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Join Dr Liew in answering your questions. Post a comment on the Facebook Post specific for HIP and KNEE REPLACEMENTS and Dr Liew will read, and answer most questions on here. The current segment is focussing on Hip and Knee Arthritis and Joint Replacement Surgery. Please note that sensitive medical information will not be disclosed on this page. This area will be used for general questions that can be used to help others that may have the same questions as you.

Had knee replacement 7 years ago and hip replacement 13 years ago. How much longer will they last?

I have a knee replacement and a hip replacement they are still going good, knee about 7 years & hip about 13 years can you tell me how much longer they will last please

Thankyou for your great question – it is often asked. Currently the Australian Joint Registry monitors all knee replacements and all hip replacements. This shows that at 15-16 years after your primary hip or knee replacement, the general revision rate is approximately 8%. This means that at that time period, the rate of hip and knee replacements that have NOT been revised for ANY reason is about 92%. This is fantastic, and we are only forecasting that this number improves with time. ie: we believe that with current minimally invasive methods and better materials and more accurate methods of aligning implants (such as when we use patient specific technology for hip and knee replacements), this will likely result in an improvement of the survivability.

I would say that you have nothing to worry about with either at this stage, and only pain or functional changes should prompt you for further investigation. I recommend that my patients have a repeat Xray around the 15 year post op mark to check the prosthesis, or earlier if there are any unusual symptoms. Otherwise, the time of 20-30 years survivability of hip and knee replacements is probably here.

I hope this helps clarify things as we often hear from our patients that the general belief is that hips and knees only last 10 years or so, which is absolutely not the case. Enjoy your hip and knee!

68yo, had arthroscopy 6 months ago. Diagnosed with osteoarthritis as cartilage is worn down.

Hi, I’m 68 years old, have had an arthroscopy on my left knee around 6 months ago. Since then I have had to have an MRI done due to pain and Bakers cyst.
My surgeon diagnosed osteoarthritis, and said my cartilage is worn almost all the way down on the inside of my knee. He recommended a knee replacement.
Do I have any other options, if not, what is my recovery time using your methods. Thanks

Hello – and thankyou for your question. Unfortunately if you have had a knee arthroscopy and MRI that confirms full thickness cartilage loss, this would best be managed with a knee replacement. You would have found little long lasting success from your knee replacement due to the fact that you had osteoarthritis. An arthroscopy often only provides temporary relief, due to washing out of the loose floating cartilage and inflammatory cells. Current studies show a low rate of success in patients over 50yo who do not have a significant injury causing a definable tear of the meniscus with no osteoarthritis. In all other cases, the benefit of the knee arthroscopy is low.

With total knee replacements performed via patient specific technology, we have found this to be an excellent method for aligning the knee accurately, and providing us with reproducible and excellent results. From my own experience, I have changed from conventional methods 5 years ago to all my knees being performed using patient specific technology. The ability to personalise the solution for each and every patient is critical to my success and provides me with a level of customisation that I was not able to achieve previously. It is currently one of the most accurate methods of performing a knee replacement. We are pleased to provide this technology for our hip replacements as well.

As far as recovery time goes, in our practice, it has certainly improve our outcomes. We find that our patients are more active at earlier timeframes, and generally need less pain medications post operatively. The fact that we do not have to drill large rods into the bone or any tracking pins into the bone is an excellent thing, and decreases the pain associated with that. Whilst every patient recovers at a different rate, our general recovery rate is certainly quicker than what it was 5 years ago.

I hope this helps.

Patellas moving outwards and becoming very painful. What type of operation does this repair need?

My Patellas r moving outward and becoming very painful. My sister had this and her patella came completely away. What type of operation does this repair need?

Thankyou for your enquiry – I am guessing that you have not yet had a total knee replacement and this is your native (unoperated on) knee. This suggests that you have dislocating or subluxating patella. The cause of this can be bony or soft tissue. A thorough assessment is made, to determine which the cause is, and then the appropriate operation is performed. In general the following operations are considered:

  • Medial patellofemnoral joint reconstruction – hamstring is harvested and a re-grafted to reconstruct the MPFL (Medial Patellofemoral Ligament). This is performed using 3 small cuts and a special kind of anchor. 2 anchors are placed into the patella and 1 into the femur. This acts as a restraint to your knee cap dislocating.
  • If the bony anatomy of your knee is the issue, then you may have discovered that you have had this issue for a very long time. In these cases, a tibial tubercle osteotomy, combined with an MPFL reconstruction is the operation of choice. This is performed with a single long incision down the inside of your knee. The osteotomy moves a portion of your tibia to the side to “realign” the patella tendon. This allows the pull onto your knee cap to be correct for your anatomy.
  • If your cartilage has been worn due to years of dislocating and it is now bone on bone, and you have other signs of degeneration – in some cases a total knee replacement is performed.

The choice of operation is highly dependent on further imaging, and at least, an Xray, CT (for a special study of alignment) and an MRI is needed.

I hope this answers your question.

Knee replacement in 2017, and have been very unwell since. Inflammation factor is now over 100. Could this be due to the prosthesis?

I had a knee replacement in sept 2017 and have been very unwell since. My inflammation factor is now over 100. Could this be caused by an allergic reaction to metals in the prothesis?

Thankyou for your question – it is very rare to have an allergy to the prosthesis. The prosthesis is very inert, and in my experience, I have never actually seen or heard of a patient who has a true allergy to metals from the prostheses that are implanted. The best thing to do would be to have some allergy testing, although this is skin testing, and not deep tissue so the relevance isn’t 100% proven.

If you have been unwell, and your inflammatory markers are elevated, then the possibility of infection should never be discounted. This is the main cause of feeling generally unwell, with elevated inflammatory markers. I would suggest that an arthroscopic biopsy of the tissue and synovial fluid be performed.

For your reference, usually the prostheses are made from Cobalt and Chromium. In some cases, titanium is used on the undersurface (when cement is not used).

When there is some evidence that someone is allergic to the metals used, we would opt for a low allergenic coating on the prosthesis. In our case, it is a gold coloured prosthesis which has different (even lower allergenic) metals used.

Can I still have hip surgery while I have three screws inserted in the near top of my femur?

Hello. Can I still have hip surgery while I have three screws inserted in the near top of my femur?

Thankyou for your question – it sounds like you may have had a neck of femur fracture, in which 3 screws called Cannulated Screws are placed into the neck of your femur and the head of your femur. With neck of femur fractures of this type, the head can loose blood supply, or due to the slight change in alignment of the femur, you may have developed post traumatic arthritis.

A total hip replacement can certainly be performed, and I recently performed this for a patient with exactly this condition. It is a straight forward operation. One small incision to remove the 3 screws (and usually 2 washers) and then a total hip replacement performed via the direct anterior approach. We find that this is no difference to having a total hip replacement without the screws, except for a very slight increase in the risk of fracture during the procedure. This can occur anytime there is metal work depending on how the metalwork was placed, and what metal work in in your hip.

