Sydney Hip and Knee - Dr.Michael Solomon Dr.David Broe
Dr Solomon Information on knee replacement

Dr. Solomon's Knee Arthritis information:

There are many misleading statements in the media , on the internet as well as claims made by providers who claim that certain tablets, injections or even stem cells can reverse the arthritis process. Unfortunately most of these claims are completely false. There is NO scientific literature evidence that proves that by taking a certain tablet or having an injection into your knee, you arthritis will resolve. There is nothing that can stop a knee joint that has started to wear out from continuing to wear out. There are measures however that can assist with pain management before surgery is indicated.

Stem Cells:

Is this stem cells or stem “sells “ !

We all would like to believe that stem cells would cure our arthritis. Unfortunately this is not the case and NO controlled scientific study has shown this. There are ongoing studies looking at how an injection of stem cells may affect the knee. We are still awaiting the outcome of studies that prove one way or another that stem cells will be a useful addition to the treatment of knee arthritis. Stem cell injections cost close to $9000 and personally I would not be spending that type of money when there is no proof that it will fix my knee pain and reverse my arthrit

I am all for ongoing research into this area however I would caution patients when deciding whether to spend a fortune on something that is still experimental.

Knee Replacement Surgery

Similar to hip replacement surgery, a knee replacement is indicated when you have advanced osteoarthritis of the knee joint and non-operative measures (eg. Weight loss, anti-inflamatories , physiotherapy etc) are no longer controlling your pain.

Modern day knee replacements are a successful way to treat end stage arthritic knee pain and immobility. It is never really too late to replace the knee so if you can manage with your current arthritic knee……………. keep going until such time as it becomes too uncomfortable and is interfering with your quality of life.

There are 50000 primary knee replacements performed every year in Australia.

Types of Replacement:

Arthritic knees that require surgery usually require a Total Knee Replacement. A unicompartmental or “half knee” replacement is reserved for a select few patients who have knee arthritis isolated to one area of the knee joint and who satisfy other preoperative criteria. The revision rate of a unicompartmental knee replacement is significantly higher that a total knee replacement (20% vs 6.5% at 15 yrs) and therefore there are strict requirements in patient selection.

The 2016 Australian National Joint Registry https://aoanjrr.sahmri.com/ shows that successful knee replacements have an average of 6.5% revision rate at 15 years following surgery and that if you are over the age of 65 your revision rate is less than 5% and over the age of 75 your revision rate is less than 3%. Younger patients have higher rates of revision.

A total knee replacement is designed to resurface the femur, tibia and patella and in-between the femur and tibia is a layer of polyethelene. The polyethelene (plastic shock absorber) is the bearing surface which ALL knee replacements use. Unlike in hip replacement surgery there is no ceramic on ceramic knee replacement bearing. There is also NO metal on metal bearing so the problem that happened with some metal on metal hip replacements does not exist in knee replacements.

It is anticipated (laboratory studies) that a well aligned and functioning knee replacement should last around 25-30 years before the plastic wears out.

You may have heard about computer navigation , patient specific instruments etc. These are simply tools that some surgeons use to align the replacement during surgery. There are no scientific studies that have proven that a standard surgical technique using instrumentation is any better than computer navigation or patient matched blocks PROVIDED the surgeon doing the surgery is a competent surgeon who aligns the implants correctly and balances the knee joint appropriately.

In other words choose a surgeon who is skilled at would he does using ANY method and you should have a good long term outcome.

Cement or no cement:

Knee replacements may either be cemented onto the bone or used in an uncemented fashion where the bone grows onto the prosthesis. There is no scientific evidence that one method is better than the other. My preference has always been to use cement, as patients tend to recover a little quicker in terms of pain and comfort.

Knee Replacement in the younger patient

Age is a major factor affecting the outcome of knee replacements. Those aged 55 and under have a four times higher rate of revision compared to those older than 75. Males have a higher revision rate vs females.

The final word on knee replacement.

Surgery is indicated when non-operative measures no longer control the pain and your quality of life is significantly affected. Over 85% of knee replacements will achieve a good pain free functional result however there are some patients (around 5%) that may still have a niggling ache in the replaced knee joint.

Patients are able to play sport including golf, ski, tennis, bowls, cycle, swimming etc HOWEVER a knee replacement is not designed for impact sports such as running, contact sports, basketball, squash and any sport that results in constant and significant impact on the knee.

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