. By comparison, partial knee replacements typically result in better postoperative mobility and function, making it a good option if wanting to return to sport. Partial knee replacements are also easier to revise if required. According to Gavin McHugh, around 50% of knees with osteoarthritis are suitable for partial knee replacement, so if you are considering a knee replacement, ask your consultant about both options.
Following knee replacement surgery, a course of physiotherapy is typically required to improve mobility and strength, thereby increasing the likelihood of a successful return to sport. To find out more about physiotherapy post-surgery, please check our blog here.