Total Knee Replacement (TKR) for Knee Arthritis in Bristol
A total knee replacement is one of the most reliable operations in modern surgery – and one of the most life-changing when it is done for the right reasons, at the right time. It replaces the worn surfaces of the knee with metal and plastic components, and for most people it delivers lasting pain relief and a return to everyday activities they had given up on.
That said, I am always honest with patients: a knee replacement is a big undertaking. Recovery takes real effort, the early weeks can be uncomfortable, and about 10% of people are left with some persistent discomfort even when the operation has gone well technically. Getting the timing and expectations right matters enormously, and that is a large part of what I do in clinic.
Understanding knee osteoarthritis
Osteoarthritis is wear of the smooth cartilage that lines the joint surfaces. As the cartilage thins, the bone underneath becomes exposed and irritated. The knee is one of the most commonly affected weight-bearing joints.
There is rarely one single cause. Risk factors include:
- Age – it becomes more common over 40
- Sex – it is more common in women than men
- Body weight – excess weight increases load through the knee
- Previous injury – old ligament, meniscus or cartilage injuries can raise the risk
- Family history – there can be a strong genetic tendency
In some people it develops without a clear trigger – it simply progresses over time.
What it feels like
Most patients I see describe pain and stiffness as the main problems. Typical patterns include:
- Pain that worsens with activity or towards the end of the day
- Stiffness after rest – first thing in the morning or after sitting – that eases after a few minutes of moving
- Grinding, creaking or crackling sensations
- Swelling, puffiness or warmth
- Reduced walking distance, difficulty on stairs, or loss of confidence in the knee
How I diagnose knee arthritis
There is no blood test for osteoarthritis. I make the diagnosis from your symptoms, examining the knee, and weight-bearing X-rays. On X-ray, I am looking for joint space narrowing (where the cartilage has worn) and bone spurs (osteophytes).
An MRI scan is not always necessary, but I sometimes use one when I want to assess the meniscus or ligaments more closely – for example, to work out whether a partial knee replacement might be a better option, or when the symptoms and X-rays do not quite match up.
Trying non-surgical treatment first
I generally recommend exhausting non-surgical options before talking about surgery. For most people with knee osteoarthritis, the first-line approach includes:
- Low-impact exercise – cycling, swimming, walking – to keep the knee moving
- Physiotherapy to build strength around the knee and improve movement control
- Simple pain relief (such as paracetamol) and anti-inflammatory medication (such as ibuprofen or naproxen) if suitable for you
- Weight loss if you are overweight – often the single most effective lifestyle change
- Injections – including steroid, hyaluronic acid, PRP, or Arthrosamid – which can help manage symptoms while you decide about surgery
The exception is when your symptoms and imaging clearly show advanced arthritis that is unlikely to improve without surgery. In those cases, I will say so.
When is the right time for a total knee replacement?
I typically recommend a TKR when:
- Your arthritis is advanced and non-surgical treatments are no longer controlling the pain
- Pain and stiffness are significantly affecting your quality of life
- Everyday activities – walking, stairs, work, sleep – are consistently affected
The decision is ultimately yours. I give you my assessment of what the operation is likely to achieve, but I also want you to go in with realistic expectations. A TKR aims to relieve arthritis pain, but early recovery involves a different type of discomfort – surgical soreness, swelling, stiffness. Improvement continues over several months, and it can take up to a year for the knee to fully settle. Most people tell me they are glad they did it, but it does require committed rehabilitation.
Preparing for surgery
Before the operation, you will attend a pre-admission assessment. I need to know about:
- Any medical conditions (diabetes, heart problems, previous blood clots)
- All medications – especially blood-thinners like warfarin or clopidogrel, which may need to be adjusted
- Any allergies or previous reactions to medications
Please let me know if you develop a cough, cold or infection before your operation, or if there are any cuts, ulcers, insect bites, spots or broken skin near the knee. These can increase the risk of wound problems, and sometimes it is safer to postpone briefly.
