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July 29, 2017 at 11:31:29 AM Why are knee replacements painful? Written by James Lewis July 2017. Well some are and some are not. This is fascinating. What are the factors that mean some patients have no pain following surgery? The observed pattern is lower weight patients, often men but sometimes women, have no pain. Yes, NO pain after knee replacement. In hip replacement surgery patients frquently tell me that thier pain goes immediately on the day of having the hip replacement. This does happen in knee replacements surgery too but some have pain from the surgery - but some don't. We have been looking in to this. It seems that there are three factors; the bone quality and how careful we are with the bone - interlinked with this is the degree of arthritis as arthritis "hardens" the bone, the soft tissues as in all surgery, and a positive psychology. More

Knee Replacement Surgery    

  • Knee replacement relieves pain from arthritis and restores quality of life.


  • The arthritic pain often goes on the day of surgery.


  • Significant advances have made the recovery quicker and easier.


  • The quality of knee replacement outcome has also advanced giving a new knee with a natural feel such that it feels like one's own.

  • We specialise in modern knee replacement, carrying out over 2500 audited knee replacements (including partial). 

  • The focus is on comfort in recovery and quality of final outcome. 

  • Mr Lewis uses the Attune and Conformis custom knee replacement designs.


  • Both have proven improvements in patient satisfaction and numerous measures of outcome over standard knee replacements.

Video Showing Rapid recovery using modern proven and inhouse developed approaches:


Custom Knee Replacement / Resurfacing 

Attune Knee Replacement / Resurfacing.


Ethos: To provide the very best in service, experience and outcome.

National Specialist in Custom Knee Replacement, including total knee and partial knee replacement.

Video showing walk in walk out Total Knee Replacement using the Attune Knee Replacement system.

Why choose James Lewis?
In short I am driven to continually improve every aspect of the knee replacement experience and outcome. The small details added together make a real difference, I am continually amazed at the improvements in early outcomes, this is great for patients - such as the lovely chap last week who cycled two miles to see me for his two week follow-up check and then cycled home again.
The details are in preoperative preperation risk reduction, surgical precision and judgement and a close knit, excellent, stable theatre team. Members include assistant anaestetist, scrub staff, anaesthetic assistant.
After care is also extrememly important with hand picked physiotherapist, hydrotherapy, pain prevention and sleep protocol and the amazing Gameready device 
The surgery itself is carried out without use of tourniquet where possible to reduce pain and swelling and therefore aid early recovery. 
Implant postionioning with developed techniques for reproducability. Technical areas at surgery including low impact cementing and fixation technique to reduce hammer induced bone trauma and accurately reproduce cement thickness to within 1mm of designers recommendations. 
I am obsessive regarding infection prevention approach including infection restistant stitches with increasing specialisation, critical assessment, team work. I have made and perhaps pioneered a number of advances which translate in to reprocucabiliity and predictability of outcome. I use specialist additional intstruments, some custom made for a particular stage of the operation, I am privaledged to train and share experiences with other consultant surgeons on a one to one basis and both present at and attend national knee replacement meetings.
Most Custom knee replacement patients go home the day following surgery, most Attune knee replacement patients go home after 2 nights.
My aim is provide a first class outcome for those with painful knee arthritis seeking:
  • a rapid recovery with as much comfort and minimal swelling as possible,
  • restoration of quality of life,
  • a new knee that feels like one's own,
  • trust and stability in thier knee
  • strength
  • return to an active and enjoyable lifestyle
  • focus on risk reduction including avoidance of transfusion and and an exceptionally low infection risk.

Which is the Best Knee Replacement?

The focus of knee replacement has been on how long they last rather than how they "drive" or perform.

In my view the Conformis iTotal is the best performing Knee Replacement. It has taken me over three years to be sure of this view and a number of technical operational refinements to deliver reproducability to reach this conclusion. I have formed this view from studies, presentations, and personal experience. The Custom iTotal is a little more expensive (£13900 plus CT scan) but does well in the following areas of: 

knee feeling like one's own natural knee, 

strength and power in the knee, 

straight leg alignment,  

trust in the knee,

flexion (bend in the knee), 

low incidince of clicking,

near natural movement, 

forgetting about one's new knee

return to activities

material quality and thus wear expections and predictions

overall satisfaction.

and finally documented side by side patient diaried recovery experiences are startling (standard knee of the 2000s on one side and a Conformis on the other)

Apart from cost and a manufacture time of 6 weeks I am not aware of any downsides when properly implanted. I think the tolerances of implantation with the Conformis are potentially narrower than some other implants. A possible limitation is that it has been available for 10 years, it is true that some older knees have been available for longer and thus have a longer follow op time period. Overall I would rate it as 9.8 / 10. I have fed back suggested refinements to Conformis the manufacturer on instruemtation and planning areas rather than the implant itself. 

