​​​​Knee Replacement

​The knee joint is made up of the bottom your femur (thigh bone) and the top of your tibia (shin bone), with the patella (kneecap overlying it). The end of these bones are aligned with synovial cartilage which functions to allow smooth and friction free movement. When the cartilage is worn away (usually by arthritis), the bone rubs on the opposite bone causing pain. During this operation, the end of the femur is reshaped to accommodate the prosthesis or implant. The top of the shin bone is also cut and the worn out cartilage with a tiny amount of bone is removed and replaced with a metal component. A plastic insert made of polyethylene is fitted in between these two components.

What does the operation involve?

You are usually admitted on the day of surgery and the hospital will contact you regarding the ideal time for you to come in. ​The operation can be performed under spinal anaesthesia with sedation or a general anaesthetic. You are not allowed to have any food six hours before your surgery but you can drink clear fluids (water only) up to 2 hours before your surgery time.

A tourniquet (like a blood pressure cuff on the arm) is placed on your thigh above the knee.​ This restricts the amount of bleeding that occurs during the operation. The scar is made along the middle of your knee. As mentioned previously the knee joint is reshaped to take the components, which are fixed onto the bone with the use of cement (this acts as grout). All the structures that were cut are then repaired (e.g tendons). A waterproof dressing is applied and the whole knee is covered with a bulky bandage. The bandage gets taken off the next day.

What happens after the operation?

If you’ve had a general anaesthetic, you usually wake up in the recovery area after the operation. I prefer my patients to have a spinal anaesthetic

 - then they can see me lifting their leg and seeing how straight it is! It is also part of the enhanced recovery programme is use.

Do you not be too alarmed to see a drip line in your vein when you wake up. This is normal and fluids are given through this. Patients that have had spinal anaesthesia usually have good pain relief for the rest of the day. I use enhanced recovery protocols, so that my patients are usually walking on the day of surgery (with the help of physiotherapist). The knee can become very painful that night or certainly the next morning and you will be written up for strong painkillers that I give to all my patients regularly. Always ask the nurses on the ward if you are still in pain.

Post-operative Physical Activities

It is imperative that you keep the knee moving after the operation. The first three days can be very painful. The physiotherapist will begin teaching you how to move your knee and how to walk with crutches. You will be allowed to put all your weight on the knee and most patients end up leaving the hospital using crutches. They usually stay in hospital for 3 to 4 days. Due to the enhanced recovery program I use, and relatively short tourniquet times, I encourage my patients to walk on the same day of surgery and this has been shown to lower the length of stay in hospital with patients having less pain.

General advice       

As mentioned previously, patients are often in a lot of pain in the first three days, which can continue for two weeks. It is important to ask for painkillers and ensure you take them regularly. Obviously, everyone is different and the degree of pain experienced can vary widely. Consistently, there is always swelling and bruising which can continue for 2 to 3 months. Occasionally, it can go on for six months. The stitches or clips are usually removed by the nurse at your GP practice around two weeks after the operation. Until then the wound needs to be kept dry with a waterproof dressing on at all times.

It’s very tempting to place a pillow under your knee when in bed or resting on the sofa, as patients often find this is a comfortable position. Please try and resist this, as there is a danger that the knee gets stuck in that position and cannot be straightened fully. Take care not to stay in one position whilst in bed. Moving every hour can help prevent getting sores on the back of your heels and buttocks.         

Most surgeons review their patient six weeks after the operation. You should try and increase your physical activity each day during this six-week period. It is also important to keep exercising your knee and making sure that the movement is maintained.

When can I drive and how long do I need to take off work?

Most people return to driving around the six week mark. Once again, due to the enhanced recovery program and minimally invasive techniques I use, I advise my patients to return to driving as soon as they can do an emergency stop. This can be around 3 to 4 weeks following surgery.

Return to work is that little more difficult to answer. This largely depends on the nature of your work. Often return to work correlates with when the patients can drive. Most patients take a minimum of six weeks off.

What are the risks of the operation?

All surgery carries risks. The main risks regarding this particular operation include:

Infection

This may be superficial or deep. Antibiotics are usually used to treat superficial infections. Deep infections may require further surgery to eradicate the infection. A deep infection can be a life-changing event, but fortunately are a rare occurrence.

I regularly consult with my microbiologist to give the best possible antibiotics to prevent this complication from occurring. Keeping the surgical time to a minimum also helps prevent infection. I perform the surgery in a special laminar flow (ultra clean) operating theatre to further lower the risk of infection.               

Blood clots

A blood clot in the leg is called a deep vein thrombosis (DVT). This can occur in either leg following surgery. A pulmonary  embolism (PE) is when the clot migrates to the lungs. ​This is less common than a DVT but very rarely, can be fatal.

