Total Knee Replacement
A total knee replacement is a highly successful and widely performed procedure, offering long-term relief for patients with severe knee arthritis or joint damage. It is one of the most reliable treatments in orthopaedics, significantly reducing pain and improving the quality of life for patients who have not found relief from non-surgical treatments.
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A Brief History
Modern total knee replacement surgery was pioneered in the 1970s by surgeons such as John Insall. Prior to this, knee replacements were rudimentary, using simpler hinge-like designs. The development of anatomically shaped implants that mimicked the natural movement of the knee was a groundbreaking advancement. Today, knee replacement surgery is a highly refined procedure, backed by decades of research, improved surgical techniques, and better materials.
Proven Success and Longevity
Knee replacements today are made of durable metal alloys and medical-grade plastics. These materials are designed to last 15–20 years or more in most cases. Advances in implant design and fixation methods, such as cemented fixation, have resulted in excellent long-term outcomes for the majority of patients.
Types of Knee Implants
In my practice, I focus on cemented fixation for all total knee replacements. This method provides a reliable, long-lasting bond between the implant and the bone.
For the majority of patients, I prefer ligament- and bone-preserving implants, which maintain the integrity of your natural knee as much as possible. This approach allows for a more natural range of motion and knee function after surgery. However, for more complex cases, such as those with significant deformities, bone loss, or previous surgeries, I may opt for a more constrained implant to ensure stability and proper function.
Another important decision relates to the patella (kneecap). I do not routinely resurface the patella in every total knee replacement. This decision is based on:
• The X-rays taken during your consultation
• A clinical assessment of the knee
• The condition of the patella and surrounding joint tissues observed during surgery
This careful, case-by-case approach ensures the best possible outcome for each patient, avoiding unnecessary procedures and focusing on what will provide the most benefit.
A Note on Robotic-Assisted Surgery
In recent years, robotic-assisted surgery has gained popularity among some surgeons and patients. While it is often marketed as offering enhanced precision, in my experience, traditional techniques—guided by years of expertise—remain just as effective, if not more so, for knee replacement surgery.
Robotic systems can be helpful for simpler cases, but they are limited when it comes to more complex knee replacements. One key limitation is that robotic systems primarily rely on the morphology of the bone, but they do not consider the soft tissues around the knee joint. These soft tissues—such as ligaments and muscles—can become contracted or stiffer on one side of the knee due to arthritis or other factors. This critical aspect of knee function cannot be fully addressed by robotic systems, and it needs to be carefully considered during surgery for optimal results.
Furthermore, the literature does not show any long-term superior outcomes for robotic-assisted surgery when compared to well-established, traditional techniques. In fact, hands-on surgical methods, which allow for direct assessment and modification of both the bone and soft tissues, continue to deliver excellent, long-term results in more complex cases involving deformities, soft tissue changes, or prior surgeries.
That said, if and when compelling evidence shows that robotic-assisted surgery leads to superior outcomes for knee replacement, I will certainly consider incorporating it into my practice. My primary focus has always been—and will always be—achieving the best possible outcomes for my patients. If robotic-assisted techniques can demonstrate clear, long-term benefits, I will be committed to adopting them to provide the highest standard of care.
Considering Knee Replacement?
If you’re dealing with persistent knee pain, stiffness, and limited function, and non-surgical treatments have not provided lasting relief, cemented total knee replacement could be the solution for you. Book a consultation to discuss your symptoms, learn about the options available, and find the best treatment plan for your specific needs.
Knee Arthroscopy
Knee arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems inside the knee joint. It involves inserting a small camera (arthroscope) through tiny incisions around the knee. This allows the surgeon to view the inside of the joint clearly and, if needed, perform repairs using specialised instruments.
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When Is Knee Arthroscopy Used?
Knee arthroscopy is most commonly used for conditions such as:
- Meniscal tears (cartilage damage)
- Loose bodies (small fragments of bone or cartilage)
- Inflamed or damaged synovial tissue
- Knee joint locking or catching
- Some early cartilage damage or mechanical symptoms
It is not typically used for advanced arthritis, as the benefits in such cases are limited. The decision to proceed with arthroscopy is based on your symptoms, clinical assessment, and imaging such as an MRI.
Benefits of Knee Arthroscopy
Because arthroscopy uses small incisions and specialised tools, it typically results in:
- Less post-operative pain
- Quicker recovery time
- Minimal scarring
- Early return to daily activities and work
Most patients can go home the same day and begin moving the knee shortly after surgery, depending on the procedure performed.
My Approach
I offer knee arthroscopy selectively, for patients where it is likely to make a real difference in symptoms and quality of life. In many cases, non-surgical treatments such as physiotherapy, injections, and activity modification may be tried first.