I hope this answers your query, and thankyou for your question.

Husband has had knee replacement 18 months ago but still experiences severe pain. Arthroscopy revealed no infection. What are the options?

My husband had a knee replacement 18 months ago but is still experiencing severe pain almost continuously . Does he have any options? An arthroscope revealed no infection.

Thankyou for sending me this scenario, and certainly it must be troubling for you. A total knee replacement should be a fantastic experience and it is very rare that pain continues past the first 3-12 months. The usual post operative recovery very is one of continuous improvement. To have severe pain 18 months later is extremely unusual. What I would suggest is that a full analysis of the knee replacement is performed. This includes a set of blood tests, a bone scan (or SPECT CT), and an alignment study. There are many reasons for why a knee replacement may still be painful, but it requires a full examination and careful analysis of the history to determine what investigations are needed.

Ultimately, if a knee replacement is still painful, and it is not caused by other things (ie such as a compressed nerve in the back, or hip arthritis), then it is almost certainly from the knee replacement. One of the most important factors to determine is whether or not the pain is the same or different compared to before the surgery. If it is the same, then we would look more closely at other causes of the pain. If it is worse after surgery, then something is wrong. You mentioned that a knee arthroscopy was performed – this can rule out major infections, but sometimes there are infections under the prosthesis that cause pain, but may not be evident on first inspection or biopsy of the synovium. At the time of revision surgery, an infection may be found, beneath the prosthesis. We run an intraoperative testy called the Synovasure test which can identify an infection about 95% of the time in 20 minutes.

I hope this information is useful for you.

Patella did not track correctly. Several operations. What can be done - any suggestions?

Hi. I am 61 and had a knee replacement 4 years ago. After about I months I noticed my patella did not track correctly, and came out of the socket. I have been back in again with the sme doctor for another operation. This did not fix the problem. After much discussion he did not know why the problem still existed, and suggested I see another specialist. I seen another specialist who was highly recommended by family members, and he also went in. Now after three operations my specialist has told me he is not keen on going in again. I honestly can not tell you what either of them done. My patella still comes out but goes back in. When I walk I can feel it, walking up or down stairs and straightening my leg. Can they take the kneecap out or would this not fix the problem. This makes me feel unstable and as I am getting older will this. Cause a problem. my other knee is not good as well so I feel I should get this one stable before having the other one done if that makes sense. Any suggestions?

Thankyou for sending me your clinical situation – I am sorry that you’ve been having such a difficult time with your knee. Patella tracking is a very important part of the alignment of your knee, as it requires the alignment of your entire leg to be correct. Depending on the cause of your patella tracking issues, will depend on what is required to fix things.

A few things are generally the case with a poorly tracking patella. The first is the overall alignment of the prosthesis in the knee. If the femur is rotated away from your natural alignment, the patella will want to flick out. As you have felt, the patella always comes back to the correct position after you straighten the knee, but people with poor patella tracking often find it hard on stairs and hills due to the increased knee flexion required. Going down stairs is often the worst. The next thing is whether or not there is a large effusion (fluid) within the knee – this can cause the knee cap to sit in a awkward position as well. Of course, there will be a reason why your knee is still swollen after many years.

My suggestion is the first get an alignment study called a “Perth Protocol”. This will show the relative alignment of your knee prosthesis. If the rotation of the implant (femoral and tibia) is off, this can cause your knee cap to dislocate. A full workup is usually performed to assess this, including blood markers for infection. If it is a major issue, and the alignment is off, then a full revision with all the components is required. This can be longer surgery, especially due to the fact that you have had 3 surgeries meaning that you would have a lot of scar tissue in and around your knee. A patellectomy is the last resort and would result in you having an inability to fully straighten your knee actively. This can cause issues for you when lifting your leg, and it is not recommended unless there really are no other options.

A dislocating patella is not common, and is not correct. The cause should be found.

I suggest discussing this and further options with your orthopaedic surgeon.

TKR at aged 49. I have nerve damage since. Is there anything that can be done to fix the problem?

Hello, I had a knee replacement (as well as a knee cap) in 2013 at the age of 49. I have had nerve damage (severe pins & needles) since. Is there anything that can be done to fix the problem or at least reduce the pain?

Hi there, and thankyou for your enquiry – nerve damage is rare after total knee replacement so I am sorry that you are going through this. By now (5 years on), there is little chance that anything will improve with respect to your nerve damage as any nerve that would have regenerated would have done so by now. Nerve pain can be difficult to deal with, but there are some medications called “nerve stabilisers” that can be used to help you with the pain. One of these medications is called Lyrica. Depending on your other medical comorbidities, as well as the pattern of nerve injury – Lyrica might be a useful medication. You should discuss this with your general practitioner before deciding if this is a medication suitable for you.

Thanks again for getting in touch.

My mother is 83 and needs a knee replacement but she has Lypodema and they say there is nothing that can be done she is in a lot of pain

My mother is 83 and needs a knee replacement but she has Lypodema and they say there is nothing that can be done she is in a lot of pain. 

That sounds like a difficult situation. Depending on the severity of the Lypodema will depend on whether or not a total knee replacement can be safely performed. Whilst the legs are enlarged, ad the tissue is of a different quality, the healing process is altered. This increases the chances of infections and poor wound healing. Due to the extra tissue around the knee, there is generally more bleeding as well. Whilst it is not impossible to perform the surgery, there is some degree of Lypodema which would carry a much higher risk for surgery and therefore there needs to be a very real discussion about what happens if something does not go according to plan. These are very case by case decisions and I would suggest further direct discussion with an orthopaedic surgeon if surgery is contemplated. Of course, trying as many non operative modalities would be of high value. I hope that helps this difficult situation.

Knee arthroscopy 3-4 months ago. Now has severe pain. Does this sound like she will need a knee replacement?

My mum had procedure done on her knee approximately 3 -4 months ago cannot remember what it was called but I think it was keyhole surgery to remove / scrap osteoarthritis before opting to have replacement was good for about 1 month now she has started to experience severe pain and feels like its grinding when she walks or bends it ( hopefully that makes sence ) . She has been having physio and has been doing the exercise shes been told , does this sound like she will have to have replacement now for it to improve . Thank you

Hi there, and thankyou for your question. A knee arthroscopy in the presence of knee osteoarthritis is not usually completely predictable. Generally, we would consider doing a knee arthroscopy in the setting of knee osteoarthritis if there has been some sort of traumatic basis for the deterioration (ie a bad twisting injury on the knee). If it is just pain associated with osteoarthritis then the benefits of a knee arthroscopy are limited. It is usually a very short lived improvement.