The anaesthetic
Your consultant anaesthetist will explain the options. Most of my patients have either a spinal anaesthetic (so you are awake but numb from the waist down) or a general anaesthetic, often combined with nerve blocks. I also inject local anaesthetic around the knee during surgery, which makes a real difference to pain control in the first 24 hours.
What happens during the operation
A total knee replacement takes around 1 to 2 hours. I make a cut at the front of the knee, reshape the worn joint surfaces using specialised instruments, and fix the new components in place.
What the new knee is made of
- The metal surfaces are cobalt-chrome alloy
- Between them sits a polyethylene spacer – a very strong, wear-resistant plastic
- I may also resurface the back of the kneecap, depending on how much wear I find
The components are fixed with bone cement.
Closing the wound
I close with a dissolving stitch under the skin and wound glue on top. I rarely use clips – glue gives a neater result and is more comfortable for the patient.
Recovery after surgery
The first few days
The focus is on pain control, getting you moving safely, and reducing the risk of complications. You will start walking and doing guided exercises soon after surgery – early mobilisation helps prevent blood clots and chest infections and makes a real difference to how quickly you recover.
Blood clot prevention
- Foot pumps may be used initially to encourage blood flow
- Blood-thinning injections are started the day after surgery and continued for a short course at home
Going home
Some patients go home on the same day; most stay for 1–2 nights. You will leave with crutches or walking sticks and use them for a few weeks until you are confident walking independently.
Risks and complications
Total knee replacement is a well-established operation and serious complications are uncommon, but they do happen and I believe in being upfront about them:
- Deep infection – uncommon but serious. May require antibiotics and sometimes further surgery
- Blood clots – clots can occur in the calf (DVT) and, more rarely, in the lungs (pulmonary embolus)
- Nerve or blood vessel injury – rare, but possible because of important structures behind the knee
- Stiffness – the knee commonly feels stiff for weeks. A small number of patients need additional treatment for significant stiffness
- Numbness – numb patches around the scar are very common and may improve over time
- Wear and loosening – implants can wear over time and may eventually need revision surgery
- Persistent pain – up to 10% of patients experience ongoing pain despite a technically successful operation. This is one of the most important things I discuss in clinic, because it means the decision to proceed should not be taken lightly
- Fracture after a fall – a heavy fall can fracture bone around the implant and may affect fixation
Your personal risk profile depends on your overall health, medications, previous clot history, weight, and other factors. I discuss these in detail during your consultation.
When to seek urgent advice after surgery
- Increasing redness, heat, wound leakage, fever or feeling unwell
- New calf pain or swelling
- Chest pain, shortness of breath, or sudden collapse
- A sudden change in knee function or inability to weight-bear
Common questions about total knee replacement
How long does a total knee replacement last?
This varies between individuals. Longevity depends on activity level, body weight, bone quality, alignment and surgical technique. Many total knee replacements function well for 20+ years, but some people will eventually need revision surgery if wear or loosening develops.
Will I need physiotherapy?
Absolutely. Physiotherapy is a core part of recovery and I arrange it after your operation. Good rehab makes a real difference to the final outcome.
When can I drive?
After a right knee replacement, most people avoid driving for around 6 weeks. If it is your left knee and you drive an automatic, you may get back sooner. The key is that you must be able to safely control the vehicle and meet your insurance requirements.
How long does swelling last?
Swelling can take several months to settle fully. It is common for the knee to feel warmer than the other side during this period – that is normal.
How long will I need off work?
Desk-based roles may return within 6 weeks. Physically demanding jobs often require up to 3 months.
Can I kneel after a knee replacement?
Some people manage it, but kneeling can remain uncomfortable because of scar sensitivity and limited bend. Gradual desensitisation – practising kneeling on a soft surface – helps, but I am honest that this is one area where a knee replacement does not always give a perfect result.
Can I play sport?
I advise against high-impact activities like running, because of the risk of early wear. But many of my patients return to walking, swimming, cycling, golf, bowls, and doubles tennis once recovery is well established.
Can I be assessed in Bristol?
Yes. I see patients at my clinics in Bristol and can guide you through the whole process – from working out whether surgery is the right option, through to rehabilitation afterwards.
