Bone surgery
Sources of information on knee replacement
Most people we interviewed wanted information about partial knee replacement surgery when they found out they were eligible for it, including what would happen during the operation and how long it would take to recover. They knew little about knee replacement, though some had heard about the experiences of family, friends or neighbours. People found out more about the surgery and recovery from health professionals they saw at the hospital, the internet, and other people who’d had this type of operation before.
The surgeon told people more about the surgery, including the risks and benefits. Many remembered being told that they would probably need a partial knee replacement but, if total knee replacement was necessary, the surgeon would know this only after looking inside the knee during the operation. They felt prepared for this and the possible complications of the operation. Everyone we interviewed had a partial knee replacement apart from Kevin:
Kevin found out after surgery that he’d had a total knee replacement. The cartilage was completely worn. Doctors did ‘a good job’ and it’s made a difference.
Kevin found out after surgery that he’d had a total knee replacement. The cartilage was completely worn. Doctors did ‘a good job’ and it’s made a difference.
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And afterwards I found out that they’d replaced the whole knee. They said the other cartilage was absolutely worn, the knee was almost shot away, you know. So they replaced both cartilages and put a new kneecap in. I felt it after a few weeks at home and thought well that kneecap doesn’t feel like my own, you know.
It’s good though. It’s good, you know. But it was a good job Mr [consultant’s name] done, you know. And his friends, well I saw his friend when I went back, his partner. He said he did, they did the operation in about two hours.
Two hours.
And I was quite pleased. But it’s certainly made a, it’s certainly made a difference.
A doctor explains that the pros and cons of partial and total knee replacement surgery are discussed with patients before the operation.
A doctor explains that the pros and cons of partial and total knee replacement surgery are discussed with patients before the operation.
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In hospitals who offer partial knee replacement, a discussion about that type of surgery will occur when there are parts of the knee which are damaged but parts of the knee which are still functioning normally. So in an effort to preserve those parts of the knee which are not damaged, partial knee replacement becomes an option. And that includes not only retaining the normal ligaments in the knee but also some of the normal cartilage surfaces in the knee. And in those circumstances, partial knee replacement offers some advantage over total knee replacement. There are some disadvantages, and you need to understand both.
Partial knee replacement on the whole will allow you to recover faster. We think it allows you better function in terms of will you be able to achieve the type of activities you want to after surgery. And that some of the risks involved in joint replacement are less when compared to total knee replacement. In particular, the important risks of infection, blood clot and medical complications such as heart problems and stroke.
This must be weighed against some of the potential disadvantages of partial knee replacement. And in the population as a whole, if you look in the UK, it’s true to say that partial knee replacements are revised or fail at a slightly higher rate than total knee replacements. However, if your surgery is performed in a centre who does a lot of partial knee replacements, and that’s certainly the case in our centre here in Oxford, then the risks of the two techniques in terms of how long an implant lasts are evened out. So I think a patient needs to have a good understanding of the pros and cons of both approaches.
A doctor explains what partial knee replacement involves and shows what the implants look like.
A doctor explains what partial knee replacement involves and shows what the implants look like.
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So this is a model of an Oxford partial knee replacement. And we can see that the metal and plastic components are replacing this inside part of the knee where the damage is. But unlike a total knee replacement, we’re going to preserve the ligaments and this normal part of the knee on the outside, which is functioning normally and doesn’t really need to be replaced. And so the essence of partial knee replacement is replacing the parts of the knee that are damaged and preserving the parts of the knee which are functioning well.
The key parts of the procedure are the implantation of this metal component on the femur and a metal component or plate, base plate, on the tibia. And in between there’s a small plastic component called the bearing. And this is, in essence, what a partial knee replacement is.
Jennifer said she had lots of good information from the surgeon, who told her that she had arthritis and what the operation would involve. She was given an information booklet and looked at it many times before surgery and during recovery. Most people were given written information such as leaflets or a booklet and some said they didn’t need any more information. Several read the leaflets carefully at different times, while others, like Peter, said he had had only a quick look but other members of the family had read them properly. Many people talked about the tests and information given to them by different professionals at the pre-operative assessment (see ‘Views and experiences of healthcare from people who had a knee replacement’). This included verbal, written and video information. During this appointment people were shown a new type of computerised information that includes 3D pictures and videos that can be watched and listened to on the internet. This is called Technology Enhanced Patient Information (TEPI). The 3D videos are designed to help people understand why they need partial knee replacement surgery, what it involves and the different stages involved, from the pre-operative assessment to recovery.
