Knee arthroscopy is now a routine operation performed as a day case. It is a “key hole” procedure performed through two small incisions either side of the knee cap. Arthroscopy can be used to treat the following conditions:
The operation is performed under general anaesthetic and takes approximately 30 minutes. At the end of the operation the knee is filled with local anaesthetic to abolish pain. The two holes are dressed and a bandage applied to the whole knee. Your surgeon will see patients two weeks post-op to inspect the wounds and ensure recovery is on schedule. Further physiotherapy may be required. Normally it is safe to go back to work and drive a car approximately 10 days post-op.
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All forms of ligament reconstruction are performed under general anaesthetic. Normally patients stay in hospital overnight and go home the day after surgery.
The anterior cruciate ligament (ACL) is the commonest ligament requiring reconstruction. The ruptured ligament is removed arthroscopically and replaced by a graft harvested from either a portion of the patella tendon found at the front of the knee or from the hamstring found at the back of the knee, depending on your surgeon’s preference. The graft is tunnelled into the knee joint and held in place with two screws. Post-operatively the physiotherapists provide a rehabilitation programme directed at building up muscle strength and increasing mobility. Activities of daily living should return to normal within 6 weeks and light training can start at that stage. Return to sport depends on the individual patient. Contact sport should be avoided for approximately six months.
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Some people, particularly adolescents and young adults, suffer injuries to the actual surface of the knee joint. If left untreated, the knee often becomes painful and swollen. In severe cases osteoarthritis may develop. Various treatments are available ranging from simple drilling of the defect through to cartilage transplantation. Your surgeon is one of a small number of surgeons trained in the use of cartilage transplantation and participates in a national trial based at the Royal National Orthopaedic Hospital.
People who are naturally “bow legged” or “knock kneed” can develop arthritis of the knee because the alignment of the leg is incorrect. If left untreated the arthritis may progress to a stage where partial or total knee replacement is required. Restoring the normal alignment of the knee using a technique called “osteotomy” prevents further deterioration of the joint and relieves pain. Osteotomy is performed either on the lower end of the femur (thigh bone) or the top end of the tibia (shin bone) depending on which type of malalignment is present.
In most people osteoarthritis of the knee starts off in the medial compartment (the inside of the knee) and some notice their knee becoming bowed. If there is no arthritis elsewhere in the knee it is preferable to replace only the arthritic part, thus preserving the unaffected part of the joint. The advantages of a minimally invasive partial knee replacement compared to a conventional total knee replacement include:
In a minority of patients their arthritis is confined to the patello-femoral joint (between the knee cap and the lower end of the thigh bone). Providing the rest of the knee is in good condition these patients can be treated by patello-femoral replacement (see picture). The advantage of this procedure is that only the diseased part of the knee is replaced and the main weight bearing parts of the knee are preserved. If, in the future, the arthritis should progress then the procedure can easily be converted to a total knee replacement.
By the time most people’s arthritis is bad enough to warrant surgery the arthritis is often affecting all three compartments of the knee. In this situation total knee replacement is required. The operation involves removing the damaged surfaces of the knee and replacing them with an artificial joint containing metal and plastic components (see right). The operation takes about an hour to perform and most people stay in hospital for 5-7 days. It takes about 6 weeks to fully recover from surgery and return work and drive a car etc. It is an extremely successful operation for the vast majority of people. Contrary to popular belief nobody is “too young" for a knee replacement. We believe people should be treated on merit and if someone’s symptoms are bad enough, knee replacement should be considered regardless of age.
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Knee replacements have a life span of 10-15 years after which they tend to loosen. When this happens the knee becomes painful on exercise and revision surgery is often required. The old components are removed and a new knee is inserted. Revision surgery is more challenging than replacing an arthritic knee first time around. The operation takes longer (about 2 hours) and recovery is slower. Contrary to popular belief, however, there is no limit to the number of times a knee can be revised.