Knee Arthritis

Knee Arthritis

Are you worried about your Knee Pain?

Over the last few months have you noticed increasing discomfort, aching and stiffness in your knees? Perhaps you have noticed a “grating” feeling or that your knee has odd lumps and bumps on it which never used to be there. You may have pain aggravated by turning or twisting movements.

Maybe it’s been going on a long time, and gradually you find you cannot do as much as you once used to. Perhaps you find it difficult to walk or climb the stairs. Or be as active as you would wish to be. Or maybe you’ve had discomfort from your knees now that has been going on for quite a while, and now you find you need to take painkillers when you are out and about – or even just to be able to get to sleep at night.


Before any medical problem can be treated, the consultant needs to understand exactly what is causing the symptoms – to make a proper diagnosis. And here at the Manchester Hip and Knee Clinic we are particularly well equipped to do this, because our team of specialist physiotherapists and occupational therapists is led by Mr. Winston Kim, FRCS(Orth), an orthopaedic surgeon with many years of experience and expertise in diagnosing and treating all problems affecting the knee and hip joints.

But what could be causing my symptoms?

Pain, discomfort, stiffness, clicking, swelling, sudden sharp pain when turning or twisting, a grating feeling when you move the knee all indicate an on-going problem in the knee, and the commonest cause of this is arthritis or early arthritic changes in the knee.

The arthritic knee (including changes seen in early arthritis)

On the left is a section through a normal knee, on the right is a diagram showing what happens in arthritis. It looks complicated, and there’s a lot going on, but in short the smooth, slippery cartilage that lines the knee gets damaged and eventually destroyed, allowing the rough bone ends to rub together. This results in pain, stiffness and swelling which with time becomes very debilitating.

The front view of an arthritic right knee

However, before the changes seen above, early arthritis of the knee is often encountered after years of sports injuries or overuse. Patients often complain of an aching discomfort in the front or inside of their knee, aggravated by turning or twisting movements, causing sharp pain or catching/clicking. Walking any significant distance can be uncomfortable, and patients struggle to keep active. In such patients, wear and tear of the meniscus or soft cartilage of the knee is often the cause of such pain. Such pain is often aggravated by turning or twisting movements. It is an extremely common problem.

Common causes of knee pain

  • Knee arthritis (including early wearing arthritis)
  • Meniscal tears (soft cartilage tear)- often indicating early arthritis/wear and tear
  • Loose bodies (often seen in early arthritis)
  • Localised loss of hard cartilage (osteochondral lesion)
  • Ligament sprain or partial tears of ligaments
  • Poor balance/ hip/ core strength resulting in overloading of the knee
  • Referred pain from the back/hip



The different types of arthritis

There are three common types of arthritis, and these are:

  • Post-Traumatic Osteoarthritis
  • Familial Osteoarthritis
  • Inflammatory Arthritis

1. Post-traumatic arthritis

This is a very common cause of knee pain and arthritis, and occurs as you would expect after injury. The knee is complex and very strong but once injured either through accident or a sporting injury it becomes vulnerable to further injury and damage. Over time the damage – even if it has been well treated before – can worsen causing the well-known symptoms of arthritis.

You may never have had surgery on your knee in the past, or you may have had several operations, but in either case if you have previously injured your knee you are at greater risk of developing this type of arthritis in the future.

2. Familial Osteoarthritis

There is a genetic link to arthritis, and if you have a family history of the problem you are more likely to develop the condition yourself. And although we can do little to prevent this from happening the good news is that it is still very treatable.

3. Inflammatory arthritis

As the name suggests, the problem here is that the knee – specifically the lining of the knee – becomes inflamed and damaged.
There are many causes for this, including pseudogout, polymyalgia rheumatic and so on but the most well-known of course is rheumatoid arthritis.

What is Rheumatoid Arthritis?

In rheumatoid arthritis antibodies form to the joint lining which causes inflammation and further damage to the cartilage inside the knee. This causes the swelling, pain and stiffness patients with this condition experience. It can also affect many other joints in the body.

Why is it important to have my knee looked at?

If there is one common theme in medicine, it is this:
The sooner a diagnosis is made the easier it is to treat the problem.
If you are getting symptoms from your knees or are worried it is far better to see a specialist and either have your mind put at rest or the correct diagnosis made and treatment started. This is particularly true fo arthritis of the knee (or early arthritis of the knee), more so than any other joint.

What happens when I see the consultant?

