The most common reason for knee arthroscopy is to treat a meniscal tear (known as the sport cartilage). These most often occur on the inside (medial) part of the knee. Tears in the meniscus can sometimes happen after a bad twist of the knee, but they can sometimes occur without any history of an injury. Meniscal tears can cause pain, swelling, jamming or locking and sometimes the feeling that the knee wants to give way. There is some good evidence that many of these get better on their own within six months. However if symptoms continue to persist or cause significant problems then arthroscopy of the knee can treat these symptoms quite reliably. Usually a procedure called debridement (where the torn edges are trimmed away) is performed. In cases of large tears, especially in younger patients, meniscal repair can be performed using small sutures inside the knee.
Arthroscopy is usually performed as a day case procedure. You would be seen by the anaesthetist and normally given a general anaesthetic. After the operation you will have a bandage on the knee. You will be encouraged to stand and walk. You will be offered crutches and allowed home after a few hours. Symptoms usually improve straight away, however it may take up to 6 weeks to gain the full benefit of surgery.
Knee arthroscopy is keyhole surgery of the knee. Using advanced arthroscopic techniques, tears to the meniscus can be debrided or repaired and small areas of worn cartilage can be treated using chondroplasty or microfracture.
Knee replacement surgery is a highly successful operation for knee arthritis. It can significantly improve the quality of your life. Knee replacements are now performing extremely well. Over 95% last over 10 years, and many last up to 15 years or sometimes even longer.
Knee replacements resurface the worn ends of the knee joint. These metal implants are cemented in place using special bone cement. Between the two metal implants there is a hard wearing plastic insert. The worn surface of the kneecap (patella) is resurfaced using a plastic button. I routinely use the Triathlon knee replacement by Stryker which has an excellent long term track record. I am also involved in a scientific trial testing the Unity knee replacement by Corin.
Certain risk factors exist for knee arthritis. These include previous trauma to the knee (breaks, fractures or ligament tears), previous surgery (such as where the whole meniscus has been removed), other diseases that affect the joints (such as rheumatoid arthritis or gout) and being overweight. It can also run in families too.
The symptoms of knee arthritis include pain (especially on walking and going up and down stairs), stiffness, swelling and sometimes clicking or grating.
There are a number of treatments for knee arthritis. In the early stages, the treatments include simple painkillers (such as paracetamol or ibuprofen), activity modification (to stop doing the things that hurt!), losing weight, physiotherapy to strengthen the knee and exercise. Out of these in fact, exercise is probably the best treatment in early arthritis of the knee!
As symptoms become more severe, stronger painkillers can be prescribed by your GP, and injections with cortisone (steroid) and local anaesthetic may temporarily improve symptoms.
Once the symptoms of knee arthritis are such that they cannot be controlled by simple means, and it is effecting the quality of your life, knee replacement surgery has been found to be extremely effective.
I encourage all of my patients to be well informed about their arthritis and the treatment options. The NHS website has a great page going into detail about arthritis of the knee and the treatment options available, containing many great pictures and videos. Please click on the button below to view the page.
Knee arthritis is commonly referred to as ‘wear and tear’ inside the knee joint. The knee is one of the more commonly affected joints in the body.
Knee arthritis occurs where the cartilage (the smooth lining inside of the knee joint) becomes worn away. When the cartilage is worn away it leaves the hard bare bone surface that may lead to pain and sometimes deformity (such as the bow-leg or knock-knee appearance).
In the clinic Mr Phillips will take a thorough medical history, perform an examination and Xrays will be taken. A detailed conversation will take place where the risks and benefits of the surgery will be discussed and you will be given the opportunity to ask any questions you may have.
After being given a date for surgery, you will attend a pre-op assessment appointment to ensure that you are fit for surgery.
You will be admitted on the day of the operation. You will be seen prior to surgery by the anaesthetist. Mr Phillips' routine practice is for his patients to have a spinal anaesthetic (where the legs are made numb). At the same time, If you would like, you can be made sleepy so you are completely unaware of the surgery. Mr Phillips would also perform a local anaesthetic injection at the time of surgery to improve your post-operative pain relief. We have found that this is the best way to have the surgery causing the least discomfort.
During knee replacement surgery, the worn surface of the bone is removed and replaced with an implant that is cemented in place. On the tibial side, the implant is made of metal (usually cobalt chrome or titanium, depending upon the implant). On the femoral side, the implant is made of cobalt chrome and is shaped to fit onto the end of the bone. Between the two metal components, a plastic (ultra-high molecular weight polyethylene) is placed so that there is no contact between the metal components (so there is no concern about metal on metal implants in knees). Usually the worn under-surface of the knee cap is also resurfaced using a plastic button cemented in place.
The knee replacement is positioned in your knee to fit the way that you are made. Precise checks are made to confirm that everything is stable prior to the final implants being cemented in place. The aims of surgery is to give you a stable, straight knee.
You will wake up in the Recovery Room and be transferred to the ward once you are ready. You will be seen on the ward by the physiotherapist the day after surgery where you will start getting the knee moving and you will be able to walk with support. The average length of stay is three days in hospital.
After the operation the knee is quite stiff and uncomfortable as you recover from surgery. This does improve and normally patients are able to walk free from crutches at about the six week stage. Patients are advised not to drive for the first six weeks after surgery.