If there is know established osteoarthritis, and the pain is worsening and function is worsening, then it is time to consider a total knee replacement.

I hope this helps.

Does the nerve damage after a hip replacement ever heal ?

Does the nerve damage after a hip replacement ever heal ?

Thankyou for your question – without knowing the type of nerve damage that you are experiencing, the exact likelihood cannot be determined. However, in most cases, nerve damage is very rare after a total hip replacement. In general, nerve damage can be one of 2 types: Motor or Sensory. It can also be both. In most cases, people who have early nerve damage will have this nerve damage resolved.

One of the reasons why I chose to use the direct anterior approach for all my total hip replacements is because the nerve damage profile is very different. When I was performing the posterior approach, the sciatic nerve was at risk, and if damaged, this could cause a foot drop, with altered sensation in the foot. This required a special splint to be placed until the nerve recovered (hopefully). Whilst this is relatively rare, studies show it to be around the 1% mark.

With the lateral approach, there is a risk to the superior gluteal nerve which can cause denervation of the abductor muscles of the thigh.

The other way that nerves can be damaged are if pins are inserted during ther surgery for any kind of “in operation” navigation. This requires pins to be drilled into the pelvis which attaches to sensors that are used to help guide some surgeons into where to place the prosthesis.

For our procedure, we use the direct anterior approach. One of the great parts of the anterior approach is that the major motor nerves are not risked. Therefore, the chances of waking up with a foot drop or muscle weakness is extremely low. There is, however, a higher rate of damage to a sensory nerve (Called the lateral femoral cutaneous nerve of the thigh) and whilst this usually recovers, the implications if it doesn’t are quite low – it is very well tolerated. Luckily, permanent nerve damage is rare. We do not place pins into the bone during surgery as we do all of our preoperative planning prior to surgery using special tools and scans.

In most cases, any nerve damage should show signs of recovery. If it is taking more than 6 weeks to show signs of recovery, then this usually indicates that a level of permanent damage may occur.

I hope this helps.

Despicable knee needing replacement. Am a very active person. What are the time frames for 10 pin bowling?

Hi there, have a despicable knee needing replacement, as I’m a very active person please could you give me some kind of time frame that I will be out of action, such as ten pin bowling and long walks?

Thankyou for your enquiry – the recovery is generally quick, although a period of rehabilitation is always required. Whilst everyone recovers in a different way, there are some time frames which people generally reach.

Firstly – active patients are excellent patients, as you really do get the most out of a joint replacement. As you notice that your quality of life and activity levels decreasing, you will find that it is extremely difficult to continue doing the things you love. Like 10 pin bowling and long walks!

After a knee replacement, you will spend the first 4 days on average in hospital. We like to to get you walking either the day of surgery or first thing the next morning. You would go home after your hospital stay, and spend the first 2 weeks doing range off movement exercises and letting the swelling come down. Physiotherapy starts at 2 weeks in its more dedicated state, and you use this time to push your range of motion to achieve between 110-120 degrees of flexion. For walking longer distances, you will take about 6 weeks until you are walking long distances. Uneven ground can still be an issue but you should be able to achieve a good level by 6-12 weeks post op. 10 pin bowling, especially if its your front leg, you may need about 8-12 weeks to return to good function here. Of course, you can return to these things earlier, but you will not be fully recovered. As always, limiting the duration of activities for the first few weeks is wise, as your leg is still swollen.

I perform all of my knee replacements using patient specific technology, with a design of the implant allowing a very natural movement of the knee once you have fully recovered.

I hope this answered your question.

What is the recovery like after a knee replacement? What is the waiting time for consultation.

Hi I’m wondering how long the recovery is after a knee replacement? Currently what is the waiting time for a consultation and subsequent knee replacement?

Recovery after any sort of joint replacement is variable. There are many factors, but generally 90%-95% of our patients fall within some general timeframes.

For a knee replacement, you will walk either the same day of surgery or first thing the next day. Your stay in hospital is usually between 3-5 days, and most of our patients go straight home. In some cases, due to home situations or other considerations, you may be assessed as requiring additional rehabilitation. This is arranged whilst you are in the hospital, but only if required.

We keep you using ice for the first 2 weeks on the knee to decrease swelling, and at the 2-3 week mark, you will attend your first appointment with us, to review your wound, pain medications and recovery. The more strenuous physiotherapy starts here, and you will have as many sessions as is necessary help you with walking and range of movement. When you reach your 3 month review, most patients are about 80-90% recovered. Driving is suitable at the 2-4 week mark for about 80% of our patients.

At 1 year, the aim is to give you essentially a “forgotten knee”. This means that you can do all of the activities you would like without considering or even thinking about your knee on a day to day basis.

Our waiting time for consultation is generally within 2 weeks, but can be prioritised in cases of urgency. Please indicate this when calling if required. We will do our best. Once deemed suitable for surgery, you will need to undergo your 3 dimensional scan to assess the overall alignment of your leg, and a scan of your knee in order to create the patient specific guides. These are created in Switzerland and shipping down for each and every case. We use disposable instruments specially made for each persons operations, so the lead time from booking for surgery and performing your surgery is a minimum of 6 weeks. I perform all my knee replacements using this technology as I truly believe in the accuracy, and personalised solution that seems to be giving us the results we are looking for.

I hope this answers your question.

How long until I can fly after a TKR. What happens at security points?

I am having a total Knee Replacement and was wondering how long after until I can fly overseas. Also when going to the Airport what happens when you go through the security points? Does it set the alarms off and if so do they require me to be able to prove it?

A great question, and one that gets asked often. For our knee and hip replacements, we allow our patients to fly interstate within a few days of discharge, provided the flight is less than 3 hours. This does occur, due to patients flying from interstate for their surgery in Adelaide.

For longer trips, we suggest waiting approximately 4-6 weeks. At 4 weeks, we stop your blood thinners, and generally you are walking very well.

As you pass through security points, it is likely that your joint replacement will set off the alarms. This is of no issue and the security guards have advised us that they do not require, or pay any attention to any cards/letters. They will still scan you/pat you down to check that you are not carrying anything dangerous.

Happy travels!

Lots of negative reports about hip and knee replacements failing. Are they safe now?

I have seen a lot of negative reports about hip replacement ..and the artificial joints failing ….are they safe now?…..and the knee joint ones? ….I don’t need them but many people my age ( well all ages really) do

Thanks for your question – the reports are not accurate, and often the media sensationalises a lot of the failures. There have, however, been noticeably failures in the past with more experimental designs of implants.

In hip and knee replacements in general, the statistics show a 92% survival rate of implants at 15 years. This statistic, is likely to improve in time as our accuracy improves. Dr Liew performs all hip and knee replacements now with patient specific technology.