The first thing you can expect is your consultant to listen to your story about what has been happening – to take a detailed “history” of your symptoms. He will also ask about any history of injury as well as any other health problems you may have.
Mr. Kim will then examine you thoroughly to see exactly what the problem is.
At this stage, although your consultant will have a pretty good idea what the problem is with your knee, he will want to arrange further tests to confirm the diagnosis and to make sure there are no other problems which could be the cause. The tests he is likely to consider will include:

An X-Ray

An X-ray of the knee is a simple test that gives much information about the bones of the knee joint and is often all that is needed to make a diagnosis.

A CT (“Computed Tomography”) Scan

This is an advanced series of X-rays of the knee which are turned into three- dimensional images by computer. The CT scan is very good at showing “hard” structures such as bone, and is sometimes necessary when planning treatment.

An MRI Scan

An MRI (“Magnetic Resonance Imaging”) scan. This is a special scan that does not use X-rays but is especially useful at showing soft tissues and fluid. It is good for looking at the muscles and ligaments around the knee.


An arthroscopy of the knee joint is a common procedure in which a camera is passed through a small cut in the knee and into the knee joint. It is most commonly used for the treatment and diagnosis of injury to the knee rather than in arthritis. Often small procedures can be done through the arthroscope, which saves you from the discomfort and recovery time of a bigger operation.

The scans above are all quite painless and done as an outpatient. An arthroscopy however involves you being put to sleep with a gentle anaesthetic so that the surgeon can pass a tiny camera into the knee through a small nick in the skin. This allows him to look directly into the knee and to see what the problem is directly.
You might ask why this is necessary with all the other scans at our disposal, but the fact is that firstly no scan is 100% accurate and perfect (neither is arthroscopy, for that matter) but also we can sometimes treat certain problems within the knee using the camera (the “arthroscope”) and so avoid a bigger operation. If your surgeon thinks you would benefit from an arthroscopy he will of course discuss it with you fully beforehand. You can find out more about arthroscopy by clicking here.

Blood tests

The commonest problem with the knee joint is osteoarthritis otherwise known as “wear-and-tear” arthritis, but there are other potential problems such as rheumatoid arthritis that can affect the knee too. A blood test is often useful to distinguish between the two problems.

How is arthritis of the knee treated?

There are two main ways of treating arthritis of the knee:

  1. “Conservative management” – in other words painkillers, physiotherapy treatment and exercise
  2. Surgery.

Once your consultant has assessed you and taken any X-rays or scans that he feels are necessary, he will discuss with you the best way forward. A great deal will depend upon how bad your symptoms are and how much impact they are having on your quality of life, as well as the underlying cause of the arthritis. For example, there a number of medicines which can be given to treat some of the inflammatory causes of arthritis.

Conservative management of knee arthritis

If your consultant does not feel you need an operation, or if you do not want to have surgery for your knee arthritis, he will suggest various measures that will help with your symptoms. Some of these are:

  • Anti-inflammatory medications
  • Over the counter or prescription pain medications
  • Low or non impact daily exercises
  • Offloading Knee Braces
  • Shoewear modifications
  • Physiotherapy treatment
  • Weight Loss Program
  • Injections for targeting and treating the source of pain.

Surgery for knee arthritis

In the end many people with knee arthritis go on to have surgery for the problem, and one of the big advantages of surgery is the tremendous improvement in quality of life that can result, particularly when it comes to mobility and freedom from pain.

Many people put off surgery for as long as possible, and although this is generally sensible when they finally have their operation they are so astonished at how much better they feel they wish they had done it sooner!

If I feel the only way to really help with your symptoms is an operation I will discuss the various surgical options including optimally invasive, partial or personalised knee replacement surgery, exactly what is required from you (in terms of the need for compliance with exercises and rehab after surgery) and go through the details of the surgery recommended. I would often refer you to a physiotherapy colleague if not done already before surgery, to prepare you for surgery and to reassure you that it is the most appropriate option for you.

What is involved in knee replacement surgery?

To really understand knee surgery for arthritis you need to first of all have some idea of the structure of the knee:
On the left is a section through a normal knee, on the right is a diagram showing what happens in arthritis. It looks complicated, and there’s a lot going on, but in short the smooth, slippery cartilage that lines the knee gets damaged and eventually destroyed, allowing the rough bone ends to rub together. This results in pain, stiffness and swelling which with time becomes very debilitating.

