Knee conditions and injuries can affect people young and old, including sportsmen and older people who are more susceptible to falls.
When other, less invasive, treatments have been explored then you may be offered knee surgery.
Knee surgery may be needed to treat:
- sprains and strains
- tendonitis
- dislocated kneecap/patella
- Osgood-Schlatter’s disease
- torn ligament, tendon or meniscus
- cartilage damage
- Osteoarthritis
- Bursitis
- A range of other conditions
Although knee surgery is an operation, it often leads to long-term relief from symptoms and may bring about a complete, or very significant, reduction in pain and excellent functional recovery.
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Knee Treatments
In the first instance, there are treatments you can try at home to ease the pain of a knee that has sustained minor injury or damage. These are not suitable, however, if there is major injury or severe pain.
In the case of minor injury, rest the knee and avoid putting weight on it, use an ice pack or frozen food packs wrapped in a towel to reduce swelling and bruising, and take painkillers to manage the pain.
Non-operative treatments that may be recommended by the doctor or hospital include:
- Orthotics – these are often used after a fracture or in the case of ligament/cartilage tears to prevent further injury and strain.
- Injections – these may be used to alleviate pain if you are suffering from osteoarthritis, or if the cartilage is worn. Possible types of injection include: steroids for inflammation, hyaluronic acid to lubricate the joint and platelet rich plasma for the symptoms of knee osteoarthritis.
- Physiotherapy – particularly effective for bruises, strains or inflammation resulting in swelling and chronic pain.
Minimally invasive surgery
Arthroscopy is often called keyhole surgery, although it is used for both diagnosis and treatment. It involves making a small cut through which a thin tube (the arthroscope) is inserted, in which there is a tiny camera. Small surgical instruments can also be inserted alongside the arthroscope with which it is possible to carry out surgery as necessary.
Knee arthroscopy is used to treat conditions such as a torn meniscus, repairs to damaged cartilage and knee ligament reconstruction surgery. These techniques involve little or no incisions of muscle and because only a small cut is needed, recovery is faster and mobility can usually be regained more quickly, with less scarring.
Minimally invasive surgical treatments that may be available include:
- Arthroscopy (keyhole surgery) – this involves making a small incision through which a thin tube containing a tiny camera is inserted. Small surgical instruments can then be used to carry out surgery.
- Arthroscopic meniscal surgery – The meniscus is a type of knee cartilage that acts as the knee’s “shock absorber”. It can be damaged if the knee is twisted or subjected to sudden shocks. Arthroscopy can be used for limited meniscal resection, or for repairs of a torn meniscus.
- Arthroscopic articular cartilage repair – The articular cartilage covers the ends of the bones that form the knee, and enables them to move smoothly together. It can be damaged by knee injury and is also subject to wear and tear over time. Among the techniques that can be used to repair damaged articular cartilage are thermal chondroplasty. This entails removing damaged tissue using heat, smoothing out the cartilage. Another technique is called microfracturing, which involves making tiny holes in the underlying bone to stimulate the growth of new tissue.
- Ligament repair and reconstruction – There are four main knee ligaments, which connect the femur and tibia. The posterior cruciate ligament (PCL) and the anterior cruciate ligament (ACL) cross each other in the middle of the knee. The ACL is particularly prone to damage from sudden twists or shocks to the knee, and repairs can involve complete reconstruction of the ligament itself.
- Patella instability surgery – The patella is the kneecap, the bone that links the femur and tibia. It is held in place by four ligaments. The kneecap can become unstable following accidental damage to the ligaments or cartilage, as the result of wear and tear, or because of a congenital abnormality in the joint itself. Remedies may include medial patellofemoral ligament reconstruction, using tissue grafts, and tibial tubercle transfer, which involves surgery to realign the bones to reduce the load on the kneecap.
Knee Surgery
Knee replacement surgery is very widely used to alleviate pain and improve mobility. There are now well over 100,000 such operations in the UK each year.
Although investigations would always be made to whether minimally or non-invasive treatments can be used to alleviate knee pain, it is sometimes the case that more major surgery is necessary.
