Total Knee Replacement and its Alternatives

Total Knee Replacement and its Alternatives

What is a Total Knee Replacement?

Total Knee Replacement (TKR) is a surgical procedure whereby an artificial joint/prosthesis replaces a damaged knee joint. Usually, for a TKR to take place, a person’s daily activities must be significantly affected by pain and functional limitations. This is because, as with any surgery, TKRs come with some associated risks and complications. These include: deep vein thrombosis (formation of blood clots in large veins), infection, stiffness, loosening, persistent pain and dissatisfaction and osteolysis (the softening and loss of bone). Clinically significant pain has been reported in 20% of patients following a TKR (Reference 1). Thus, it is important that, before a TKR is offered to a patient, the clinician has made sure that there is significant cartilage damage to the knee and that all conservative measures have been tried.

What Conservative Alternative Treatments are there to TKR?

Alternative, non-operative treatments options are:

  • Non-steroidal anti-inflammatory drugs – This should be the first-line treatment for all patients with symptomatic arthritis.
  • Tramadol – This is a treatment option for patients with symptomatic arthritis;
  • Rehabilitation, education and wellness activities - This involves self-management and education programs;
  • Weight loss programmes – These are for patients with symptomatic arthritis and BMI >25.

Key Learning Point

The principal learning point is that, in cases where there is not severe osteoarthritis affecting all three compartments of the knee joint, very careful counselling needs to take place and all conservative measures should be attempted for as long as possible before trying surgical intervention. Surgical intervention should be done only when all other non-surgical measures have failed and after careful explanation to the patient that knee replacements carry a significant risk of persistent postoperative pain.

References

  • Reference 1 - Beswick AD, Wylde V, Gooberman-Hill R, et al. What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2012.
  • Co-authored by The TMLEP Clinical Risk and Patient Safety Publishing Group and Ms Georgia Millington, TMLEP Analyst and Mr Panos Gikas, Consultant Orthopaedic Surgeon. (2021). Total Knee Replacement and its Alternatives. TMLEP Clinical Risk Case Studies. 4 (8), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact [email protected] or call +44 (0) 203 355 9796.