Your concerns are valid. Your surgeon knows how to address them. Honest answers to the most common questions — without minimising or exaggerating.
Book a ConsultationBeing afraid of having surgery is a normal, healthy response. No patient should accept an operation without understanding what will happen, what may go well — and what may go wrong. The right information does not eliminate fear, but it turns it into an informed decision.
What follows are the most common concerns that patients bring to the appointment, with direct and honest clinical answers. If you are left with doubts — book an appointment. There is no such thing as a question that is too basic.
Intraoperative awareness (waking up during surgery) is extremely rare — an incidence of less than 0.1–0.2% with modern anaesthetic monitoring techniques. Anaesthetists use bispectral index (BIS) monitoring and other parameters to ensure adequate depth. Most knee surgery can be performed under regional anaesthesia (spinal anaesthesia), in which the patient may be awake but pain-free — completely eliminating this risk.
✓ Incidence <0.1% with modern monitoringKnee surgery is performed under general or regional anaesthesia (spinal anaesthesia + femoral/saphenous nerve block). In neither case does the patient feel pain during the procedure. The modern multimodal analgesic protocol begins before surgery and continues throughout the immediate postoperative period, ensuring that waking up is not a painful experience.
✓ Multimodal protocol — pain controlled from the startComplications do exist and should be discussed honestly. Deep vein thrombosis (DVT) is prevented with prophylactic anticoagulation and early mobilisation — the incidence of clinically relevant pulmonary embolism is less than 0.5%. Deep infection is the most feared complication in arthroplasty — an incidence of 1–2% in specialised centres. The risk is reduced with prophylactic antibiotic therapy, rigorous aseptic technique and control of individual risk factors (diabetes, obesity, smoking).
✓ Active prevention — real but manageable riskRecovery from knee surgery has improved dramatically with modern enhanced recovery protocols (ERAS — Enhanced Recovery After Surgery). Mobilisation begins on the very day of surgery. Most patients walk unaided within 3–4 weeks and return to sedentary work in 4–6 weeks. Pain is controlled by a multimodal protocol — avoiding dependence on strong opioids. Full recovery is gradual, but most patients notice significant improvement compared with the preoperative state within the first few weeks.
✓ ERAS protocols — mobilisation on the same dayThis is a legitimate concern. The success of surgery depends on the correct indication, the technique and the patient's commitment to rehabilitation. For most knee conditions with a well-established surgical indication, satisfaction rates are high — >90% for total knee replacement. There is, however, a minority of patients (5–10%) with an outcome below expectations — which is why the surgical decision must be careful and never rushed.
✓ >90% satisfaction with knee replacement — correct indication is everythingThe longevity of modern implants is excellent: >90% of total knee replacements work well at 15 years. ACL grafts have a failure rate of 5–15% depending on the type of graft, sport and return-to-play protocol. When failure occurs — of an implant or a graft — revision surgery is possible and, in many cases, with outcomes similar to the primary procedure. Regular monitoring and respecting activity restrictions are essential to maximise longevity.
✓ >90% longevity at 15 years — monitoring is keyThe best way to deal with fear is to turn it into active preparation. Patients who arrive at surgery in better condition have better outcomes.
Transparency is part of care. There are things that go very well — and things that may not go as expected. Both deserve to be said.
The vast majority of knee surgeries have satisfactory outcomes. The pain of the operation is managed — patients are surprised by modern postoperative comfort. Early mobilisation is possible and makes a difference. Most feel significant improvement within weeks.
Complications do exist — infection, stiffness, persistent pain, implant failure. They are rare but real. Some patients are left with expectations that surgery does not meet. That is why the surgical decision should never be rushed — and the correct indication is the first guarantee of a good outcome.
Orthopaedic Surgeon · Knee Subspecialist
Hospital Lusíadas Porto · Hospital Misericórdia Vila do Conde · Paços de Ferreira
An appointment does not commit you to surgery. It is the place to raise all your questions, understand your options and make an informed decision — in your own time.
Book an Appointment 926 850 194