• Arthritis
  • ACL reconstruction
  • Arthroscopy
  • Meniscal
  • High tibial ostetomy

Arthritis

Arthritis is characterized by the thinning or complete absence of the normally smooth cartilage lining of the joint. The process is irreversible and develops over a prolonged time. Symptoms are dominated by pain, stiffness and loss of function.

The most common cause of arthritis is age related wear and tear and and is known as osteoarthritis. In posttraumatic arthritis recurrent trauma like dislocations or a previous fracture lead to a destruction of the joint. A more rapid progression is observed in inflammatory conditions such as rheumatoid arthritis.

In the early stages arthritis can be treated non operatively. Accurate pain management and  physiotherapy can maintain mobility of the joint and strengthen the knee muscles.

Knee joint replacement surgery is warrant in advanced cases. During surgery the worn areas are removed and replaced with a prosthetic joint. This addresses the pain associated with advanced arthritis. In most cases an improvement in the range of motion and function of the now artificial joint is noted.

In patients with advanced arthritis affecting the patello-femoral part of the knee a specific joint replacements in form of a patellofemoral joint replacement can be performed. Patellofemoral replacements address the worn cartilage of the patella and it’s grove instead of replacing the total knee.

In cases with isolated medial or lateral compartment arthritis a unicompartmental (half) knee replacement can be done. Surgery is possible through a smaller incision than normally would be used in a conventional total knee replacement. Only the worn out compartment gets then replaced by a specific prothesis. A conversion to a total knee replacement can be done if later on other compartments are affected by arthritis.

Surgery is performed under a general anesthetic. The average hospital length of stay is 4-5 days. During this time the patient commences a gentle physiotherapy program to regain strength and prevent stiffness.

Improvements in shoulder replacement designs and advances in surgical techniques allow Knee replacements to last for 15-20 years.


ACL reconstruction

The anterior cruciate ligament (ACL) has the function of a major stabilising ligament in the knee. The ACL is a  strong structure which runs through the center of the knee from the femur to the tibia. Injury to the ligament often leads to recurrent  episodes of instability. Participation in certain sport and work activities can be difficult and can further damage the joint. In the long terms this can lead to progressive changes within the knee.

Injuries to the ACL can occur in several ways. Often a change of direction movement, a direct impact, landing from a jump or sudden stopping is involved.

Initial symptoms include pain, hearing of a pop (30-50%), instability and a rapidly swelling knee are the main symptoms.
Commonly further structures including the menisci, collateral ligaments or the surface cartilage of the knee can be injured.

Anterior cruciate ligament reconstruction (ACL reconstruction) is a frequently performed surgical tissue graft replacement of the injured ligament. This operation restores the function of the ACL after injuries. Recent advances in arthroscopic surgery allow minimal incisions and a low complication rate. The ruptured ligament is removed and tunnels in the femur and tibia are drilled to accept the new ligament. The graft is usually taken form the hamstrings. Alternatives to the hamstring graft are the patella tendon or donated grafts depending on the surgeons preference and surgical situation. The graft is prepared to take the shape of a new ligament and then passed through the predrilled holes. Interference screws are then used to secure the new graft.

During the procedure the rest of the knee can be clearly visualised and any other damage can be addressed.

The surgery requires an anaesthetic and possible nerve block. Patients are usually in hospital overnight. Early mobilisation is encouraged. A specific accelerated physiotherapy program is designed to rehabilitate the knee following the months after ligament reconstruction.  


Arthroscopy

Knee Arthroscopy is often referred to as key-hole surgery and allows the direct inspection of the knee joint and its structures. It can be performed alone or in association with other procedures such as Anterior cruciate ligament reconstruction or patello-femoral reconstructions for recurrent patella dislocations.

Knee Arthroscopy is a commonly performed procedure and treats various problems within the knee joint.  The knee consists of two types of cartilage. Hyaline cartilage covers the ends of the thigh bone (femur) and the shin bone (tibia) and is often called surface cartilage. The menisci are two half moon shaped structures which lie between the weight-bearing surfaces of the femur and the tibia. They act as shock absorbers and protect the surface cartilage of the bones from impact. 

