My 'Savile Row' knee op: This yoga teacher suffered years of agony until doctors fitted her with a bespoke new joint
They have been dubbed ‘Savile Row knees’ after the London street famous for bespoke tailors. And these designer prosthetics, customised for the individual, may offer an alternative to total joint replacement for thousands of Britons with osteoarthritis.
New scanning technology allows surgeons to remove and replace just the worn-out areas of bone and cartilage, preserving healthy tissue. They can now plan surgery based on patients’ individual anatomies and are no longer limited by the sizes available on the hospital shelf.
Researchers say the partial joint operation is less invasive, so has a faster recovery time, improves gait and provides a greater range of movement.
Anastasia is getting full movement back in her knee after the pioneering operation
‘In many cases, patients are having their whole joints removed when they could have what is simply a renewing of the worn-out part,’ says Justin Cobb, Professor of Orthopaedic Surgery at Imperial College London. ‘About 80 per cent of those who have total knee replacement may be suitable for this technique.’
The first 20 patients have had the implant, based on designs developed by Prof Cobb and his team, over the past six months, and researchers say early results are very encouraging.
One of the first to benefit is Anastasia Alexander, a 48-year-old business consultant and part-time yoga teacher from Primrose Hill, North London. Her knee problems were triggered by a sporting injury more than 25 years ago. The damage to her left knee led to osteoarthritis, in which parts of cartilage – the substance that lines the joints to allow smooth movement – wear away, causing pain and immobility.
It has been four months since her operation – and Anastasia has just returned from a skiing holiday.
‘I have always been very sporty and enjoy skiing and hiking,’ she says. ‘After the original injury to a ligament in my knee, I had a repair operation but over the years the stability of the left knee deteriorated and there was excessive wear on the cartilage.
‘Last summer, I noticed it becoming very painful when I walked. Then I went out dancing one night and the knee swelled. I was in agony for weeks.
‘I saw my GP and had an MRI scan, which showed there was damage to the inside of the joint, the area where I was experiencing the most pain. My boyfriend had undergone a hip replacement operation with Professor Cobb after a skiing accident and the results had been amazing, so I went to see him.’
First of all, scans are taken of the
knee and then used to design a personalised implant. During the
operation itself, the patient is given an epidural – anaesthetic that
numbs everything below the waist – and the procedure is carried out in
about three hours through an incision on the inside of the knee.
surgery the joint was hot and swollen, and I used crutches for about
six weeks,’ recalls Anastasia. ‘It was quite painful, but four months
after the operation we went skiing. There was still some stiffness, yet I
felt strong enough to get back on the slopes.’
70,000 knee replacement operations are carried out in the UK each year
and the number is rising. Over the years, total knee replacement, or
arthroplasty, has been shown to be an effective surgical treatment for
knee osteoarthritis. The procedure involves removing the ends of the
bones in the joint and replacing them with artificial parts.
Anastasia had an MRI scan to try and get to the route of the problem. There are more than 70,000 knee replacements operations which are carried out in the UK annually
The end of the thigh bone is replaced by a curved piece of metal and the end of the tibia, the main bone in the lower leg, is replaced by a flat metal plate.
These are fixed using special cement, or are treated to encourage the bone to grow in and around the replacement parts to hold them in place. A plastic spacer is placed between the two pieces of metal to act as an artificial cartilage, preventing the two grinding against each other.
A complete new knee joint lasts about 15 years and, although it can be replaced again, this so-called revision surgery is not as straightforward and involves a lengthy hospital stay – as long as two weeks. Patients are also likely to continue to have some difficulty moving, especially bending the knee and kneeling.
Considerable research is being carried out into partial, or unicondylar, knee replacement.
The knee has three compartments, and the wear and tear damage of osteoarthritis usually occurs first in the medial or inside portion of the joint.
A partial knee replacement involves the damaged side of the knee only, leaving healthy tissue in place. It gives greater range of movement, and a total knee replacement is also possible if needed later.
Astonishingly, it is no more expensive than conventional surgery using old-fashioned devices.
Anastasia says: ‘My knee is improving all the time and I am now getting almost complete movement.
‘I am also getting back to my yoga – and feel stronger and more flexible than I have for longer than I can remember.’