Among the surgical procedures available are:
- Osteotomy – An osteotomy (the word literally means “bone cutting”) is a surgical technique to lengthen, shorten or change the alignment of the thigh-bone or shin-bone. It is often used to treat localised bone damage (as a result of trauma or osteoarthritis) or to correct bone malformation.
- Knee replacement (full or partial) – This involves removing a joint that is badly damaged or diseased, and replacing it with an artificial one. A total knee replacement involves replacing a damaged, worn or malformed knee with a complete artificial joint. In most cases, post surgery, you will have better mobility, and pain will be reduced or eliminated altogether. The knee has three parts or sections: the inner (medial), outer (lateral) and the kneecap itself. If only one part is damaged, a partial knee replacement may be sufficient. The advantage of this is that it involves a more minimally invasive surgery, so recovery times are quicker.
- Revision knee replacement – A knee replacement will normally last 15-20 years, if it is cared for properly. Eventually, however, the artificial joint will wear out. Revision knee replacement is designed to replace the worn artificial joint. Revision surgery is more complex than primary knee replacement surgery, and at present revision joints do not always last as long.
- Complex revision surgery for infections – In around 1.5% of cases, infections occur in the artificial knee joint, sometimes after several years of use. Treatments include:
- debridement, where the infected area is cleaned out with surgery
- modular exchange, where the bearing surfaces of the artificial joint is replaced
- implant retention, where the implant components are retained if possible
- antibiotic treatment, to help prevent a recurrence of the infection
- Complex salvage surgery – Unfortunately, some knee conditions, particularly those resulting from trauma or disease, cannot be treated medically or with joint replacement. Amputation, either above or below the knee, is only carried out as a final resort. Knee fusion, where the thigh and shin bones are surgically joined – fused – using specialised metal pins as appropriate, is sometimes recommended where the knee joint cannot be replaced effectively. Again, both these procedures are only considered when all other options have been evaluated and rejected. If complex salvage surgery of this nature becomes necessary, guidance and advice is provided throughout the entire process, including help with prosthetic fitting and physiotherapy.
Risk Factors
All surgery comes with risk. Among the risks associated with knee surgery are:
- Blood clots – symptoms to look out for include a hot, reddened, hard or painful area in the legs. Deep vein thrombosis may result from lack of movement in the leg after surgery. The risk can be reduced by wearing support stockings, having anticoagulation injections and ensuring you start to walk or exercise as soon as possible.
- Pulmonary embolism – this is a blood clot on your lung, leading to chest pains and breathlessness, which can be serious.
- Anaesthetic carries a small risk – approximately one in every 100,000 people receiving a general anaesthetic experiences a problem, which can include death. Pre-operative assessments are used to lower any risks when possible.
- Other risks include: stiffness, bleeding, infection in the wound; ligament, artery or nerve damage; excess scar tissue forming; dislocation or a fracture of the knee.
FAQ’s
Are there risks associated with keyhole surgery?
All surgery carries some risk. In the case of knee arthroscopy or keyhole surgery, the possible risks include:
- blood clots
- infection
- bleeding inside the knee joint
- damage to cartilage, meniscus, blood vessels, ligaments or nerves
- knee stiffness
How long does it take to recover from knee replacement surgery?
You should be able to resume your normal activities without the need for crutches or a walking frame within six weeks of surgery. It may take three to six months for the pain and swelling to subside.
Personal outcomes – what to expect
Each year, knee treatments enable thousands of patients to enjoy an active life, free of chronic knee pain.
Our patient-care process
- Once all of your diagnostic procedures are completed, we will be able to explain whether surgery is recommended.
- We will go through the procedures with you, covering the operation itself, the recovery process and the future prospects.
- Your orthopaedic surgeon will also explain the risks: these are small, but it is important for you to understand them.
- You can feel reassured that you will receive expert care from the start of the process, including your after-care.
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If you are experiencing pain in your pelvis, hip, knee or ankle, or are suffering from a sports injury, seek specialist help to get you back to living your life. Contact can be made direct, or through your GP.
Email:
enquiries@carrothersorthopaedics.co.uk
Phone:
+ 44 (0) 1223 667 376.