Revolutionary knee-replacement procedure that sees patients in and out of surgery in just four hours


A revolutionary knee-replacement procedure is offering NHS patients the chance to walk in and walk out the same day, sparing them a lengthy stay in hospital.

Unlike traditional procedures, which require an admission of at least three days, the new operation is typically performed at 8am and, by 12pm, the patient has regained the full use of the leg.

By 3pm, they are free to go home with their ‘good-as-new’ knee.

Surgeons have hailed the treatment ‘pioneering’ and claim the speedy recovery will free up beds, potentially saving the NHS millions of pounds every year.

The surgery is conducted almost identically to traditional methods. But instead of having a general anaesthetic, patients are awake.

A numbing injection is delivered to their spine, preventing them from feeling their legs while the new knee is fitted.

Fast-track physiotherapy sessions then help them learn to use the new joint before they are discharged.

Consultant orthopaedic surgeon Graham Walsh, who developed the technique and introduced it at the Calderdale and Huddersfield NHS Foundation Trust, believes it is the start of a ‘big explosion in day-case knee surgery in the NHS’.

The Huddersfield Hospital, a private hospital run by BMI healthcare, has been carrying out the procedure since February last year, and so far all 65 patients have seen astonishing results. 

The trial has been so successful that Mr Walsh has convinced the local NHS trust to adopt the approach.

Knee replacements are the third most common surgical procedure in the UK, with more than 100,000 carried out in 2017.

Horse-rider Helen Spencer, a retired GP, was among the first to have the one-day knee operation at the BMI hospital in November. 

Helen, 67, from Upper Hopton, near Huddersfield, said being able to bend her new knee so quickly after surgery significantly improved her recovery.

‘I was back to normal in about eight weeks, mucking the stables out, carrying hay bales and driving, very soon after,’ she said.

Day patients are admitted at about 7am and an hour later are taken to theatre. An anaesthetic injection is administered into the lower back so they can’t feel their legs. 

A sedative is also given to help the patient relax. The rest of the 45-minute procedure is similar to the standard operation.

A velcro strap tourniquet is fixed above the affected knee to reduce blood flow to the lower limb. A vertical incision is then made on the knee and the kneecap is pushed to the side, exposing the thigh bone and shin bone. 

The surgeon chips away the ends of the two bones before inserting a shiny cobalt-chrome metal cap on each end. A plastic disc is placed between the pieces of metal and attached to the shin bone, to act like cartilage.

The wound is stitched and a waterproof dressing applied instead of the normal bulky, fibrous dressing.

Back at their bed, the patient will then be visited by a physiotherapist up to three times. 

‘The short-acting spinal anaesthetic means as soon as the operation is over, the patient will start feeling their legs again and be able to do their exercises,’ Mr Walsh said. ‘Once the physiotherapist is happy, they are ready for discharge.’

Ms Spencer had her walk-in, walk-out op in November, after tearing the cartilage of her left knee. Almost immediately after the sedative wore off, she was able to move her knee again.

Having had her right knee partially replaced 15 years earlier, Ms Spencer couldn’t believe the difference. She said: ‘There was a lot less pain this time.’

According to Mr Walsh, about 40 per cent of patients needing a total or partial knee replacement are eligible for day-case surgery.

‘I’ve not met a single patient who has regretted going home as a day case,’ he said.


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