You will be given blood-thinning medications to lower the risk of getting clots. The sooner you are walking and more active, the lower the risk of getting blood clots. Again, this is why I use enhanced recovery programs to enable my patients to be up and walking early.

It is advisable to not go on any long distance flights for at least six weeks, but it is better still if you delay for 12 weeks.

Nerve injury

Numbness on the  outer aspect of the scar is quite common. It’s not a cause of pain, but rather patients are aware of an altered sensation. Very rarely, the nerve that supplies muscles to the ankle and foot (common peroneal nerve) may get compressed or damaged leading to a foot drop.   

Instability

The knee might feel wobbly after the operation. This could be due to a number of reasons and will need a thorough clinical assessment with x-rays. You may well need an examination under anaesthesia to determine the cause of the instability.

Stiffness and ongoing pain and swelling

It is imperative that you do exercises at home to regain the movement you had in your knee before the surgery or to improve it afterwards. The physiotherapist usually give you a program to do. Nonetheless, stiffness in the knee can still occur. This is usually dealt with extensive physiotherapy. However, a manipulation under a general anaesthetic may be required to break down the scar tissue that has formed causing stiffness. If this is needed, then you are usually put in a continuous passive motion machine. This slowly and smoothly bends and straightens the knee to maintain the range of motion that was accomplished after the manipulation.    

Dissatisfaction rate of 20%

All patients that have had a joint replacement surgery in the UK have the data entered in the National joint registry. This is the largest registry of its kind in the world and has approximately 3 million entries. From this data, we can conclusively say that a knee replacement is a successful operation 80% of the time. However, this means that there is still a dissatisfaction rate of around 20%. A lot of research is going into why this is the case and I have presented in several international meetings regarding this.

Loosening

​All artificial joints have a finite lifespan and wear out with time. The National Joint Registry (NJR) has shown us that 90% of knee replacements last more than 15 years.

 If you have any questions regarding this or any other hip or knee problems, give us a call. I will be very happy to help.

​Why Choose Mr. Jaiswal?

A​s a result of completing two fellowships (2 years of highly specialised training in hip and knee surgery), I have extensive experience in performing simple and complex total knee replacements. If possible, I use minimally invasive techniques and always use enhanced recovery programs, thus resulting in better pain relief after the operation. Furthermore, patients are quicker to mobilise and  have shorter length of stays in hospitals.

As I mentioned previously, all patients undergoing joint replacement surgery have their data entered in the National Joint Registry (NJR). All patients are requested to fill in a 12-point questionnaire assessing the pain and function in their hip (called the Oxford Knee Score) before and 6 months after surgery. The graph below shows that my patients (blue circle) have experienced greater gains than the national average (red dashed line) following a knee replacement and tend to do better.

What they say

“Fully recommend Mr. Jaisawal”

I first met Dr Jaiswal at Guy’s hospital in March 2017 & from our first encounter he was pleasant & immediately likable. He gave me the opportunity to fully explain exactly what issues I had & how they were affecting my daily life, he was very sympathetic, patient & I felt that he could empathise with me. He then used charts & diagrams etc to explain to me exactly what was causing my condition & how it could be repaired, what the pros & cons were, also the success rate for the procedure. He gave me enough information to make an informed decision to go ahead with surgery asap. The surgery carried out was a right hip arthroscopy & repair to labral tear, since surgery all the pain I had previously endured has totally gone & my recovery has been very good so far. I commend & fully recommend Dr Jaiswal, may I take this opportunity to thank you & all the staff who gave me excellent care during my short stay at Guy’s.

“Attentive and understanding at all times”

I have been massively impressed with Mr Jaiswal throughout my treatment (I first saw him in Feb 17). Attentive and understanding at all times; he explained things extremely clearly, outlined my options and I always felt that the patient came first. I was particularly impressed with the amount of time he gave all his patients during ward rounds (he seemed to visit more often than other consultants). My surgery was, apparently, not straight forward but I have made a good recovery and I am delighted with the treatment I have received. I can not recommend Mr Jaiswal highly enough.

“So glad I saw Mr. Jaiswal”

Mr Jaiswal has a great manner and talks to you with respect and compassion. I had wanted to see a colleague of his who specialised in my hip condition. His waiting list was over 9 months so I was referred to Mr Jaiswal instead. I am so glad. He immediately recognised my problem after 5 years of it being missed or ignored by other NHS professionals. He performed a total hip replacement under local anaesthetic and within hours I was able to use the toilet (no bedpan!) and go home the next day. He did a great job and 7 weeks later I am able to walk, stand up straight and get out of a sitting position without pain or restriction

“An excellent surgeon”

Mr Jaiswal is an excellent surgeon. The competency & dedication of him and his team was exemplary when I suffered an injury in December. As a trainee doctor, it is inspiring to see how a caring attitude together with excellent clinical practice directly results in the best clinical outcomes. I am sure, the fact that I am almost ready to consider running again after breaking my hip less than four months ago, is due to the fantastic care I received whilst an inpatient and continue to receive during follow-up.