For those few implants that have higher rates of revision (ie: Metal on metal hip replacements, Unicompartmental knee replacements, Patellofemoral Joint replacements and modular neck hip replacements), the news sometimes creates panic when anything falls outside our excellent results shown above. In general, those implants are not as frequently used, and therefore, the failures are few.

For our hip and knee replacements of today, revision rates are extremely low, and success is extremely high.

I hope this answer your question.

42yo with moderate osteoarthritis - cortisone used. Pain unbearable. Should I push for surgery?

I’m 42yo with moderate osteoarthritis in both knees, on daily imflammatories, glucosamine, fish oil and turmeric. Had cortisone injections in both knees 10 days ago. Panadeine forte is not helping and the pain is becoming unbearable. The dr says I’m too young to be operated on. Are there other options for me to consider or should I try to push for surgery? The pain is becoming unbearable

Hello, and firstly, I am sorry to hear that your pain is getting out of control. It sounds like you are doing all the right things. The mainstay of non operative treatment includes Weight loss (to a healthy weight), Panadol osteo, Glucosamine and Fish oil with use of an anti-inflammatory in an on and off manner. Once you need to escalate things further to stronger pain medications or regular injections, then the time really does come to deciding on whether surgery is the right option.

When we decide on surgery, it is not just based on age, and we have stopped using that as our main criteria. The reason for this is that materials, methods and accuracies are fantastic these days. With patient specific technology, disposable instruments and 3 dimensional pre-operative scanning and planning, as well as modern plastics (polyethylene), we are noticing that knee replacements are getting fantastic results. The current joint registry which analyses all knee replacements and hip replacements performed in Australia shows an overall rate of revision for all patients of around 8% at 15-16 years. For those patients who are younger than 55yo, it is higher, at 15% at 15years.

The questions to ask is, what is your current quality of life, and what age will it make a difference to wait until. I suspect that you are looking at a knee replacement earlier than ideal, however after discussions with your orthopaedic surgeon, I would say it may become clear about an appropriate time to perform the surgery.

Please do not hesitate to use us as a further sounding board.

Second operation - different recovery. Numbness on thigh and stiffness and one leg feels longer.

Hi ,
I have just completed my second hip operation which I have found recovery to be different .
I have a feeling of numbing on my thigh and stiffness also I feel my leg is longer than the other .
I presume that I would need to assist help with a heel insert to balance my hips but will the numbness go away ??

Hello and thankyou for your enquiry – 2 hips generally recover differently – often my patients will tell me that their 2nd total hip replacement performed via the direct anterior approach is easier than the first. From what you have written though, it seems like your 2nd operation is recovery in a slightly slower way, with some sensations you didn’t feel with the first one.

The numbness on your thigh is generally unusual. With the direct anterior approach for total hip replacement surgery, the benefit is that we do not come close to the femoral or sciatic nerves – meaning that muscle weakness and “denervation” is highly highly unlikely. The only nerve that is potentially at risk with an anterior approach is the lateral femoral cutaneous nerve of the thigh. This can cause some numbness around the side of your thigh, but generally, this returns to normal within 3 months. If it is just sensory loss and not motor, then generally we would leave this and wait for it to recover (which 95% do by 3 months post op).

The feeling of having a longer leg is also relatively common after a joint replacement (first or second). This is because we have generally lengthened a leg in comparison to what it was prior to surgery. It may have taken years for you to lose around 5mm of length as your cartilage degraded, and we are restoring this overnight. If you feel longer on the recently operated side, it is usually due to a compensatory pelvic tilt which develops as your arthritis develops. This also usually returns to normal and unnoticeable by 6 months post operatively. Our recommendation with these sensations is not to have any investigations or treatments (like shoe raises) until 6 months. If you are still feeling uneventful at 6 months, then a CT scannogram is used to accurately quantify any leg length discrepancy.

To directly answer your question – I would not use a heel insert until minimum 6 months post op, and only after further consultation with a physio or orthopaedic surgeon. I would also not treat any numbness as it should recover by 3 months post op.

I hope this helps.

Waiting for a TKR - on Aspirin for a stent placed 20 yrs ago. Is this a problem?

My husband is waiting to hear if a total knee replacement can go ahead as he takes aspirin daily and has a stint that was put 20yrs ok. Why would this be a problem?

Hi there, and thank you for your email We regularly have our patients assessed by our peri operative team to ensure that their medical conditions are fullyt optimised. What you are describing is a common scenario, and the safety of either stopping or continuing on Aspirin is determined by what type of cardiac stent is in place. In general, we like to gather advice from the treating cardiologist who would know these details well, and the specific risks of stopping Aspirin.

Prior to any total knee or total hip replacement, we would prefer patients to be off Aspirin – however it is not essential. There will be extra bleeding when patients continue on with Aspirin, or other anticoagulants such as Clopidogrel or even Fish oil. But in some cases we proceed with the surgery knowing that extra care needs to be taken to ligate the smaller vessels that would normally not be a problem. Just today, we performed surgery on a patient in consultation with the cardiologist and our peri-operative team, and the patient stayed on Aspirin during the case. With Patient Specific Technology we do not need to instrument (place rods) into the femur or tibia, and we do not need to place tracking pins either. We rarely use a tourniquet, and did not need to with today’s patient. We utilise a few modalities to decrease bleeding considerably during surgery which has allowed us to rarely (if ever) transfuse our patients, and we rarely (if ever) require a tourniquet during surgery anymore.

I hope this helps to answer your question.

After hip replacement - 1 leg shorter than the other. Still limping after 3 years.

After my hip replacement I now have one leg shorter than the other and after 3 years still walk with a limp. What can I do?

Thankyou for your question – It is certainly a difficult problem, and one that we try as surgeons to avoid. Using our technique with the anterior approach for all total hip replacements and the use of intra-operative X-ray (unique for this particular method), we do not have major discrepancies with leg lengths. We are more accurate than ever, and a newer technique that we are employing, called My Hip technology, gets it even more accurately positioned. With your particular case, it is important to work out how much difference there is. If it is only under 1cm, then generally people don’t feel it, although we try to get the leg lengths within 2mm now a days. If you have a limp ONLY from the leg length discrepancy, then a simple shoe raise should help you, when positioned well on your shorter leg. If you have a limp despite this, then there is something else going on. The most common cause of a limp after hip replacement surgery is when the muscles do not recover after the approach to the hip. This is one of the big reasons which led me to the direct anterior approach for all my total hip replacement operations. As we do not cut or detach any muscles, there is a fair far lower risk of a limp. The most common approach to result in a long standing limp is the lateral (Hardinge) approach, as the abductor muscles are detached. If these do not fully reattach after repairs, then a Trendelenburg gait is common.

The first place to start is determining what approach you had, and then further investigations from here. A CT scanogram can quantify the leg length discrepancy with most accuracy.