Arthroscopy is a useful tool when the cause of knee symptoms isn’t entirely clear, or when there is a specific mechanical issue (such as a torn meniscus or loose cartilage) that can be treated effectively through this minimally invasive approach.
Considering Knee Arthroscopy?
If you’re experiencing knee pain, locking, or mechanical symptoms that haven’t improved with other treatments, I’d be happy to assess your condition and discuss whether arthroscopy is the right option for you. You can also read more in the [knee arthroscopy patient leaflet] available on the website.
Book an appointment to find out what treatment options are most suitable for you.
Revision Knee Replacement
A revision knee replacement is a procedure performed when a previous knee replacement no longer functions effectively, due to wear, infection, loosening, or other complications. While total knee replacement is highly successful, some patients may require revision surgery to address ongoing pain, instability, or decreased function over time.
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When Is Revision Knee Replacement Needed?
Several factors can lead to the need for a revision procedure, including:
- Implant wear or loosening: Over time, the materials used in the knee implant can wear down, causing discomfort or instability.
- Infection: Although rare, an infection can occur, requiring removal or replacement of the implant.
- Knee stiffness: If the knee becomes too stiff and limits movement, revision surgery may be necessary to restore function.
- Instability or “loose” feeling: Some patients experience a feeling of instability or the knee giving way, even after a knee replacement.
- Deformity or misalignment: If the initial implant was misaligned or if the bone has changed over time, revision surgery can correct the issue.
The Complexity of Revision Surgery
Revision knee replacements are generally more complex than primary knee replacements, as they often involve addressing bone loss, previous scarring, or changes in knee anatomy. In some cases, bone grafts or specialised implants may be required to restore stability and function. The procedure typically involves:
- Careful removal of the old implant
- Assessment of the remaining bone to determine the best approach for securing the new implant
- Use of custom implants if necessary, tailored to the unique anatomy of the patient
Revision surgery can be more challenging and requires a highly skilled surgeon to ensure the best outcome. With years of experience in performing revision knee replacements, I’m able to provide personalised care and the expertise needed to achieve a successful result.
What to Expect After Revision Surgery
Recovery from revision knee replacement surgery can be more involved than primary surgery, as it may take longer to heal due to the complexity of the procedure. However, with proper rehabilitation and support, many patients experience significant improvements in pain relief and function, allowing them to return to an active and independent lifestyle.
As with any surgery, your rehabilitation will be a key part of the recovery process. A comprehensive physical therapy program will help restore strength, flexibility, and range of motion to your knee.
Considering Revision Knee Replacement?
If you’ve had a knee replacement but are still experiencing pain, instability, or other complications, a revision knee replacement may be the right option. Book a consultation to discuss your specific needs and find out how we can help restore your knee function.
When to See a Specialist
If knee pain is affecting your daily activities or does not improve with self-care, you can book a consultation by filling in your details below or by contacting my secretary directly at
Patient Reviews
Knee Injections
Knee injections can provide relief from pain and inflammation in conditions such as osteoarthritis, inflammatory arthritis, or soft tissue irritation around the knee. They are often considered when symptoms persist despite physiotherapy, lifestyle changes, or medications.
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When Are Injections Appropriate?
Injections are especially useful:
- When surgery isn’t appropriate or needed at this stage
- If you are not considering surgery at the moment
- If you are medically unfit for surgery
It’s important to understand that injections do not reverse arthritis, and their benefits may be temporary, particularly in more advanced cases.
Injections I Offer
I routinely offer corticosteroid injections, which are combined with local anaesthetic to provide immediate and lasting relief:
Corticosteroid (steroid) + local anaesthetic – This is the most effective and well-established injection for reducing inflammation and pain in arthritic or irritated knees. Relief may last from several weeks to a few months, depending on the condition.
Other Injection Types
There are other injection options available in some practices, but I do not routinely offer them for the following reasons:
- Hyaluronic acid (viscosupplementation) – These gel-like injections aim to lubricate the joint. While they have been used for years, the evidence does not show clear superiority over steroid injections, and the results can be inconsistent.
- Platelet-Rich Plasma (PRP) – PRP uses components of your own blood to promote healing. While it is a promising area of research, current evidence for its effectiveness in treating knee osteoarthritis is still limited and inconclusive. Until larger and more consistent studies show a clear benefit, I do not routinely offer PRP for arthritis.
There is commercial interest and promotion surrounding some of these injection options; however, the cost of these materials can often not be justified, especially in the absence of strong supporting evidence. Additionally, some of these treatments may not be covered by insurance providers for that very reason.
Considering a Knee Injection?
If you are experiencing knee pain or swelling and looking for non-surgical relief, a corticosteroid injection may help.
Book an appointment to see if this treatment is right for you. You can also read more in the [knee injection patient leaflet] on the website.