Complex Total Knee Replacement

Learn more about knee replacements at King Edward VII’s Hospital

We know living with a damaged knee can be a painful experience and can impact your quality of life.  Here you can find out more about our London knee replacement specialists and find out if this treatment is the right option for you. On this page King Edward VII’s Hospital London knee replacement consultants answer your questions about the procedure.

If you choose to have your treatment with us you can be rest assured you’ll receive the best possible care. As part of our wrap around care before, during and after you knee replacement you’ll be able to access Joint School where you’ll have dedicated 1 on 1 time with a team of clinical nurse specialists and physiotherapist. This dedicated service will give you the ability to get personalised advice to enhance your healing journey and get back to feeling like yourself again quicker. Find out more. 

Why would I need complex primary total knee replacement surgery?

Most patients requiring this kind of surgery need it because they’re experiencing major problems within their knee joint. This could be due to a major loss of bone due to arthritis or a bone fracture, or a significant deformity of the bones within the knee.

A complex primary total knee replacement is also sometimes performed on patients with weakened knee ligaments that are leading to knee instability.

What symptoms does complex primary total knee replacement surgery address?

Complex primary total knee replacement surgery is used in patients with severe arthritis that is significantly affecting their quality of life and ability to move around, causing severe pain and discomfort.

It’s a more complex surgery than a total prosthetic replacement of the knee joint and often involves the use of a longer stemmed prosthetic that is fixed more deeply into the thigh and shin bones to provide more stability.

It may also involve a procedure called an osteotomy, where the shin bone is surgically cut and realigned so that your knee is no longer bearing your weight.

When should you speak to your specialist about complex primary total knee replacement surgery?

If you’re experiencing extreme knee pain that makes it difficult to move or perform everyday activities and alternative treatments haven’t helped, speak to your GP about the possibility of undergoing complex primary total knee replacement surgery.

How is complex primary total knee replacement surgery performed?

Complex primary total knee replacement surgery is normally performed under a general anaesthetic and takes between one and three hours. A spinal anaesthetic can also be used. Most patients require a few nights in hospital following surgery.

Your surgeon will make a cut on the front of your knee and move the knee cap to one side. They will then remove the damaged part of the thigh and shin bones within the knee joint and replace it with a prosthetic joint. They may perform an osteotomy, but this will be discussed with you beforehand.

The prosthetic will be fixed into place using a surgical cement and your knee cap replaced before your wound is stitched or clipped together and dressed.

What is the recovery like for complex primary total knee replacement surgery?

Your recovery from complex primary total knee replacement surgery will depend on multiple factors, including your age, fitness level and the nature of your procedure.

Shortly after your surgery, the physiotherapy team will help you try to walk, often with crutches or a frame, and there might be some initial pain or discomfort. As your recovery continues, you will work with a physiotherapist on different exercises that will help with your knee’s strength and mobility.

You and your surgeon will decide upon your best recovery options after your surgery. Most people require help getting about for around six weeks. It can take up to three months for the pain and swelling in your knee to completely disappear.

Are there any risks/complications associated with complex primary total knee replacement surgery?

As with any medical procedure, it’s possible for risks or complications to arise. Speaking with your specialist or surgeon beforehand will help you avoid any adverse reactions.

Complex primary total knee replacement surgery has a relatively low risk of serious complications, but the following risks and complications can occur in a small number of cases:

• An infection in the surgical wound
• Knee stiffness
• Knee pain
• Blood clots
• Nerve damage in the knee joint or surrounding area
• Knee fracture
• Bleeding
• Bruising
• Swelling
• Dislocation
• Loosening of implants

How can I prepare for complex primary total knee replacement surgery?

Prior to complex primary total knee replacement surgery, your surgeon will discuss with you how best to prepare, as each patient is different with differing needs.

Common preparations for complex primary total knee replacement surgery include:

• Routine blood tests, x rays or scans as requested by your surgeon
• Taking steps to stop smoking if you smoke
• Losing weight if you’re overweight
• Remaining active and doing regular exercise

Are there alternatives for complex primary total knee replacement surgery?

Pain relief, the use of a walking frame or stick, steroid injections and physiotherapy may all help to relieve your symptoms.