I hope this helps your difficult situation.Please let us know if further information is required.

How long does it take on average to do a total Knee Replacement, has Dr Operated on both knees at same time?

How long does it take on average to do a total Knee Replacement, has Dr Operated on both knees at same time?

Hello, and thankyou for your question – whilst it is technical no problem with performing bilateral (both side) total knee replacements, it is generally not advisable. In our experience, patients recover better doing one knee replacement at a time, due to the fact that you will still have a predictable knee to rehabilitate on. Despite both of your knees being painful and arthritic, we find that those who have at least 3 months between their total knee replacements do better than those who have them closer together. Once you have had your first total knee replacement you will understand why this is the case, due to the rehabilitation requirements.

I like to wait at least 12 weeks between any major joint replacement due to the inflammation post operatively, blood clot risk, and bleeding risk. By 3 months, your blood levels and blood markers, as well as your surgical risks return to normal.

A total knee replacement that I perform using patient specific technology takes about 50 minutes to complete. This is from the time we make our first cut to the last stitch and dressings. In some cases it can take longer, and we take as long as is required to ensure a fantastic outcome.

I hope this answers your question.

Please how much does a knee replacement weigh??

Please how much does a knee replacement weigh??

Hello, and thanks for getting in touch – a knee replacement is relatively light. it will not add a lot to your body weight. Current models of total knee replacements that we use are more like “resurfacings” of the knee joint. We remove only about 8-9mm from the surfaces of the bone, and replace this with metal and plastic. This leaves most of the knee joint intact. Because this area is replaced by metal, you will find that you are ever so slightly heavier after your total knee replacement. This would be in the order of 50g, as a total knee replacement would not weight more than about 300g total. Total knee replacements come in various shapes, and sizes. The bigger your knee, the bigger the implant, and therefore the heavier the implant would be.

An interesting question! Thankyou for asking it.

Specific Execises before surgery - does it help with a speedier pain free recovery?

Does performing specific exercises well before surgery help with a speedier pain free recovery? Also my lower legs are very sensitive to touch and circulation problems does this hinder recovery? Appreciate being able to ask these questions

Thanks for your question – and a good one! Yes, specific exercises do help with the recovery of your joint replacement. In general, people who have total knee replacements benefit the most with some kind of pre-habilitation. It is less important with total hip replacements. What we find is that people who are able to maintain some muscular strength, especially in your other leg, will benefit with a slightly faster recovery, due to the fact that you have more muscle power to hold yourself whilst you walk as your other leg recovers. Because with our technique of the direct anterior approach for total hip replacement surgery, no muscles are cut, and therefore recovery is already extremely quick. Coupled with some unique methods to minimise post operative pain and swelling, I find that I am often trying to hold patients back from recovering too quickly, as this can also be something that maintains some discomfort in your joint for longer than it has to be. With knee replacement surgery – I use patient specific technology. This means a 3 dimensional scan is done to get the more accurate understanding of your leg alignment, and not just your knee, but also in relation to where it sits with your hip and ankle. This also means that during surgery no large rods, or sensor pins have to be placed, which decrease pain associated with that.

Regarding your lower leg circulation – depending on the severity of your circulation issues, this can affect recovery. If you have very poor circulation, then the soft tissues will definitely heal slower, and swelling will be maintained for longer. Generally, circulation is OK, but there may be other issues for what you are feeling.

I hope this helps you for your scenario.

Some close has serious hip and knee pain. This person won't see a specialist. What should I do?

Someone very close to me has been having serious pain in his hips and knees. They lock up at times and kneeling, squatting and bending is a problem. The person is 50 this year. This person keeps putting off going to see a specialist. What should I do?

Thankyou for your enquiry. As a friend/family member, it can be difficult to see loved ones in pain. This is especially true when you might know that they would be far better off with something being addresses. Luckily for us, there are so many good methods of removing pain, from simple pain relief, to physiotherapy, to surgery. If your friend does not want to see a specialist, there would be a definite reason for this. I certainly feel that at least talking to any doctor about this is the first step. Your GP is a great resource – they often see people with similar issues, and can advise wisely about the best course of action. A GP is also very good at identifying the reasons why someone may not want to take the next step in removing their pain and address this itself.

It does sound like your friend has hip and/or knee osteoarthritis. This is something that can easily be fixed, and joint replacement surgery is highly refined and advanced now. It is extremely rare for major complications now, with both surgery and anaesthetics, and the refinement of total hip replacements and total knee replacements in Adelaide is very high. In my personal practice, we have dedicated ourselves to stay on the cutting edge of reliability, accuracy and personalised solutions with peri-operative care, as well as the surgery itself. Not everyone is built the same way, which is something I truly believe in and practice with all of our hip and knee replacements.

I understand that your friend is reluctant to see a specialist, but perhaps you could suggest that they come here and ask whatever questions they would like. I am passionate about my patients being very well informed about all options and treatment plans, so this would be a great opportunity for some unofficial advice.

I hope this helps you. Thankyou for getting in touch.

Blood clots previously - would a spinal allow a knee replacement?

I have had clots, so couldn’t get my knees done, I can’t walk the pain in the left knee and crunches all the time, the pain won’t let me bend, I have had a back operation 30 yrs ago, was wondering would I be able to have needle in spine to deaden the feelings past my knees so I can have at least one knee replaced?

Hello and thankyou for your great question! Blood clots are a risk of any joint replacement surgery. In our practice, we use 4 main modalities to reduce the risk of blood clots. The first is an anti-coagulant medication – usually Aspirin, which is given to thin your blood after your operation slightly. The 2nd is white compression stockings. The 3rd are specially designed foot compression pumps which simulate walking when they are on to increase blood flow. The 4th is that we try to get out patients up and walking the same day of surgery where possible. Most of our morning patients achieve this.

From a spinal perspective – you are correct in saying that YES, you can have that as your anaesthetic for the operation. In fact, 98% of our patients undergo a spinal anaesthetic for their hip or knee replacement. With your operation, you can choose to be as awake or as asleep as you wish, as the spinal allows the full operation to be performed without needing tubes into your lungs. It is very rare for our patients to require a tube to go into your lungs to help you breath for the operation. A spinal is our preferred method, and allows our patients to wake up feeling fantastic after the operation and less mentally clouded. A spinal anaesthetic has actually been shown to decrease the risk of bleeding and BLOOD CLOTS after joint replacement surgery, so with your history, it would be very suitable.

For more information, please do not hesitate to contact us. Thanks again for getting in touch.

49yo needing a TKR in the future. Wondering what the best system is.

I am 49 and I need a knee replacement in the near future. Just wondering what might be the best system. I am interested in the XP vanguard as I would like to conserve my ACL/PCL. I was just wondering what exercise limitations I might have after the procedure long term. Thanks in advance and this forum is a great idea..