We often see patients in whom the earliest signs and symptoms of arthritis may be treatable by a combination of expert physiotherapy treatment guided by me and my team and minimally invasive key hole surgery (knee arthroscopy)

Knee Replacement Surgery– including partial knee replacements and personalised knee replacements

Once I have assessed you I will be able to recommend the best treatment to help you with your symptoms. For example in advanced arthritis of the knee the best option is often knee replacement surgery. There are two broad types of surgery for knee arthritis: partial knee replacement and a total knee replacement.

What can I expect on the day of surgery?

Unlike the NHS, where a consultant will supervise but may not perform every operation on every patient, privately I always see my patients personally. Furthermore if anyone needs an operation I also perform the procedure personally.
On the day of your operation you will be met at reception by hospital staff and taken to your own room. Here the nurse looking will greet you and you will be seen shortly afterwards by the anaesthetist and the consultant surgeon looking after you. They will go through the procedure with you and answer any questions you may have.
After your operation you will feel drowsy but will feel little or no pain. Your specialist will see that you are well in the recovery suite of the operating theatre and in your room later and if you wish will telephone your partner or other relative to let them know that all went well.

Are there any potential complications of surgery?

It is important to realise that all surgical procedures have the potential for complications and although knee replacement surgery is a very common and safe operation it should still not be taken lightly. Possible complications following knee replacement surgery include:

Scarring: We encourage early movement and exercise to stop scar tissue from encroaching into the joint and limiting movement. This also helps to prevent on-going pain and stiffness.

Infection: This is uncommon, occurring in less than one in 100 patients

Wear and Loosening: The replacement knee joint is made up of a metal crown on the thigh bone and metal base plate with a high wear resistant plastic insert in between. These are of course very strong but nevertheless do eventually wear out and may need replacing in around 15 to 20 years’ time with revision surgery. At the Manchester Hip and Knee Clinic we use the most up to date, high quality materials to ensure long-term excellent outcomes.

Ongoing symptoms/ dissatisfaction: This is a recognised risk of knee replacement. Compliance with exercises and rehabilitation after surgery is important to minimise such risks which has been reported in the literature to be in the order of 15-20%.

Nerve and Blood Vessel problems: Very rarely, the nerves or main blood vessels in the back of the knee can become injured and may result in numbness and weakness for a few months or even require surgery to repair them. This can happen in more complex cases and in revision surgery cases rather than first time knee replacement surgery.
Fracture: the bone around the implant can fracture if a fall is sustained.

Stiffness and persistent swelling

An area of numbness on the skin around the scar


As you might imagine, training and experience are very important in ensuring a good outcome for patients. I am delighted to say that our patients are extremely satisfied with the care and their outcomes. Mr Kim is a recognised specialist field and this is reflected both in his clinical outcome ( and Patient reported outcome measures.


A vital part of knee replacement surgery is post-operative rehabilitation, and your commitment to this is vital in determining how well you are going to recover from surgery.

Physiotherapy after your knee replacement

Physiotherapy is the cornerstone to good recovery and here at the Manchester Hip and Knee Clinic we only work with specialist knee physiotherapists who will put together a tailor-made programme for you based upon your own health and level of activity prior to surgery as well as your goals after surgery.

At the Manchester Hip and Knee Clinic we deliver a complete package of care, everything from initial tests, surgery and post-operative physiotherapy on an individual basis

Post-operative Rehab Guide

Each and every one of us is different and the treatment you will receive is tailored to you, so the most important thing is to follow your surgeons’ advice.

After undergoing knee replacement surgery, it is important you have realistic expectations about the types of activities you may perform. Driving, keep-fit activity, walking, and other everyday activities will all be impacted in some way.


You may return to driving a few weeks after surgery, usually you are given the go ahead once seen at the clinic around the 6 week mark. If the surgery was performed on your right side, we may recommend that you wait longer than if you had surgery on the left side, assuming you drive a car with automatic transmission. In any case you must be able to move the leg easily from the accelerator to the brake, and make a safe emergency stop before driving. That time typically varies from 4 to 8 weeks depending on multiple factors. Always inform your insurance company before going back to driving once given the all clear by your surgeon.

Keep-fit Activity

Your fitness regime will be started in hospital as part of your recovery program. More strenuous activity may be recommended anywhere from 4 to 6 weeks following surgery. Your surgeon and physical therapist will discuss different aspects on an individual basis.