“Eternally grateful to Mr. Jaiswal”

My husband and I are eternally grateful to Mr Jaiswal for the care he took in replacing both of my hips in two separate surgical procedures over two years. I can now walk painfree and can go on to enjoy our retirement as we would wish. I would not hesitate in recommending him as an excellent orthopaedic surgeon who is technically competent, very professional in manner and someone who gives you close personal attention even when he has a waiting room brimming with patients. He was patient in answering all our concerns, he addressed the risks and limitations of the new joint, he explained in detail everything that the surgery would entail and how the recovery process might unfold. Mr Jaiswal turned my traumatic procedure into an everyday experience tossed in with humour. Now that both of my hips have been “done”, we shall miss him and wish him every success in his career going forward.

I admire Mr. Jaiswal greatly as a surgeon and as a person”

When I first met Mr Jaiswal in the outpatients department at Guys he heard that I had been dieting and had lost 2 stone in weight. He got up from his chair and came over to me to shake my hand and congratulate me. He was extremely courteous. He discussed the operation with me taking time to talk to me and explained everything in simple English that I was able to understand. When I arrived in the operating theatre I could see Mr Jaiswal talking to his team in a relaxed friendly way and this helped a great deal to give me confidence. At my post op assessment Mr Jaiswal was very caring. My operation as been a great success and I admire Mr Jaiswal greatly as a surgeon and as a person.

“I cannot praise this surgeon enough”

I cannot praise this surgeon enough, I have suffered for many years with arthritic hips and at the age of 44, classed as a “young patient” I was very nervous that this was the right option for me but Mr Jaiswal was/is a fantastic man ! From the very first time I saw him and my issues were discussed, I knew that I was in the best hands possible. All aspects of the operation were explained to me so I was made to feel like I mattered. Mr Jaiswal was also very considerate when carrying out the operation, taking great care to preserve a memorial tattoo I have of my Mum. I was “awake” for the op and I would definitely recommend it – what an experience, I also feel that my recovery time has been quicker – I went in on the Thursday afternoon and was home on the Saturday afternoon. Amazing care on Sarah ward too.

“Mr. Jaiswal is delightful and approachable”

I had a total hip replacement just over a year ago and have just been discharged. Since I had the operation, progress has been swift and recovery total. It was a complete success. I cannot fault the after care which was regular and thorough. I was in hospital after the operation for just 3 days. During that time the staff were helpful and friendly. Mr Jaiswal himself is delightful and approachable, answering any questions that one may want to ask; and he is obviously a highly skilled surgeon. I had complete trust.

“Significant improvement”

After nearly two years of struggling to find a diagnosis for my pain at a different hospital, I was finally referred to Mr Jaiswal at Guys,who very quickly organised a range of scans, found a diagnosis and arranged hip arthroscopy and labral repair. 3 months later and I already have a significant improvement in the movement in my hip and the pain has drastically reduced.

“I would recommend him completely”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“Our family cannot thank Mr. Jaiswal enough”

Mr. Jaiswal operated on my father , prior to this every other surgeon that had seen him back so many words said that his condition was inoperable. Until that is he was seen by Mr. Jaiswal. I cannot thank this man enough. After completing an extremely complex surgery on my father he now is not in any pain and actually has an extremely good chance of being able to walk with a walking stuck and not crutches. Our family cannot thank Mr. Jaiswal and his team at the Royal Free enough.

A. Ward

“I cannot speak highly enough of the care I received from Mr. Jaiswal”

Dr. Parag Jaiswal is without doubt a first class Orthopaedic surgeon. I have been “under” him on two occasions and with each procedure he was caring, re-assuring and very understanding to his patients needs and would always listen to his patients. The total hip replacement he gave me in November was perfect in every detail. The speed of my recovery has also been enhanced by Mr. Jaiswal’s technique of making the smallest incision, a scar of about 6 inches, to perform the procedure and therefore healing time and discomfort have been kept to a minimum. Not only has he given me back a painfree life, I can now start attending events, social gatherings and family parties without the worry or stress of being in pain and discomfort. Dr. Jaiswal opted for the best prosthetic to suit bot my life style and job role (printroom manager) which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal, fellow Doctors, nurses and all the background staff at Guy’s hospital. Without doubt this great NHS is full of wonderful caring people like Mr Jaiswal and his team. Thank you for giving back my life.

