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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 - Computer planned

Minimally Invasive Hip Replacement

All other adult Knee problems    

  • I'm sorry you are in pain, and the limitations that follow that. We would like to help.

We offer:

The best knee replacement implant worldwide in terms of how it performs - this is the Conformis Custom made (bespoke) knee replacement. There is no other knee with proven better satisfaction, stability, natural knee feel, fit, natural knee motion and strength. 

We specialise in it. (Over 220 Conformis knee replacements carried out, over 4000 joint replacements in total).

The remarkable custom technology makes a real difference to real people every day of thier lives after a Conformis Knee Replacement.

It still amazes me that from a scan in the UK, manufacture in USA, it fits like a glove on the knee back in the UK, some 6-7 weeks later.

Its been available since 2011, I have used it for 5 years now.

We combine this with obsessive detail at surgery including precision guides, seperate cementing, millimeter implant placement, low impaction and a pain prevention medicine and a modern coolant approach.

Anaesthesia is local spinal anaesthetic with "completetely out of it / deep sleep" clean sedation. You won't hear or know anything about it- and when you wake up you will be pain free as the spinal is still working.

Open transparent discussion of the options including non-surgical, this makes up over 50% of our consultations.

Time to explore, understand, reflect on why the knee has deteriorated, what the options are. 

If we do talk about knee replacement, details on preparation, anaesthetic, recovery, quality of outcome risks and risk prevention.

Tourniquet free knee replacement giving a rapid recovery, better strength, lower risk and much less pain and swelling. We have reviewed 693 papers on the use of tourniquet in knee replacement and are left in no doubt as to its benefits.

State of the art cooling and massage with the Game Ready device, starting immediately post-surgery, with the option of hire at home (£300 / 4 weeks) 

Tecatherapy - again state of the art improvement in pain, swelling and recovery. Used in many knee conditions including following knee replacement.

This is what we specialise in. We also treat and advise on all knee problems working with physiotherapists, orthotics, and MRI, xray and ultrasound experts.

If you have knee pain and want to know what you options are then call us:

0345 912 1000  Appoinments in Wimbledon, Sussex and telephone consultations.

Three 2018 videos showing the Conformis Knee replacement outcome



Video Showing Rapid recovery using evidence driven techniques and inhouse developed approaches with the Attune knee, although we have stopped using the Attune product itself.

Our off the shelf knee of choice is the PFC with an all polyethylene tibia- the is the leading implant in terms of not needing to be redone. Data source the 2017 National Joint Registry.



Custom 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 recently 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. The theatre team includes a surgical assistant, anaesthetist, scrub staff, and anaesthetic assistant and porters- all of these make significant contributions.
After care is also extrememly important with hand picked physiotherapist, hydrotherapy, pain prevention and sleep protocol and the amazing Game Ready device. 
The surgery itself is carried out without use of tourniquet where possible to reduce pain and swelling and therefore aid early recovery. We do this in 95% of knee replacement surgeries.
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. 
We are also the first to use precision drills to eliminate error in guide placement.
I am obsessive regarding infection prevention approach including infection restistant stitches, glove change every 20 minutes, patient skin sealant with adhesive iodine impregnated drape, 2 intravenous antibiotics, minimising of use of the sucker, pulse lavage (like a mini jet wash), patient pre-warming (significantly reduces inadvertant hypothermia during surgery which has been shown to be a significant infection risk factor) , no touch technique where possible, antibiotic impregnated cement, avoidance of skin clips 95% of the time, no drain, no touniquet again 95% of the time, signle use of swabs and no fingers in the wound! You would be surprised!  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 priveledged 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. Currently looking forward to presenting with colleagues at  in Switzerland in October 2018 on the subject of Conformis custom knee replacement.
Most Custom knee replacement patients and PFC knee replacemnts go home the day following surgery. 
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 terms of how long they last it is the PFC with an all poly tibia.

In terms of the quality of the "ride" it is in my view the Conformis iTotal is the best performing Knee Replacement, this is also the best in terms of studied patient satiisfaction. 

The Custom iTotal is more expensive (£14000 plus CT scan plus Game Ready) -perhaps 2.5K more expensive than a standard knee replacement. 

The Conformis 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,

very 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 up time period. These older knees have a patient satisfaction rate of 82%.

I have 17 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 82% 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. 

My experience of Conformis and Attune or PFC 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 computer 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)

What about an off the shelf knee?

I use the PFC CR which has the best survivorship at 10 years accoring to the 14th edition of the National Joint Registry. To use a car analogy its like a Toyota, it just keeps on going. It performs well in the domain of pain relief. 

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

PFC Knee Replacement  £11 500

Custom Total Knee Replacement £14000 plus CT scan (Conformis itotal G2 with enhanced polyethylene)

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 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.

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 up to approximately 1-2% of traditional total knee patients. The ideal patient match for a partial knee resurfacing is a slim male with a bowed leg and a normal back of knee cap on MRI.

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 5 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?

Gradual deterioration in pain, and walking distances, often swelling but not always.  Change in the alignment on the leg with the knee going in or out. Often people struggle with stairs and getting up from a low seat. Some can feel boney lumps around the knee. Family and friends comment on a limp. Some find it difficult to brace the knee fully straight. 

What are the alternatives to knee replacement?

Knee replacement is always a choice.

The alternatives vary from person to person.

Please see options PDF here.

Key alternatives are weight reduction, osteotomy, acceptance of the current state, pain relief, braces, physiotherapy.


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?

I don't support this concept, mainly from the infection perspective but also it helps to see what you are doing and to remove excess cement. I have carried out knee replacement on one leg where the patient has had a minimally invasive knee on the first side - and by a world leader in minimally invasive knee replacement in the States. The patient commented on the quicker recovery from my side. The primary issue is the reduction in infection risk with a normal length scar as this allows the skin edges to be kept out of the way - it is these that are responsible for 80% of patient infections.


Which Knee Replacement is best for me?

In general a Conformis custom knee, it is safer and better than rest. Safer as there isnt a stage of gaining alignment from a rod that goes up the canal of the femur (thigh bone), this rod dispaces fatty bone marrow into the circulation, of which most is filtered by the lungs. The Conformis aligment is preplanned and built into the surface guides / jigs - thus no rod and therefore no bone marrow fat into the circuation. 

If you are seeking a knee that will last the longest, then from the National joint registry its the PFC with an all poly tibia. This is a good quality knee replacement option.

What is it made of?

Metal and a specialist polymer. The Metal is a Cobalt Chrome Alloy, this contains some nickel and molyednem.

How much does it weigh?

About 700g but they varie widely as the smaller sizes weigh less than bigger ones.

Will it set the alarms off at the airport?

Every time. The security personnel have thier processes and a letter doesn't help. They will hand scan your knee, the alarm will go off, they will pat around your knee to ensure no weapons. Knobbly knees are okay. On to the Duty free.  


What type of knee replacement does Mr Lewis use?

  1. The Conformis custom total knee replacement
  2. The PFC with all poly tibia
  3. Genesis 2 with all poly tibia, if available, for nickel allergic / sensitive patients.Metal and Plastic. 

How much does a Knee Replacement Cost?

£11499 all in (except your own choice of at home ice based therapy)- this is for the PFC with all poly tibia. 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


I would like to meet you and take the time to explain in detail your options.  If knee replacement is your chosen route then to personally carry it out to the highest possible standards. There are no stand-in surgeons, its me throughout.


February 2018 


Trading as Sussex Orthopaedic Clinic Ltd.



Hip Replacement