A look at what goes on during a knee replacement operation
I HAVE often been in awe of surgeons as they perform life-changing operations on patients, head to toe in scrubs and surrounded by a dedicated team of anaesthetists and nurses.
But of course, this has always been from the safety of my sofa, in front of my television.
Now, I don’t consider myself squeamish and have even been lucky enough to spend a night with ambulance crews in Bolton.
I even saw a dribble of blood and didn’t faint.
Naturally, I thought the next challenge would be to watch an operation in ‘real time’ at the Royal Bolton Hospital — if for nothing else than to get dressed up in scrubs think ER.
And thankfully consultant orthopaedic surgeon Jeremy Jarratt agreed to let me watch him perform a knee replacement.
Now this may not sound like the most cutting edge of procedures and, you’d hope, it is not matter of life and death, but with an ever-ageing population this operation is essential for many older people who want to keep mobile and independent in their own home.
Our patient is 85-year-old Eileen Wakes from Sharples who needs a new right knee.
The pain caused by the arthritis in the joint means Eileen struggles to get around the house or run day-to-day errands, such as going to the shops.
She explained: “It is very uncomfortable for me at the moment and I can’t walk very far. It affects everything in my life and I am hoping this operation will relieve the pain and allow me to do more things for myself.”
Knee replacement surgery, also known as arthroplasty, involves replacing a damaged, worn or diseased knee with an artificial joint.
Mr Jarratt explains Eileen’s new implant will be made of cobalt chrome and will take about an hour to, for want of a better word, ‘fit.’ Mr Jarratt, who usually performs up to four replacements a day, explained: “The aim of a knee replacement is pain relief and to improve patient mobility.
“The replacement knee will never function in the same way as a normal knee but it will be a significant improvement to an arthritic one.”
By this point, I was starting to feel anxious — and it wasn’t even my knee being replaced.
Even when it came to donning my scrubs, the part I had been looking forward to the most, I was too worried about fainting in theatre to enjoy it. All I could think was I was going to pass out and crash into all the implements mid-operation. But as all the lovely, relaxed staff members assured me — I was in the right place should that happen.
Once in theatre the team prepares the area for the procedure while Eileen is given a spinal anaesthetic.
Even though she is not undergoing a full anaesthetic,she is heavily sedated and will not remember anything from the procedure.
Meanwhile, the scrub nurse Sally McLeish lays everything out ready for Mr Jarratt.
To an outsider the equipment looks like a tray of rather severe woodwork tools and implements, including a trial knee replacement. Once the patient is brought through, her leg is bound up with just the knee exposed and Mr Jarratt can begin.
This was when I took a deep breath ready for the first incision. After watching the first minute through one eye, I realised it wasn’t that bad and there was very little blood.
When Mr Jarratt announced: “And that’s the knee cap off” I realised I was watching a human knee be turned inside out. It was one of the most surreal experiences of my life but once I’d got used to the idea, it was fascinating to watch.
“I even saw the notorious anterior cruciate ligament — the bane of many a footballer’s career.
Mr Jarratt shows me where the cartilage in Eileen’s knee has worn away and how the bone-to-bone contact in the joint causes so much pain.
Before the final implant is brought in, a trial implant is fitted to the knee to ensure Eileen will have the correct range of movement.
The whole team is remarkably calm throughout the procedure but this is not always the case: “Most of the time it’s calm but we do have our fraught moments — especially if you come across something unexpected,” says Mr Jarratt.
When you see a joint exposed in such a way, it makes you realise how mechanical our bodies are and how much strain we must put on our knees over our lifetime.
When I look at the Eileen’s shiny new knee (it really was), it seemed amazing to me that the body accepts this metal replacement and is able to function.
But I have to ask Mr Jarratt whether surgeons feel the financial pressures faced by the NHS. This operation alone will have cost about £12,000.
The 45-year-old said: “We are aware of it and we do feel it. It’s a case of working with a team to take those cost savings yet make sure it doesn’t affect patient care and quality.”
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