 

Anthony Chaplin

“I cannot recommend him highly enough”

Mr Jaiswal operated on my leg following a fall, he was extremely kind and gentle. He explained step by step everything I needed to know, which not all surgeons will do. I found him very professional and he had a very good bedside manner. I was very anxious about being able to walk in the future, he reassured me through explaining all details. I felt he really cared, and my future rehabilitation mattered to him personally. Anybody that needs an orthopaedic operation would be very lucky to have him. I can not recommend him highly enough.

L. Blackman

“Mr. Jaiswal did a superb job”

I saw Mr Jaiswal for a full hip replacement when in great pain. He was sympathetic in the initial consultation and went to trouble to explain the procedure, discuss the hip replacement and out me at ease. I opted for general anaesthetic and suffered no poor consequences on the first day I was up and walking with crutches. People had warned me to expect a long have recovery but I was off the crutches inside 2 weeks and walking to my local village an back with shopping in a back pack, no crutches no pain from my hip. Of course there was some pain from the operation but that soon went. I was climbing stair again straight away on return home of course slowly at first but no crutches. The physiotherapist said my recovery was remarkable but I am confident it is because Mr Jaiswal did a superb job leaving me the easy part of getting on my feet. I plan to return to tennis now. Whilst I can only give my personal experience I happily recommend Mr Jaiswal and consider myself fortunate to have had his services.

“The most amazing work”

One year from having total hip replacement well I’ve had no pain from my hip. I can do single leg pistol squats also I’ve climbed stairs for half an hour with ease. The best test I’ve done for my hip was going snowboard and had no problems with it. Dr. Paraj Jaiswal done the most amazing work on me he even cut into my hip which he done around my tattoo you can hardly see the scar. I thank him and his team for what I consider was the best job they could have done as I also can walk correctly now once again big thanks to all.

Jason Hinton

“Very glad to have been treated by Mr. Jaiswal”

My 24 year old artificial hip snapped and Mr Jaiswal was very enthusiastic about redoing the hip. He actually tweeted the xray with my permission and I noted that it was commented on by a Professor of Orthopaedics at Harvard!. He explained to me {and both my daughters individually!} the whole procedure outlining the possible difficulties and risks. He was very patient about this and I felt informed and confident that I was in very good hands. I did have to wait nearly a week for the operation but that was partly because the hospital was particularly busy and also because specialist equipment had to be acquired. In the event the operation was relatively straight forward. It did not take as long as it might have done if he had had to break the femur to remove parts of the old prosthesis. It did involve a bone donation. I did not need a period in the ICU where a place had been reserved. I made a speedy recovery with the help of the hospital physios and was glad to be sent to a rehab unit for a couple of weeks. I had several conversations before and after the operation with Mr Jaiswal and other members of the team. All were positive. Mr Jaiswal also rang me this week to enquire about my progress during the lockdown and we discussed exercises and the problem of my other hip. He was constructive and made several suggestions. I hope to have a follow up appointment after lockdown I am very glad to have been treated by Mr. Jaiswal and his team and I feel confident he will help with any future orthopaedic problems I have. I hope he stays at the Royal Free!

Irene Woodworth

“Delighted in the outcome of surgery”

I required total hip replacement after longstanding distortion to pelvis from an accident. The op enabled early mobility and discharge less than 48 hours afterwards. Mr Jaiswal understood my ambition to return to sport and corrected unequal leg length, also arranged for long physio programme which enabled an early return. A feature of his care was his obvious delight in both the outcome of the surgery and my success in resuming my sport.

“Fantastic job”

Mr Jaiswal did my right knee replacement in August 2019. He did a fantastic job, both during the operation and after. I’m now walking fully on my knee, and cycling, after 8 weeks with no pain in the new knee at all. Mr Jaiswal is also a very good communicator and I would recommend him completely in terms of his surgical skill and medical care.

“First class orthopaedic surgeon”

Dr. Parag Jaiswal is first class Orthopaedic surgeon. The total hip replacement he gave me is perfect in every detail. The speed of my recovery has also been enhanced by Mr. Parags’ technique of making the smallest incission to perform the the proceedure and therefore healing time and discomfort have been kepto a minimum.. My occupation as a full time Firefighter can now continue and with this in mind Dr. Jaiswal opted for the best prosthetic to suit my life style which is both strong and hard wearing. I cannot speak highly enough of the care I received from Mr Jaiswal and all the staff Doctors and nurses at Guy’s hospital. Thank you.

R.J. Cummings

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