Knee surgery is a major branch of orthopaedics and many orthopaedic surgeons specialise in managing the many clinical conditions and injuries which occur in the knee joint.
The knee is one of the major weight bearing joints of the lower limb and one of the largest joints in the body. Due to its middle position in the chain of the leg, between the ankle and the hip, it is exposed to high levels of forces in vigorous activities such as running and jumping. This means that the knee is particularly vulnerable to injury and knee pain and knee injuries are some of the most common musculoskeletal complaints, especially amongst sports people.
Most knee injuries are managed conservatively with protection, rest, compression bandage, ice and elevation of the part. Physiotherapists are routinely involved in the diagnosis and treatment of the many types of knee injury such as muscle sprains, ligament injuries, contusions and cartilage injuries.
Knee surgery for knee problems is varied and rarely performed in the acute period as surgeons prefer to give the knee time to settle down so that they can test it firmly without severe pain occurring. This allows a firm diagnosis to be established to guide management.
Knee arthroscopy is a minimally invasive surgical treatment where the surgeon introduces the flexible scope through a small portal and is able to both diagnose and treat a wide variety of knee problems by a direct visual approach.
Knee arthroscopy is used for diagnosis and for treating cartilage tears by cutting them out or repairing them, removing excessive synovial membrane, drilling and tidying up the joint surfaces and doing knee ligament surgery. Most anterior cruciate ligament reconstruction is now performed via the arthroscope.
In arthroscopy for diagnostic or minor surgery the patient has a very quick recovery, usually standing and walking with the physiotherapist a few hours after surgery and not needing to use walking aids such as crutches or have an extended rehabilitation period with a physio. Normal gait is encouraged with some limitations over the first two weeks or so.
Ligament injuries are very common in contact sports in particular, with anterior cruciate ligament rupture, medial ligament injury and lateral ligament injury having different management. Medial and lateral ligament injury rarely requires surgery but anterior cruciate ligament injury typically requires ligament reconstruction if the knee is to perform well and not become arthritic with time.
Cruciate ligament reconstruction is mostly done via the arthroscope, with the method using several strands of the patient's own hamstring tendon the most common method. A few days in hospital are followed by an extended period of physiotherapy rehabilitation which may last nine to twelve months so that the knee returns to full sporting function.
Knee replacement is the operation where the knee joint surfaces, damaged by injury, disease or osteoarthritis, are replaced by artificial metal components. It is one of the most common orthopaedic operations with more than 70,000 performed in the UK each year. This means that the knee replacement cost is rising strongly and may have already overtaken the costs of hip replacement, the initial type of joint replacement developed in the 1960s.
Knee replacement complications are not common but can be serious and the treatment and rehabilitation of revision knees can be time consuming and expensive, extending the knee replacement recovery time and in some cases meaning long term physiotherapy for knee replacement exercises and functional training.
Partial knee replacement is also possible for those patients who have only one compartment of the knee affected by osteoarthritis and this technique is cheaper and patients recover faster. Larger numbers of patients may be suitable for this technique than realised.
To fully understand what has gone on in knee replacement surgery it is useful to watch a knee replacement surgery video as this illustrates the whole process and makes the reasons for cooperation with the physio after the operation clear.
Bespoke Knee Replacement Systems
Although the off the shelf sizing systems for knee replacement implants has worked well there are some patients for whom the sizing is too restrictive. A development in this field is towards more individually made components for those with smaller joints or unusual clinical circumstances. This trend is also illustrated in the Signature knee replacement which uses MRI scans of the person's knee to make surgical guides which are then used to position the new joint components accurately.
If we want to try your hands as this kind of surgery we can with a knee surgery game and virtual knee surgery 2 game, both of which allow us to take the decisions about replacing someone's knee like a surgeon. Luckily there are no awful consequences if we make a mess up.