Most frequently an arthroscopy is performed to remove or repair torn meniscal cartilage and/or to trim of torn articular surface cartilage. 

Traumatic meniscal tears occur after twisting injuries or impacts from the side of the knee. Symptoms of a meniscal tear present with pain along the joint line and pain on squatting or twisting motions. The knee can be swollen and in the case of a large displaced tear (buckle handle tea) locking of the knee can occur.

Degenerative meniscal tears occur after minimal trauma or commonly a memorable event or injury can not be recollected. Decreasing elasticity can be blamed for the the failure of the meniscus. 

Initial treatment of meniscal tears include simple pain medication, swelling control and physiotherapy.

If the symptoms persist surgery is recommended. During the procedure the torn cartilage is removed. Depending on the location, configuration of the tear and the age of the patient a meniscal repair can be done using special suture anchors to compress the torn surfaces and encourage direct healing.

In the presence of meniscal tears changes of the surface cartilage are often found. Frayed or torn parts of the cartilage can be removed to leave a smoother less irritating contact area.

Knee arthroscopy is also the procedure of choice for the removal of loose bone or inflamed synovial tissue and the treatment of plica lesions.

Surgery is generally performed under a general anaesthetic. Patients usually go home the same day. The patients undergoes a specific physiotherapy program to regain knee function and to prevent stiffness.


Tibial/Femoral Osteotomy

 

In a knee osteotomy either the shinbone (tibia) or the thighbone (femur) is cut and then reshaped to relieve pressure of the knee joint. During the procedure weight is transferred to less worn compartments of the knee.

Knee osteotomy is used when osteoarthritis is in an early stage and has damaged just one compartment of the knee. By shifting the weight-bearing forces off the damaged side of the knee joint, an osteotomy can significantly relieve the pain and improve function of the arthritic knee. The goals of a successful knee osteotomy include transfer weight from the arthritic part of the knee joint to a healthier area, to correct poor knee alignment and to prolong the life span of the native knee joint.

By preserving the knee anatomy a successful knee osteotomy may delay the need for a total knee replacement for several years. Following a osteotomy there are no restrictions on physical activities including high impact sports.

Osteotomies have some disadvantages. Pain relief is not as predictable as after partial or total knee replacement surgery. Osteotomy surgery requires a period of non-weightbearing, recovery after osteotomy surgery takes longer than after replacement surgery.

Knee osteotomy is most effective in thin active patients between the age of 40-60 years.

Good candidates have pain on only one side of the knee, and no pain under the kneecap. Knee pain should be brought on mostly by activity, as well as standing for a long period of time.

Most osteotomies for knee arthritis are done on the tibia to correct a bowlegged alignment that is putting too much stress on the inside of the knee. During this procedure, the tibia is cut and opened form the medial site forming an opening wedge straightening the leg. This brings the bones on the healthy side of the knee closer together and creates more space between the bones on the damaged, arthritic side. As a result, the knee can carry weight more evenly, easing pressure on the painful side.

Osteotomies of the thighbone (femur) are done using the same technique. They are usually done to correct a knock-kneed alignment.

Occasionally knee osteotomy surgery is effective in the treatment of knee ligament instability.

Osteotomy can relieve pain and delay the progression of arthritis in the knee. It can allow a younger patient to lead a more active lifestyle for many years. Even though many patients will ultimately require a total knee replacement, an osteotomy can be an effective way to buy time until a replacement is required.

The surgery requires an anaesthetic and possible nerve block. Patients are usually in hospital overnight. After the operation the knee is placed a brace for protection while the bone heals. Crutches will be used for 4-6 weeks after surgery. During rehabilitation, a physical therapist will give you exercises to help maintain your range of motion and restore your strength.

You may be able to resume your full activities after 3 to 6 months.