Walking and Stairs

You will progress during your physical therapy program from your original walking aid (e.g., walker, crutches) to a cane. Eventually no supportive devices will be needed as long as there are no other problems that require long-term use of a walking aid. Eventually you will be allowed to climb stairs step over step. In most cases, patients begin with smaller-height steps and gradually progress to standard-height steps.

Work Activities

Determining the date you return to work will depend both on your surgeon and the type of work you do. Some individuals may require modifications to their job, while others may easily return to their previous activities.

Leisure and Sport Activities

There are different risks associated with certain types of leisure and sport activities. Some activities may lead to damage of your artificial joint over time due to wear and tear of the joint. In general, the more vigorous the activity, the higher the risk of damaging the implant, increasing the wear and tear on the implant, or increasing the risk of loosening or dislocating the implant.

Three major categories of activities should be avoided. These include:

  • Activities that cause high-impact stresses on the knee
  • Activities with potentially high risk of injury
  • Activities that may result in falling or getting tangled with opponents, risking rupture of ligaments around the joint itself or a fracture of the bone around the implant.

These types of activities include competitive racquet sports (such as tennis, squash, and racquetball), high-impact aerobics, high intensity jogging, water skiing, skiing, martial arts, football and basketball.

Lower-stress activities such as golf, hiking, walking, cycling and swimming are excellent forms of exercise for individuals with a knee replacement.

The way a knee replacement will perform depends on your age, weight, activity level and other factors. There are potential risks and recovery takes time. If you have conditions that limit rehabilitation, you may require further help prior to having this surgery. Only a specialist knee surgeon can tell you if a replacement is right for you.

Frequently Asked Questions

It is entirely understandable that you will have concerns regarding knee replacement surgery and here I answer some of the most common questions we have been asked over many years of treating patients.

I have pain, stiffness and a grating from my knee but my GP said I was too young/not ready for surgery

Your GP may be right, but arthritis can happen to anyone at any age. The important thing to remember though is that it is important to see an expert, a specialist who has been specifically trained to assess and treat problems like this. Only an expert can give you the best advice.

Am I Ready For A Knee Replacement?

Only you and a specialist knee surgeon can decide on when is the right time for knee replacement surgery. Here at Manchester Hip and Knee you can be assured we will discuss the treatment options fully and answer any questions you may have. There is never any rush for surgery, and when you are ready to proceed we will be ready too.

How Old Do I Need To Be For A Knee Replacement?

At the Manchester Hip and Knee Clinic, we tailor each individual patient’s treatment to suit their personal needs, both young and old. This allows more arthritis patients to consider treatments at an earlier age whilst still maintaining an active healthy lifestyle. Knee reconstruction is related to need, not age.

Why Do People Wait So Long To Have Knee Surgery?

Many people delay treatment due to fear, misinformation and a lack of awareness of their options. Often, many of these same people wish they had it done sooner.

What should I Expect When I Decide To Have Knee Reconstruction Surgery?

Your surgeon will explain the procedure to you in the clinic. There will be a pre-operative medical assessment to make sure you are fit and well for the procedure. You will also see a physiotherapist to discuss the “do’s and don’ts” of how to look after your knee replacement and what to expect following surgery.

What are the risks of surgery?

The risks of knee surgery include: deep vein thrombosis, infection and bleeding. The likelihood of any problem after surgery is low and most people have no problems at all.

Will I need to be put to sleep for my knee replacement?

Knee replacement surgery can be performed under general anaesthetic or under spinal anaesthesia, similar to when a woman gives birth. You will be seen by one of our expert anaesthetists during your preparation for surgery and he or she will discuss the options with you and advise the best way forward.

How long does the operation take?

Typically around an hour.

Is the operation painful?

Some discomfort is of course to be expected after any operation and knee replacement is no different. However the discomfort is usually short-term and I always give my patients pain relief to take regularly during whilst they are recovering from surgery.

How many nights will I need to stay in hospital?

This depends upon the type of procedure you have as well as your own general health. Generally patients stay in hospital for only a few days (typically 3-4 nights) and we always try and get people home as soon as they are ready to leave, comfortable and able to cope at home. We work very closely with our physiotherapists to make sure you only leave hospital when you are ready.

How long will I need to be off work?

This varies depending on your occupation. For desk based jobs, it is possible to perform some work from home between 3-4 weeks after surgery. The ideal situation is to take off 6-8 weeks (up to 3 months off work) to minimise swelling and maximise rehabilitation time with the physiotherapists.