I have 16 years of consulant knee replacement experience and have used different brands and different designs with varying philosophies of design. In the 1990s and 2000s the outcome of knee replacement across the continents was an 80% patient safisfaction rate with the dissatisfaction commonly being in areas of pain, tightness, poor bend and limitations of activities. Of the designs in this era the data or "expert review" that compares outcome of one knee prosthesis to another is remarkably lacking. In most products such as cars or cameras there are several sources of review. I suspect the reason is partly that surgeons tend to stick with one design of knee replacement and partly the barriers of carrying out a comparative study of two types or brands. The strongest data indicates that in the 2000s that the NexGen was the best knee replacement when comparing the four leading brands althought the differences were small between the NexGen and the others. Some comparative data indicates that a medial pivot design of knee is better than other designs. In the 2010s decade there have been new designs from many implant companies. One company DePuy Syntheses has launched the Attune Knee which has 4 year Data in the national Joint Registry. Other new designs are the Persona from ZimmerBiomet, XP Preserving knee from ZimmerBiomet, Journey 2 from Smith and Nephew and Saiph Knee from Mat Ortho. There will be other knee replacements of new design but none that I have been aware of significant clinical use in the UK to include in comparions. I have searched (10.06.17) the PubMed database for outcomes with these new knee implants and can find very little to demonstate the quite probable postive outcomes of the other new knee brands. The Persona data shows better outomes with the more congruent polyethylene insert than the less congruent insert. I have  examined and interviewed a small number of  selected XP preserving patients by lead surgeons at an international meeting and formed the view that they were less good than the Conformis in the areas of feeling like a normal knee and stability. 

Returning to new vs old knee designs. The Attune performs better in every domain of patient function, performance and satisfaction than the Depuy Knee of the 2000s namely the PFC, using this comparator if the PFC was similar to the other knees of the 2000s, which it was acording to patient reported outcomes, then logical follows that it is better than the other knees of this period. However the Attune does not have long term results (3 years of at least a hundred patients). Comparative data or experience of other knees versus the Attune are lacking. Movement based studies of the implant design favours Conformis over Attune. My experience of Conformis and Attune favours Conformis in the areas of power, stability, trust and reduction in clicking. Conformis wins on power through its trochlea referencing at the front of the knee and rotational matching which reduces clicking. It also comes with pre navigated positioning guides called PSI or patient specific instruments which help the surgeon place the implant in the right place. Finally it has a better fit on the top of the shin bone (tibia)

I would probably rate the  Attune as 9.5/10 for early outcome

Other modern knee designs / Brands are probly in region of 9.5/10. Some evidence would favour the medial pivot knee (Saiph) and from my own personal assessment of the XP in expert hands I don't think the upsides warrant the downsides.

I would rate Knee replacements of 1990s and 2000s  as a whole as 8/10 based on satisfaction rates of 80%, there may well be exeptions.

How much does it cost to have a knee replament? (all inclusive Package)

Attune Knee Replacement  £12 315

Custom Total Knee Replacement £13900 plus scan

I use the Attune Knee Replacement and the Custom iTotal Knee Replacement.

Experience: I have carried out 750 knee replacement or knee resurfacing proceedures over the last 3 years, which places me in the top 15 in England and Wales and the in the top 2 for Conformis custom knee replacement.

The Attune and Conformis give proven superior outcomes in a number of measurable areas including patient satifaction. One study shows an improvement of patient satisfaction from 74% to 94% with the Conformis knee compared to a traditional knee.

Please see the rationale for Custom Knee Replacement.

Recent developments include use of Physicool - an evaporation based cooling bandage that increases comfort and is proven to aid recovery.  Further developments include the use of a transcutaneous muscle stimulating device to aid muscle recovery following surgery (Compex). The focus is on Modern knee surgery including:

Below is a Video Showing an 8 month result after a Custom 2/3rds knee resurfacing (Conformis)

More Custom Knee information here


Custom knee replacement, this is individually manufactured metallic components to exactly fit your knee. Furthermore the custom knee replacement or partial knee replacement functions as a knee resurfacing implant, where the old damaged cartilage is removed and the new product fit on the original bone on the weight bearing bone.

