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Trisha asked...

Still in pain after my knee replacement.

I paid for a private knee replacement operation. Nearly a year later, I am still in pain, and the consultant who did the operation, whom I have now seen on the NHS, says I need a new knee-cap, which he did not replace originally. I am on an NHS list which will take a year. Shouldn't he have replaced my whole knee in the first place, as that is what I thought I was paying for?

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The answer

There are many different procedures which can be done when a knee joint is damaged. If you are relatively young you would, if you were not in pain from your knee, be much more active than an older person.

All joint replacements have a limited ‘life expectancy’ which can range from a few years to over a decade. The more active you are, however, the more quickly you would be expected to ‘wear out’ a new knee. Second and subsequent revisions of a knee replacement are technically more difficult, and have a higher rate of complications and a lower rate of success, than the initial procedure. It is therefore not uncommon to carry out a partial knee replacement, such as replacing only one side of the joint, resurfacing the damaged part of the joint etc.

It is not at all uncommon to keep the kneecap during knee replacement surgery, since the patellofemoral surface – the joint between the back of the kneecap and the front of the femur (thigh bone) ‒ may be less worn than the main knee joint. Obviously I don’t know all the details of your case, but I can tell you that a total knee replacement does not always involve replacing the kneecap as well and it may have been left because the consultant considered that the potential benefits (in terms of a less invasive procedure, faster recovery time, greater success for future procedures etc.) outweighed the risk of your pain continuing.

Answered by Dr Sarah Jarvis.

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