Hello and thankyou for your question. Its a great one, as it has been debated for a long time. Still to this day, there is no consensus over what the best “implant” is. In the right hands, every implant can be excellent. What is more important, is the way it is put in, the accuracy, and the attention to detail. Currently, there are many factors which can influence the complication rates, and one of these is surgeon experience. Australian data shows that surgeons who do low volumes of hip and knee replacements actually have more complications (it seems so obvious, doesn’t it). This is why, as hip and knee replacement surgeons, we like to stick to the things we love to do.

From the cruciate retention side of things, I lie on the other side of the fence to this. When we open a knee, we often see contractors in the ACL and PCL which occur over time as the osteoarthritis develops. By removing the cruciate but leaving the very important collaterals, the knee seems to be very well balanced. I see, as many do, the cruciate ligaments as being part of the disease process, often contributing to fixed flexion deformities, and abnormal knee movements. In our method, using patient specific technology, we are aligning our knees using something called a “Kinematic” alignment – meaning that we are reproducing the native joint anatomy as best as we can. Using patient specific technology for every single knee replacement allows me a level of accuracy that has been of great success to me and my patients.

From a long term exercise limitation perspective, The only real limitation is with running. You are encouraged not to run excessively after your total knee replacement. Almost everything else is fine – cycling, hiking, swimming, surfing, golf, snow skiing etc.

I hope this helps to answer your question!

Aunty has bone on bone arthritis in both knees and only pain in one of them?

My aunty has bone on bone arthritis in both knees and only pain in one of them?

Thankyou for your follow on question – Pain is generated when inflammation occurs due to loss of cartilage (or any reasons causing inflammation). If your Aunty has bone on bone arthritis, it can be the location of the bone on bone that results in the differences between the knees. In addition to this, usually one knee is the better knee, and ends up taking more of the weight when walking (subconsciously). This causes one knee to often feel worse.

Generally speaking, it is just because one knee is more arthritic than the other. Bone on bone in itself doesn’t necessarily cause pain. What we usually find is that once one knee is replaced, and becomes the good knee, the other knee will hold people back, and require replacement.

I hope this helps.

What would be the expected longevity of a total knee replacement.

What would be the expected longevity of a total knee replacement.

Thankyou for your enquiry – Ive suggested some stats above in a few other questions about one replacements. In general, a total knee replacement performed in Australia is captured by the National Joint Replacement Registry – this is used to monitor the outcomes of joint replacements and has been utilised for over 16 years now. The revision rate at 15-16 years for a total knee replacement is 8%. This means that you have a 92% chance of the knee NOT being revised over that period of time. An excellent result (similar to total hip replacements) overall. As technology improves and methods such as Patient Specific Technology become more widespread, we may see that revision rate improve with time. Certainly, the improvement of materials in modern implants such as different polyethylenes (plastic bearing) is showing excellent signs of improving the statistics.

I hope this answers your question. Please do not hesitate to contact us if further information is required.

Is age 55 too young for total knee replacement ACL and medial ligament removed?

Is age 55 too young for total knee replacement ACL and medial ligament removed?

Thankyou for your enquiry – The age factor is something that gets asked a lot. If we look at the other decision making tools for deciding on when a total knee replacement is performed you need to start with quality of life. If you have noticed a significant deterioration in your quality of life, walking distance, pain, rest pain, and needing more pain medications, then a knee replacement is a good idea – even when considering you are on the younger side.

These days, the usual advice that “knees will only last 10-15 years” is completely incorrect. The Joint Registry in Australia published its most recent data showing that for patients 55yo and over, the general revision rate is around 8% at 15 years. This means that 92% of knee replacements had not been revised. The plastics that are used today are vastly different, and with highly accurate technologies such as Patient Specific Technology for total knee replacements, the revision rates in the future should decrease even further.

If your ACL AND Medial LIGAMENT are removed – then further considerations are required. Generally, your Medial Collateral Ligament is not removed, and I suggest that its your meniscus that was removed. Hopefully your medial ligament is intact as an absence of a medial ligament requires a special (more constrained) device when inserting a knee replacement. This would be clearly obvious to an orthopaedic surgeon who examines your knee. If it is just your medial meniscus that was removed, then your knee has lost a lot of the shock absorbing nature from the meniscus and is more prone to degenerative disease.

In summary – no, 55 is not too young, as long as you have tried some simple methods to decrease your discomfort, and you’ve noticed a deterioration in your quality of life.

Thanks for your question.

R TKR 12 years ago. Unable to leg raise. 20 operations. Anything to regain normal sensation

I have had my right knee replacement done over 12 yrs ago now but am no longer able to leg raise it despite doing exercises for the last 30yrs have had 3 reconstruction’s on that knee plus patella removed plus numerous arthroscopies done on it so maybe over 20+ opps on that knee my left knee has no patella and needs a replacement but trying to hold off I am unable to squat as no strength in my lower legs is there anything that could be done to help ease the pain and discomfort I also have many falls. I have also had both my hips replaced which helped with the pain one positive but after my right hip was done I have hardly any sensation in my right foot it is always very cold which brings me to tears at times also the pulse is very weak in that foot due to not being able to feel it properly I have broken my little toe several times and fractured my foot 3 times from falling and also broken my ankle I was wondering if there was anything that could be done to get some normal sensation in that right foot I don’t have private cover and am on a disability pension but am interested if there would be anything that could be done and what the cost might be thankyou

Thankyou for your detailed clinical scenario. I can tell that you are certainly having difficulties with your leg. I am sorry to hear about your troubles. You have had a patellectomy which can contribute to your leg weakness, especially in knee extension (ie trying to keep your knee straight). Your right foot sensation is not common. It could be due to a small nerve injury during surgery, or even a vascular issues. The other cause includes nerve damage from other medical conditions such as Diabetes.

Generally, in order to regain normal sensation, the cause of why it occurred should be determined first. If this can be determined (Often this is difficult this far down the line from your operations), then it could be reversed. Any sort of nerve compression causing long term nerve damage would not recover, even if the cause was found – and sadly, given the timeframe you have indicated, the chance of regaining sensation in your foot is low. I suggest perhaps discussing your case with a Neurologist first, to be tested, including nerve condition studies, to give you an indication of any major abnormalities here.

I hope this was at least a little helpful in guiding your direction. Thanks again.

How and why does osteoarthritis cause the pain that I have in my knee?

How and why does osteoarthritis cause the pain that I have in my knee?

Thankyou for your question. Osteoarthritis simply means Osteoarthritis (Bone), Arth (Joint) and Itis (Inflammation). It is essentially inflammation caused by the loss of cartilage in the joint. Inflammation causes pain throughout the knee, and results in more widespread pain than just the location of the osteoarthritis. This is why sometimes you feel pain deep in the knee, on the inner side, or back – and it does not always relate directly to the worst area of osteoarthritis.