How Long Will Recovery and Rehab take?

After surgery, a few days in hospital are normal. Although we try to get patients home as soon as they are ready and able there is no rush at all. Like your surgery, we tailor your post-op recovery according to your needs. It would typically take 6-9 months (possibly up to 12 months) before you begin to feel really satisfied with the knee. The time to full recovery is often correlated with how you, as the patient, works at your rehab and exercises.


What patients who had Knee surgery / Knee conditions treated by Mr Winston Kim:

Written by a retired General Practitioner

I suffered from Osteoarthritis for a year and was in great pain. I saw Mr Kim in February this year privately. He operated on me and did a Total Knee Replacement in March. i had very little pain post operatively and was discharged in 3 days. I have excellent straight leg raising and a good angle on my knee, up to 120 degrees. I drove after 6 weeks and i have just come back from a holiday in Portugal. A general practitioner friend recommended Mr Kim to me for which i am very grateful. I highly recommend Mr Kim to any patient with knee joint problems.

Dr Enid Noronha, Retired General Practitioner Worsley and Boothstown

Written by a carer

The “Go To” Hip & Knee Surgeon…… Winston Kim, to me, is the “go to” Hip and Knee Surgeon in Greater Manchester. I’m a health care professional and have seen him at work. This is a gifted surgeon- the full package- talented, well trained, generous with his time, humble (if that is possible in a surgeon) and above all, a caring Surgeon. I chose to ask Mr Kim to care for uncle Jim at the Alexandra Hospital. I have seen him look after some really tough cases, and many retired doctors and consultants have placed their trust in him, and had him operate on them. My 90 year old uncle had severe longstanding knee pain, but had refused surgery for ages putting up with pain. Mr. Kim picked up the fact that it was referred pain from the hip, even though my uncle had no hip pain. His confidence reassured us. He did a hip replacement, and gave Uncle Jim a new lease of life. “You put your life and your trust in your surgeon’s hands. Mr. Kim has given me back my life and rebuilt my trust….”, reads one of over 100 reviews online on him- check it out for yourself!. ( But, I knew that already….. P Ryder, Manchester, on behalf of Uncle Jim, April 2015

Written by a patient

Mr Kim performed my total knee replacement last September which is a complete success. I have been delighted with all the care and consideration he has shown me. He has installed me with a great deal of confidence and I believe him to be a fine surgeon who I would highly recommend. Yvonne Field

Written by a patient

I found Mr Kim most informative about the injury to my knee. He fully explained the extent of my injury and also explained in clear terms the treatment I was to have and the recuperation period and exercises needed for a full recovery. Most impressed with his calm and informative manner and allowed me to ask questions about my injury which enabled me, through his concise responses, to better understand the limits that would be placed upon my future exercise regimes. It helped that the physiotherapist I attend had knowledge of Mr Kim, through other patients, and her confidence in him supported my own views fully supported those on myself. An excellent physician who made an excellent job of my injured knee that has resulted in me returning to by normal exercises with no restrictions or negative after effects. I have recommended him to friends and colleagues and I can think of no greater compliment I can add to the above comments. My name is Arthur Edward Roberts dob 10.12.44., and had my operation on the 17.11.2014.

Written by a patient

I had a full left knee replacement in March 2014. Mr Kim was a most excellent consultant both before and after the operation. His manner was most encouraging and helped me cope with the unknown journey of recovery. Of course Mr Kim did the technical job and was supported by an excellent operating team. The hospital staff and as an outpatient for physio were all excellent in aiding my recovery. I now have almost 100 per cent recovery after 12 months. I am far better off then when I started on this road, I would recommend Mr Kim to anyone. He is a most charming person and has a wonderful manner, just what you want.

Written by a patient

Mr Kim performed my knee arthroscopy in December 2014 at BMI-The-Alexandra-Hospital and I was very impressed with my physical fitness, movement and pain free knee after the procedure. At my six weeks post op appointment, Mr Kim explained in detail what he had done, giving me advice on future exercising -ie- what to avoid etc. His excellent approach with his patients, made me feel at ease and confident about future scenarios with my knee. The physio that was put in place couldn’t have been better and this also contributed my speedy recovery. I completely trust Mr Kim’s experience, knowledge and expertise of orthopaedic surgery and would recommend him.

Listen to a testimonial from a young patient who had a partial knee replacement