Award winning Enhanced recovery program, routine walking 3 hours post surgery and sitting out for one's evening meal, if staying overnight. Patients frequently comment at the comfort levels and rapid recovery.


A national trainer for the Partial Knee Resurfacing system - an alternative to Total Knee Replacement in upto approximately 10% of traditional total knee patients. The ideal patient match for a partial knee is a slim male with a bowed leg.

Top 1 and 2 percentile length of stay outcomes compared to national peers for knee and hip replacement (Worthing and Chichester NHS data).

Exceptionally low infection rates (Data on file)

Partial knee resurfacing as a day case.

Custom knee resurafcing as a day case. First day case iDuo knee resurfacing in the UK, first lateral duo knee resurfacing in the UK..


Custom Total Knee Replacement at Wimbledon Parkside, Wimbledon, SW19 5NX. I have lived in Wimbledon for 4 years.

Two videos of Custom Knee Replacement at Wimbledon Parkside Hospital:


Surgery at Goring Hall Hospital, BN12 5AT Sussex or Wimbledon Parkside, London, SW19 5NX


Wimbledon and Goring Hall Hospital, ring 0345 912 1000 for an appointment. 

Schooled at Portsmouth Grammar.

Trained at Guys Hospital Medical School, further training at The Royal National Orthopaedic Hospital, The Royal London, The Nuffield Orthopaedic Hospital (Oxford), and  Norwich. In an obsessive fashion I did 3 Fellowships and a further 6 month consultant period alongside Niel Thomas, Basin.

A higher degree in Orthopaedic Engineering, awarded distinction.

International training in USA, Australia and Germany.

Custom Knee Information here.


Educational Talk at Warren House, Kingston, 25th April 2015. Very well attended by a wide range of GPs, talk focused of Non-operative management with emphasis on the 2014 OARSI update and Custom Total Knee Replacement including design principles, wear data, performance, opinion, and evidence based medicine......delivering a knee replacement that feels like your own and a leap in patient satisfaction.

Educational Talk at Mumbai, India, 2015. Delivering a knee replacement that feel like your own and gap balancing. Invited talk. 

Educational Talk, AAOS, USA 2014. Custom iDuo Knee resurfacing.

Attune Users group meeting 2017 Southport, talk and recomendations

Meeting with Conformis CEO and UK Conformis user group 2017

Introduction of Game Ready 2017

Introduction of Slope matching, precision cementing and intraoperative measurement

6 point soft tissue balancing algorythm

Patient reviews:

I want great care
Via email

My knee operation went very well with Doctor Lewis.

All of the treatment was great. From the consultations we had he gave the best explanation of what was going to be done with my knee. Very professional! The operation went well and I was given a summary of what he did. Scars looks small and neat!

I recommend seeing Doctor Lewis for any knee concerns!

Thanks a lot, I look forward to getting back to full fitness.

Ben Martin


What are the features of knee arthritis?


What are the alternatives to knee replacement?


What are the keys to a quality outcome?

1. range of motion.


2. getting it straight.


3. getting a good bend


4. Complication avoidance.


Putting all this together gives high reproducability and predictability of a quality outcome. We audit all of our knee replacement patient oucomes.

How to chose your surgeon?

Really difficult from the outside. Good honest results matter, ours are here also video outcomes are helpful. Also factors such as approachability, absence of infection, risk minimisation and consistency also contribute. Detailed written information on the knee replacement and anaesthetic are helpful and indicate attention to detail.

What's this about minimally invasive knee replacement?

Which Knee Replacement is best for me?


What is it made of?


What type of knee replacement does Mr Lewis use?

How much does a Knee Replacement Cost?

£. This includes everything one would reasonably think of, specifically surgeons fees, anaesthetic fees, cost of the prosthesis, physio, medicines, any gadgets, follow up appointments, 6 sessions of specialist physio including hydrotherapy after leaving hospital - this can be local to you. It also includes an element of insurance such that if there where any problems relating to the surgery or anaesthetic then any care resulting and preapproved will be covered.

Videos of patient outcomes


Would you like a modern knee replacement?

A track record of good outcomes?

Being looked after by a good and lovely, real people, team?

500m from the fresh air of the sea

Please ring 0345 912 1000 and speak to Deborah for an appointment, or use the contact form here

Looking forward to meeting you and doing my part to explain your options and if knee replacement is your chosen route then to personally carry it out to the highest possible standards. There are no stand-ins!


July 2017 


Hip Replacement