When your knee becomes bone on bone, or develops loose bodies, the pain can come directly from the bone. There are nerve endings in the surface of the bones that can sense loose bodies and bone on bone arthritis, resulting in pain. A limp develops due to either pain, or a limitation in the full range of motion of your joint.

Sometimes, the movements that cause the pain to be worse indicate where the worse area is. For example, some people can walk well on flat ground, but as soon as they need to rise from a chair, or walk up or down stairs, they get a lot of discomfort. This is almost always due to patellofemoral joint disease.

The treatment for osteoarthritis is focussed on anti-inflammatory methods. This can include Physio to strengthen your knee muscles to avoid inflammation due to micro instability. Anti-inflammatory medications are also useful. Sometimes, a steroid injection, can help a lot with pain. Steroid is a potent anti-inflammatory.

I hope this answers your question – please contact us if you have any further queries. We’d be happy to discuss this with you further.

Labral tear with osteoarthritis at aged 37yo. Injury is 9 years ago.

I have a labral tear with osteoarthritis and am 37 years old. The injury is 9 years old and still causes me daily pain. When I was last reviewed in 2012 I was told I was too young for a hip replacement and arthroscopy was seen as risky.
Would I be considered for surgery now or am I still too young?

Hi there, and thank you for sending in your clinical scenario. It is a difficult one, as based on age, you are certainly on the younger side. The decision to have surgery should be weighed up against your current functional demands, and your pain levels.

You have a labral tear with osteoarthritis – generally a hip arthroscopy in the setting of osteoarthritis is not that successful, unless the osteoarthritis is minimal. If the injury 9 years ago caused the labral tear, then surgery would have been indicated then, however some people have completely asymptomatic labral tears.

If you are having daily pain, have tried non operative options like Panadol Osteo, Glucosamine and Fish oil, and you are still finding that you are having a worsening quality of life, and pain (especially at night), then a total hip replacement would be an option. A bearing option like ceramic on ceramic would be wise, given your age, to give you the highest longevity of the implant.

Of course, there are some other factors that need to be considered, so a recent Xray, along with further details would give me more ability to make the best decision for you.

I hope this helps to answer your query.

I suffer a lot of pain in right hip and left knee. I am eighty . Could I still have replacements

I suffer a lot of pain in right hip a d left knee.I am eighty .Could i still have replacements

Hello, and thank you for your enquiry – age is generally not a factor in deciding upon whether a hip/knee replacement is suitable. It is more important to look at your medical history, functional disturbance and weigh up all the risks and benefits. For example, someone who is 55 and is a heavy smoker, with diabetes who is very overweight is more of a risk than someone who is 80, in good health.

When we look at those with medical conditions, I like to involve our physicians who help us optimise each patient for their surgery. Our specialised team will review all the medications, medical conditions and ensure that you are going into your joint replacement in as good a condition as possible.

Prior to each operation, blood tests, ECGs and other appropriate tests are performed to screen for other issues that may come up without the knowledge of each patient or their own doctor. This helps us further customise the plan for each patient.

80 is certainly not too old to have a hip replacement or knee replacement. Prince Phillip at aged 96 recently underwent his hip replacement. In my own practice, we have performed hip and knee replacements up to the age of 95.

I hope this helps you.

Husband needs a hip replacement but concerned about career as a cabinet maker.

My husband has to have a hip replacement and he is concerned he won’t be able to return to his career as a cabinet making so he is putting off surgery he is quite fit except for this.

Thankyou for the summary of your husbands condition. A hip replacement is a reliable operation, with an excellent complication profile. These days, many people can continue their professions regardless of their hip replacement. A job as a cabinet maker does not preclude surgery, and from my perspective, there is nothing stopping him from going ahead, unless there are other factors.

The main question here is how bad his hip is. If he feels that his hip is tolerable, and he requires little pain medication, and can still work, and perform at his usual level, with minor functional disturbance, then he can definitely wait further. Some optimisation of his non-operative management would be useful (ie: Glucosamine, Fish Oil, Panadol Osteo +/- Anti-inflammatories). If this fails, or he is starting to take heavier pain medications that affect his capacity to work/drive etc, then a hip replacement is definitely suitable.

His individual case should certainly be addressed by looking at his specific movements and requirements before surgery as some choices can be made based on implant etc.

I hope this helps your situation.

How do you determine hip replacement is needed ?

How do you determine hip replacement is needed ?

Thankyou for your great question. Its something that I discuss with every consult, as the correct timing and decision to operate is a fine one. A few things need to be fulfilled before a hip replacement is even considered:

  • Radiological findings consistent with hip osteoarthritis. (Xray or MRI)
  • Pain when walking, or sleeping
  • Functional disturbance
  • Failure of non operative treatment (Panadol, Glucosamine, Fish Oil, Anti-inflammatories as appropriate).

In the current state of technology advances, material advances and technique difference, the concept of age as a major factor is becoming less relevant. The current registry suggests that those over the age of 55yo will have an excellent result, when viewed from the perspective of revision rates. We are sometimes performing hip replacements on very young patients, who have other issues, such as those who degenerate their cartilage from trauma or birth defects.

For me, one of the main determinants of whether someone should have a hip replacement (once the basic criteria are filled) is how their quality of life is affected. It is different for each person which is why a tailor made approach is required. Very active people who feel a limitation in their lives may opt to have their replacement earlier than say someone who is very sedentary who only has some mild night pain.

I hope this answers your enquiry.

MRI shows bone on bone but only has pain when pushing off toes.

MRI on my right knee shows bone on bone but I don’t have pain sitting, standing or in bed at night. I can go from a squat to standing with no issues. BUT when I walk pushing off with my toes I get a sharp pain inside the knee joint that is unbearable and causes me to limp?

Thankyou for your enquiry. Whilst our radiological guidance can show various abnormalities, not all of them require action. This is why we only like to investigate things when the symptoms suggest that something is going on. In the case of an MRI, this is a highly specific investigation that shows bones, and soft tissue very well. With bone on bone, it is very dependent on the location of the bone on bone and whether there is any bone oedema (fluid in the bone) which is usually quite painful. People with patellofemoral joint disease only for example, are reasonably painfree when walking on flat ground, but they have a lot of pain squatting, and when rising from a chair.

It is likely that when you push off with your toes you are loading the spot in your knee that is bone on bone, but with the other movements, the cartilage may well be OK. If you are having trouble walking, then we would consider a knee replacement if you felt that this impediment was a quality of life issue. It sounds like your patellofemoral joint is actually quite preserved, as you can sit, and squat without major issues (which are the actions that load your patellofemoral joint). Your disease is therefore more likely in the medial compartment of the knee which is where you put most of your weight when walking.