A doctor explains what happens at the pre-operative assessment.
A doctor explains what happens at the pre-operative assessment.
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Perhaps the easiest way to think of it is that we’re going to do an assessment of the patient to make sure that we’re making that process as safe for them as possible. There are some medical checks, blood tests, heart tracing and general assessment of ability of people to be able to mobilise and to be safe at home when we let them out after hospital.
I think central to that process is the transfer of a lot of information to patients about what they can expect. And we’d also expect to answer a lot of your questions about the precise detail that may be very specific to you about having a joint replacement.
The people we spoke with talked about the TEPI videos they had been shown at the pre-op assessment. A few watched the video with the physiotherapist while others were left to watch them alone or with a relative. The physio was available afterwards to answer questions. Most people found the videos informative, helpful and said that they prepared them well for surgery. Knowing what would happen before, during and after the operation was reassuring, Lesley saying that the videos were a ‘great help’, Penelope that they ‘settle your mind’ and Jacky said that you ‘don’t go in blind...they’re good and encouraging’. Some people watched them again at home with family, many saying that the videos gave them all the information they needed and were reassuring for family to understand more about the operation.
Lesley watched the TEPI videos at home with family. They were simple, straightforward and it was interesting to see the implants that would be going inside her knee.
Lesley watched the TEPI videos at home with family. They were simple, straightforward and it was interesting to see the implants that would be going inside her knee.
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When I came home, I went on and had a look with the family. And, yes, it was really helpful and really good. All the questions that I might have had was on the tape. The assessment was on the video, but obviously I didn’t have information before then. But that was good. Each procedure, it showed me about the operation, what to expect. It showed me the part knee replacement as well as the full knee. Because he did, the doctor did explain that although it was only the left-hand side of my knee, I would have to sign for full consent for the full knee. So that was absolutely fine. I was reassured. I knew exactly what to take. I had all the literature telling me how long it would take. One or two days in hospital.
So did you look at the website on that very day then, after you came back, with your family?
Yes, yes. It, and it just looked so simple, so straightforward. Reassured you. You knew exactly what to expect. Even the, saying the doctor would be there, the nurse, the anaesthetist and the sequence of events was really helpful. Because you wasn’t anticipating what’s going to happen next. You knew what was going to happen. You knew what order it was going to happen in as well. So therefore you wasn’t just saying, “Why is nobody talking to me?”
So that was helpful. This is quite new, this, you know, using videos like this that the Nuffield [NHS hospital] are doing. Would you say then that it would be a good idea for every operation that people went in for?
I think so. I suppose people that don’t like to see something cut, and the open wound might not please some people. But in my case I found it, it was interesting to know what was going to be placed inside me, how it was going to be fitted, how it was going to work, the mechanics of it. So now I, instead of just looking at the outside of my knee I know actually what’s inside. Which is good, yes, really good.
The whole family knew what Geoff’s operation would involve. He watched the videos again after surgery and was reassured to learn his discomfort was normal.
The whole family knew what Geoff’s operation would involve. He watched the videos again after surgery and was reassured to learn his discomfort was normal.
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Was that the pre-op, the pre-med appointment or with the surgeon?
With, I think it was with the surgeon. I went to see the physio lady and she went through it with me and told me what would happen and get on the site and do this.
So you looked at it while you were there?
Yeah and then I looked at it when I got home. She said… told me which… she wrote down which website it was and I watched it when I got home and showed my wife, showed the kids.
What did they think?
They all thought it was pretty good. It was good information and everybody knew what was going on instead of thinking, 'Well Dad's going in.' I mean my children are old, they're over thirty but, 'My Dad's going in and he's just going to have a knee stuck on and he'll be back home.' But they could actually see what was happening.
So that was good to have that website?
Yeah, yeah
Did you have anything like that for the first knee?
No it was just…this was new, it was good.
And you saw it once with your wife and kids, did you look at it again at all?
Yeah, I looked at it when I'd come back home after I'd had the operation and looked at it a few times.
What kind of things were you thinking about when you think, 'Oh I think I'll have another look?' What sort of information were you trying to get?
Well I was trying to make sure that the exercises and the pain, well not the pain but the discomfort – no pain but discomfort – was normal. So I thought I'd go and have a look and see if it's a normal thing and apparently it was.
