When the joint cannot be saved,the operation still matters
Hip and knee replacement is a powerful operation. The point is to choose it for the right reason, do it well, and engineer it for the recovery that follows. SPAIRE on the hip side, TWIS-TKR and kinematic alignment on the knee side, with preservation thinking on both sides of the decision.
The operation is the easy part. The decision and the recovery are where it is won or lost.
Replacement is a one-way operation. The case for doing it has to be at least as strong as the case for delaying it.
When replacement is right, the discipline is the same
Whether the joint is a hip or a knee, the underlying discipline is the same: rule out preservation first, choose the right operation for this patient, treat the soft tissue around the joint with the same care as the bone, and build the recovery into the same decision.
Preserve first
Before replacement is the right answer, every realistic preservation pathway has been considered, mapped and either ruled in or ruled out with reasons.
Right operation, right joint
Partial vs total, cemented vs cementless, kinematic vs mechanical alignment, posterior vs anterior approach, the decision is made for this joint, not the average joint.
Soft-tissue discipline
On the hip, SPAIRE keeps the deep rotators attached; on the knee, the soft-tissue envelope drives recovery. The operation is engineered for the recovery to come, not finished at skin closure.
Recovery is part of the operation
The day-zero plan, the prehabilitation and the structured return to function are built into the same decision, not added on after the fact.
Hip replacement with the soft tissue intact
The signature hip-replacement technique is SPAIRE: Spare Piriformis And Internus, Repair Externus. The piriformis and internus are spared; the externus is detached, the hip is replaced through the surgical window, and the externus is repaired at the end. The deep rotators around the hip are largely preserved, which changes the recovery profile.
Where the patient’s anatomy and activity profile favour an anterior or Bikini-incision approach, that is offered too. The approach is chosen for the hip, not the other way round.
Approach
Posterior with SPAIRE soft-tissue preservation (deep rotators spared); anterior or Bikini-incision in selected patients. The approach is chosen for the patient, not the surgeon.
Bearing
Material and size matched to the patient and the activity profile, with the long-term wear and revisability in view.
Stem and cup
Cemented or cementless, on the published evidence and the patient’s bone quality, not on default.
Length, offset, anteversion
Leg-length equality, femoral offset and component anteversion are planned pre-operatively and verified intra-operatively, not left to feel.
Knee replacement, decided for this knee
The first question on the knee side is whether replacement is the right answer at all. The preservation pathway rules in or rules out cartilage repair, biologics and image-guided injection before the conversation moves to replacement.
Where replacement is the right answer, the decision splits across partial vs total, the alignment philosophy and the patellofemoral discipline. Each is decided for this knee, on its own merits, not by default.
Partial or total
A well-selected unicompartmental knee replacement preserves the rest of the joint and recovers quickly. Used where it fits.
Alignment philosophy
Mechanical, anatomical or kinematic alignment, chosen for the joint and the patient, not the marketing position of an implant.
TWIS-TKR
A specific knee replacement technique developed in Professor Lee’s practice; covered in detail in the dedicated TWIS-TKR section below.
Patellofemoral discipline
Patella tracking and the patellofemoral compartment treated as part of the operation, not as an after-thought.
TWIS-TKR, a specific knee replacement technique
TWIS-TKR is a knee replacement technique developed in Professor Lee’s practice. It belongs in the same family of decisions as kinematic alignment and the patellofemoral discipline above: a way of approaching the operation that prioritises the natural movement pattern of the patient’s own knee.
A deeper write-up is in development. If TWIS-TKR is being considered for your case, or if you are a referrer who would like to discuss whether it fits a specific patient, the route is the same as for any other replacement decision: imaging review, written opinion, conversation.
Local Lincolnshire services, international referrals
A specialist hip or knee replacement opinion does not have to be local.
For international patients, the structure is the same as for UK patients: imaging review, written opinion, decision framework and, where surgery is the right next step, a clear pathway to the operation in London.
Local Lincolnshire patients are seen at Hip Replacement Lincolnshire and Lincolnshire Knee.
External
Hip Replacement Lincolnshire
Local hip-replacement service for Lincolnshire patients. SPAIRE technique preserves the deep hip rotators for faster real-world recovery.
External
Lincolnshire Knee
Local clinical service for knee treatments in Lincolnshire, including knee replacement decision-making and the partial-vs-total conversation.
Where the decision often goes next
Preservation, recovery and complex second opinions are where the replacement decision is most often refined or revisited.
Hip preservation and SPAIRE
Before replacement is the right answer, the preservation question. SPAIRE explained in detail (Spare Piriformis And Internus, Repair Externus).
Read more
Cartilage and joint preservation
The preservation framework for arthritic knees, with biologics, injections and the question of when replacement may be too early.
Read more
Recovery and rehabilitation optimisation
The recovery layer is what makes a replacement work. Prehab, structured progression and Regen PhD systems thinking.
Read more
Common questions
The decision is made on patient anatomy, soft-tissue quality and the realistic recovery target. SPAIRE keeps the piriformis and internus attached and repairs the externus; the anterior approach preserves the posterior soft tissue. Both are valid in the right hands and the right hip. The wrong question is which approach is best in general. The right question is which approach is best for this hip, this anaesthetic risk profile, this activity goal.
TWIS-TKR is a specific knee replacement technique developed in Professor Lee’s practice. The dedicated section above outlines what it is and where it fits. A deeper write-up is in development; for now, ask directly if it is being considered for your case.
When the disease pattern is genuinely confined to one compartment of the knee, when the ligaments are competent, and when the patient’s activity profile rewards the faster recovery. The mistake is to pick partial because it sounds smaller; the right partial is a better operation than a borderline total, and the wrong partial is worse than either.
Yes. International referrals are welcome. The structure mirrors the UK pathway: imaging review, written specialist opinion, decision framework, and a clear route into London for the surgery itself. The recovery and follow-up plan is built around your home location.
Modern hip and knee replacements have strong long-term survivorship at 15 to 20 years and beyond when the operation is well-indicated, well-executed and well-rehabilitated. The honest framing is that survivorship in the literature reflects average operations; the joint in front of us depends on the implant choice, the surgical execution and the recovery layer, all three.
The operation that is right for this patient
Hip or knee, local or international
A written specialist opinion, the decision framework and a clear pathway to surgery in London where surgery is the right next step. SPAIRE on the hip side, TWIS-TKR and kinematic alignment on the knee side.