I hope this helps you to understand your condition a little further. If you have more questions, please do not hesitate to contact us.

65yo and left knee locking for 12 years with constant pain. When is the right time?

My orthopaedic surgeon SAYS THAT I shouldn’t have a knee replacement surgery until I get much older even though I am 65 an for the LAST 12 YEARS my left knee locks up gives away at times constantly in pain.

Thankyou for your enquiry. I believe that symptoms and medical factors are the most important decision tools when considering when the right time for a knee replacement is. If your knee has osteoarthritis, and you are 65yo and in reasonable health, I see no reason why you should not be able to have your knee replaced. In the past, when techniques and materials were not of the same quality as today, the longevity of knee replacements were much less.

Today, with the use of Patient Specific Technology, and cross linked polyethylene, and newer concepts in the placement of a prosthesis that seem to be having great results, we are advocating for knee replacements when symptoms are appropriate.

At 65yo, you are of a satisfactory age for your knee replacement, with a good chance that it will last your entire life. Unless there are extenuating circumstances, a knee replacement for you, based on the limited information I have, would seem appropriate asap.

I hope this helps you, and please do not hesitate to contact us for further information.

Do you use different types of hip implants and what factors are used to determine the most suitable?

Thankyou for your question. My philosophy is about tailoring the surgical decision making process for each and every patient. As you know, each person is very different, to their alignment, body mass, expectations, flexibility, lumbar spine and muscle capabilities. Other medical conditions also play a role (such as in connective tissue disorders, or neurological disorders). There is no one size fits all method any longer, and I truly believe in a customised solution for both hip and knee replacements.

What this means is that different types of prostheses are used depending on your requirements and the factors listed above. For example, for most patients, an uncemented prosthesis is most suitable – biologically fixing with the bone, and providing immediate stability, and a great rehabilitation. In the very elderly, with a lot of osteoporosis, a cemented implant is chosen to strengthen the bone with the bone cement. This is not usually necessary in most patients.

The prosthesis that we use has many different sizes, shapes and dimensions. When a hip replacement is placed, it is inserted using a modular system, allowing fine adjustments to all aspects of the hip replacement. Unique to the direct anterior approach for total hip replacements is the ability to image this easily, intra-operatively. For every total hip replacement, I perform an Xray of the hip whilst we have these trial components in place, which ensure that finer adjustments can be made to perfect the position, size and dimensions of the implant, prior to placing the final prosthesis. This affords a huge amount of safety, and accuracy, and prevents any unusual positioning, or unknown leg length issues.

I hope this answers your question. Please do not hesitate to contact us if further information is needed.

How long does this surgery last?

Thankyou for your enquiry regarding hip and knee replacements and how long they last. That is a great question, and recently, we received the data from the Australian National Joint Replacement Registry. This has been capturing all of the hip and knee replacement data over the last 16 or so years. For hip replacements, 400,331 primary joint replacements were included. For knee replacements, 547,407 primary joint replacements were included. The results show:

  • HIPS: Revision rate at 16 years is 10.4% for all patients, However delving deeper into this shows that at 16 years, there is actually an 8.8% revision rate for those with a diagnosis of osteoarthritis.
  • KNEES: Revision rate at 16 years is 8.0% for those with a diagnosis of osteoarthritis. Osteoarthritis accounts for 97.6% of all knee replacements performed. This is very different from a 5x rate of revision for patellofemoral joint replacements and a 3x rate of revision for unicompartmental knee replacements.

With advances in techniques, materials and designs, implants are lasting longer and longer and the old way of thinking of waiting until you are 70 yo regardless of symptoms is not true today. A combination of medical condition, age, mobility, pain and lifestyle factors now play a large role in deciding upon the ideal time for a joint replacement.

I hope this helps you.

Patellofemoral replacement - can this be performed using Patient Specific Technology

I’m up for patellofemoral replacement at some point – putting it off for as long as I can. Is this procedure able to be done via your new techniques?

Hello, and thank you for your enquiry. A patellofemoral joint replacement is far more rare than other types of knee replacement techniques, and its use seems to be decreasing somewhat. The number of “partial” joint replacements has been decreasing over the last decade as a general trend, with only 8.1% of knee replacements being partial. Of these 8.1%, 93% of them are medial or lateral compartments and only 6.2% are patellofemoral. Over the last 16 years or so, only 3286 patellofemoral joint replacements have been performed in Australia (only 305 in the past year).

Revision is more common after patellofemoral joint replacements due to progression of the disease with 14.5% at 5 years of these prostheses changed over to a total, and 41% at 14 years! This is extremely high, in comparison to an 8% revision rate of a total knee replacement at 15 years in general.

With this in mind, the role of patellofemoral joint replacements is decreasing, with more and more surgeons opting to perform a total knee replacement, which is more likely to be the one and only knee operation you may need in your life time (dependent on age, and activity levels). With newer and more advanced techniques such as Patient Specific Technology, and newer designs in implants and bearing surfaces, it is becoming better and better at knee replacements lasting a lifetime.

I hope this helps to clarify things, and give you more information for your upcoming choice.

Stem Cell Therapy & how long to wait until having the other knee done

What do you think of stem cell therapy?
And how long should you wait after having one knee done to having the other done? Thanks

Thankyou for your enquiry – stem cell therapy is something that we have all been watching with great interest. Over the last 10-15 years however, it has not progressed to the point that we have been able to use it as a viable option for 99% of people with osteoarthritis. The application of stem cell seems to be those with very very isolated cartilage loss in a small area – such as people with small cartilage defects from a specific injury. Once the cartilage is lost over a larger area, the stem cells will have trouble targeting these areas and staying there whilst their affect is seen. Unfortunately, the success rate of stem cells has not improved drastically over the last 10 years, and it still remains an interesting, but not applicable treatment option that may show more promise as more research is done.

From the other part of your question, I anticipate that you mean having your other knee replacement. In our practice, bilateral total knee replacements are never performed due to the increased risk of bleeding, blood clots and generalised inflammation, as well as the difficulties with rehabilitating two knees. It is best to focus on one knee at a time. In our knee replacements, we perform all knee replacements using patient specific technology which customises the alignment for each patients own anatomy. A custom made cutting jig is made for each and every patient, meaning that the operation is uniquely created for each patient’s bone and alignment structure. Combined with the low usage of a tourniquet, several other special instruments, special injections performed during surgery, and the fact that no rods or reference pins are used during the surgery which can cause bleeding and pain (ie those used in instrumented and computer navigation/robotics).

From this point of view the rehabilitation is fast, however research shows that blood clot risk, bleeding, and inflammatory markers all return to the normal risk profile within 8-12 weeks post the first knee replacement. For our patients requiring both knees replaced, this is performed 3 months apart.

I hope this helps to answer your question, and please do not hesitate to contact us for more information.

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