Keith watched the videos twice but couldn’t remember a lot. They were ‘nicely produced’ and simple. The most useful thing was seeing the implants that would be used.
Keith watched the videos twice but couldn’t remember a lot. They were ‘nicely produced’ and simple. The most useful thing was seeing the implants that would be used.
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After the surgery?
[mhm]
So once beforehand and once afterwards?
Yes. [mhm]
What did you think of that video? Did you feel that it was helpful at all or did it just repeat what you’d already been told?
I think it was quite helpful. I’ll be honest, even though I watched it twice I still, I can’t remember a lot about it. I think what I found very useful was the, actually, you know, seeing the device. And indeed she showed me one as well, the physiotherapist did. But, you know, seeing and sort of understanding in a way the simplicity of the device was quite useful. And I think for me that was the most beneficial thing. It then talked about, you know, post, what would happen post-surgery and so on. The fact that I can’t remember much about it probably means I found it less helpful. But I can’t be sure about that. But I thought it was quite good. It was a nicely produced video and it was simple. It wasn’t too long, it wasn’t complex, you know.
Were you given leaflets as well at this point at all?
Yes, yes, I was, yeah.
About the operation?
Yes, yes.
Did you read through those or were you fairly familiar?
I did, I did have a look at them, yeah.
The TEPI videos weren’t made the first time Jacky had knee surgery. They were good, encouraging and reassuring. Her son helped her access them when she had problems.
The TEPI videos weren’t made the first time Jacky had knee surgery. They were good, encouraging and reassuring. Her son helped her access them when she had problems.
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And you had the leaflets anyway – leaflets about the operation – but you also saw this video. What did you think of the video, did it tell you more?
I thought it was very good because it showed you the bits before and what they were going to do in the pre-op, and all this, that and the other and what they would be doing. Then you obviously had the op and they would, if I remember rightly they did a little diagram showing what would happen, and after the physio bits as well. It was very good; I found it very encourageable.
So even though you kind of knew what to expect because you'd had one [partial knee replacement], it just reinforced that.
It reinforced it and it was very good. Because with the first one I'm thinking, 'Ooh what are they going to do?' And I think that would have been more encourageable if I'd seen that before. I would have known what was going on.
So it prepares you. Was it reassuring or did it just give you the information that you needed?
A bit of both, yeah. It was reassuring and knowing what was going to happen.
But you mentioned when you came home you had the web address and you tried to look online?
Yeah, we tried to look on it. But then I had a letter from the lady from the physio saying that everybody was having trouble with it and she sent me another one. I did manage to get on it but then I got confused because me and computers don’t go together.
So did you watch it again?
I did in the end. [Son’s name] helped me; my son helped me. But yeah, it was encourageable and people have said to me, "Would you look at it?" If they asked me, “should I look at it?” I'd say, “Yes because you'd get a good idea then.”
So you would recommend it?
I would recommend them to look at the video, yeah.
The TEPI videos are a good idea but watching them should be a personal choice. Peter read what he thought was relevant and felt completely prepared for surgery.
The TEPI videos are a good idea but watching them should be a personal choice. Peter read what he thought was relevant and felt completely prepared for surgery.
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Yeah, yeah, I felt it was a very good idea.
So if people were going in for different types of operations?
Yeah, I think they should be given the choice of, you know, of being told what the video contains. And then their choice as to whether they want to view it or not. Because some people are a bit squeamish about that sort of thing. Personally I’m not because I’ve worked for so many years in hospitals, right from an apprentice. I started my apprenticeship in [hospital name] in London and I’ve been in and around hospitals most of my life. That makes me a little bit easier with seeing things like that. Other people might not like it. It’s got to be a, you know, personal choice.
Would you have liked any leaflets to take home with the information?
We were given loads and loads of leaflets. I did try to sit down and read most of them, but in some cases it’s gone in one ear and out the other. I mean I’ve read them and digested them and, over the time now it’s, you know, I’ve probably forgotten what they said. Well, if I, you know, being honest about it, I’ve concentrated on reading things that I felt was for my benefit, you know, and my knee rather than other people’s.
So before you went in for the operation, did you feel that you were prepared for it?
Yeah, oh, yeah, I was hundred per cent up for it, yeah, absolutely. I think you’ve got to go in there with a very, very, you got to be focused. You got to want it and you got to be prepared for it.
