by Dr Greg Keene, Orthopaedic Surgeon and Knee Specialist

Did you know that you don’t have to put up with a dodgy knee? Lots of people put off having a specialists look at their knee as they are hesitant to have surgery, don’t understand their options or are worried about the recovery time. 


At SPORTSMED•SA we have a number of specialists that can help you decide which treatment option is best for you and your lifestyle. Knee injuries are not just for elite athletes. They can occur in anyone of any age making life more difficult and painful.

There are a number of options for treatment that can help you get back to normal mobility and your active and busy family life. Our aim is to get you back on track and improve your quality of life. 

The knee

The knee is the largest joint of the body. It relies on strong muscles and ligaments for support and stability. In the normal knee smooth weight bearing surfaces cover with special articular cartilage allow for painless movement and shock absorption. Muscles and ligament gives the knee stability. Free movement occurs in flexion (bending) and extension (straightening). Your synovial membrane which lines the joint provides the lubricant for the joint. When you walk or climb stairs, the bones rotator, roll and slide on each other.

The knee joint has three separate compartments. The medial (inner side of the knee), the lateral (outer side of the knee) and the patellofemoral (under the kneecap).

The knee joint

Some of the causes of joint damage (arthritis) with resulting pain and disability are: 

Inflamation

Rheumatoid arthritis which causes damage to the joint surface (also called the articular cartilage), the lining of the joint (synovitis) and the ligaments. There are other forms of inflammatory arthritis. 

Degeneration

Osteoarthritis or ‘wear and tear’ of articular cartilage that may occur in many people over 50. It does not always cause serious problems, but is may be the reason for surgery if the wear and the pain is severe. 

Injury

Damage to ligaments may cause the joint to be unstable and subject to increased and abnormal stresses over a long period of time, leading to damage of the joint surface and arthritis. 

Variations in ailments

An abnormal degree of knock-knee (called valgus) or bow-leg (called varus) may develop if one half or side of the knee wears out, and thus becomes gradually and progressively worse. These knees may be suitable for a Partial Knee Replacement.

Reasons for surgery

A large number of people develop knee problems to some degree. The majority can be successfully managed without surgical operation by medication, physiotherapy, weight control or modification of leisure/sporting/work activities that aggravate the problem.

Others may require arthroscopic surgery to remove damaged or diseased tissue or loose fragments of bone or cartilage from the joint to slow down the damaging process; or to structurally realign it and so reduce the abnormal stresses caused by malalignment.

Joint replacement surgery using a prosthesis (artificial joint, also called an arthroplasty) is considered only for those people with severely damaged joints that can no longer be successfully managed by other means and is performed for the following reasons:

  • To relieve pain (the primary reason in the majority of people)
  • To improve function, e.g walking, sitting
  • To improve alignment and correct deformity
  • To improve mobility
  • To improve stability 
  • The overall aim is to improve your quality of life. 

Total knee replacement

This is performed when two or all three compartments are severely worn out.

  • The prosthesis components can be either cemented or non-cemented into place.
  • The upper metal femoral component replaces the weight bearing surfaces of the femur (thigh bone) and has a groove in which the patella (kneecap) moves.
  • The lower metal tibial component replaced the tibial (shin bone) weight bearing surfaces.
  • A plastic liner fits into the tibial component to provide smooth movement between it and the metal femoral component and replaces the cartilages.
  • If there is severe arthritis in the patellofemoral joint then a plastic button may be attached to the back of the patella (kneecap) to provide smooth movement between it and the groove in the upper femoral component. In most cases, however, the natural patella can be left intact and will work very well with the prosthetic knee.
     

Partial (unicompartmental) knee replacement


New technology developments have allowed a ‘mini’ knee replacement to be developed that can be used when only one of the three compartments if badly worn (unicompartmental).

This prosthesis is much smaller and can be inserted through a much smaller incision. Hence, the term ‘minimally invasive’ knee replacement.

Partial knee replacement can also be done to the kneecap joint (patellofemoral), as well as the medial and lateral compartments.

Recovery is much quicker and movement is usually better with this procedure compared with the total knee replacements. Complications rates are also much lower with partial replacements.

The majority of people experience good to excellent results from this operation and are able to walk, go up and down stairs near normally, drive a car and do all activities of daily living near normally.

Persistence in exercise is important to achieve this result, and some minor aches, swelling and clicking are common after joint replacement. The operation is not intended to give you a youthful knee again but to reduce or eliminate pain and increase function and quality of life. When you judge your new knee 6-12 months after surgery try to remember how bad (painful) it was BEFORE the operation and try not to focus on any minor aches or problems.

Complications can occur with all major surgery. The accepted infection rate for knee replacement surgery is under one per cent despite using prophylactic antibiotics.

Another concern is the possibility of blood clots in the veins of the leg (venous thrombosis) which can cause embolus to the lungs or brain despite numerous prevention measures taken by us. Most complications, if they occur, can be treated usually with success.

SPORTSMED•SA is pleased to advise that we have a low complication rate and special care is taken to prevent such problems. We monitor all complications (minor and major) to improve and maintain our high quality of care. We audit out complication rates against international best practice bench marks twice a year.

Later complications include wearing or loosening of the prosthesis. This is much more likely if you are overweight.

The best way to help limit complications is to get out of bed quickly after surgery and be very determined with your exercises.

If your tired of living with a dodgy, painful knee and want specialist advice, make an appointment with one of our Orthopaedics Surgeons on 08 8362 7788. We have a number of surgeons on staff that specialise in knees. A referral from your GP will be required prior to your appointment.