While Hugh was watching the TEPI videos, he was called
While Hugh was watching the TEPI videos, he was called
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Oh, that, when they brought me to show me on the TV well. And they show me on the TV what you could see on the TV and what you can do and what you can’t do. Well, while I was doing that, I had to come out the office to go and see someone else. So we had to stop that and I go and see someone else. And I think when I come back it was so much people want to go in at the same time.
So you, how much did you see?
Not a lot, not a lot.
I just have a printout here. And you can tell me how much you saw of it. This is the partial knee replacement. So the first part is sort of kind of what’s going to happen during the pre-admission clinic and day of surgery and recovery. Did you, do you remember how much you saw? And there’s that and... Did you get any information about your knee problem?
For the first, when I first went in they were telling me about the knee. That’s, I saw this part here, where they show how the knee kind of, how they’re going to operate and things like that. Yes, I see this part here. But I didn’t see the whole lot of it, the whole CD what they were showing. I had to come out the office to go and see some, the doctor.
And then there was no time --
No time, no time, yes.
-- to go and see it? And can you see it at home? Do you have a computer at home?
No, I haven’t got a computer.
So your chance of seeing the website was in the hospital?
Yes, yes.
Helene and some relatives looked at the hospital website. It told her more about the pros and cons of surgery but she had already decided to have it because of the pain she was in.
Helene and some relatives looked at the hospital website. It told her more about the pros and cons of surgery but she had already decided to have it because of the pain she was in.
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It was to the Oxford Knee website – that’s what it's called – and it just tells you, or it told me sort of about the partial knee replacement. It actually shows you the devices that are going to be put in there. Such a long time since I looked at it now. And the options – you know you could…that they had said that when we do do the operation we will look and make sure that you don’t need to have a full, change to a full one. And there was the pros and cons from people, different people, because of course you could say no you don’t want it, that you'd wait. Why I wouldn’t want, I don’t know but obviously some people don’t like the idea of surgery and would wait.
So you looked at the website. Did you mention that family members also looked at it?
Did I mention to them?
Did you say earlier that family and people in America?
Yes, yeah.
Friends and family?
It's my sister-in-law – her partner is a GP, well he was a general practitioner, he's now over seventy so he's semi-retired. He looks after hospice patients and so of course it was of interest to them and they looked it up.
And when you saw that website, did it help you make a decision or was your decision made because you were in so much pain?
I think yeah, I think honestly, I would say that it… I needn’t have looked at the website, I would have already said, "I want something done that’s going to take away the pain."
The TEPI videos were good, short and informative but Alice had looked at the hospital website before. The videos didn’t tell her anything new.
The TEPI videos were good, short and informative but Alice had looked at the hospital website before. The videos didn’t tell her anything new.
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I thought they were good. But I had already read a lot of stuff on the website, hospital website, so there wasn’t much about the actual surgery that was new to me or about what the condition of what arthritis is etcetera. I think the questions I asked were fairly practical ones about, you know, ‘cos they said about what to expect after as well. But I don’t remember. I thought it was a good video, not too long, quite informative, but there wasn’t a huge amount in there that I didn’t know already.
Phillip watched the TEPI videos before both knee operations. He stopped smoking after the first one, and can now walk well enough to enjoy time with his grandson again.
Phillip watched the TEPI videos before both knee operations. He stopped smoking after the first one, and can now walk well enough to enjoy time with his grandson again.
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Yes, the same, yes.
When did you watch the videos the second time round?
The same as when she went to check all the movement and what bone I’d got. She said, “Well, I’ll show you the...” She said, “You saw the video the first time?” I said, “Yes.” She said, “Do you want to watch it?” I said, “Yes, please, yes. Just refresh my memory.” So she put it on and out she went to get herself a cup of tea, bless her. And come back and that was it. Then she had to take your blood and urine sample and get your weight checked and... Because in between that, you know, other things happened. Since my first knee, I give up smoking now for over a year. So I give, feel 100 per cent better. Because I couldn’t get out of bed to have a cigarette and I thought, “I’ve gone two or three weeks. I don’t want one.” So I’ve knocked that on the head now, thank God.
So it sounds like you’ve made a lot of health changes?
Oh, yes, yes, a lot of changes actually, yes. Retired and given up smoking. So . . .
And now you’re more mobile to do things as well?
It is, yeah. I mean we’ve just, we took my grandson away the other week. And I still can’t move that well with this one. But to actually just walk with him along the beach is a, is a pleasure which had been taken away from me.
Last reviewed August 2018.
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