Knee Conditions & Treatments
There are a wide range of conditions that can result in knee pain. These include:
- Knee Arthritis
- Meniscal Tears
- Anterior Cruciate Ligament (ACL) Injury
- Posterior Cruciate Ligament (PCL) Injuries
- Medial Collateral Ligament (MCL) Injuries
- Unhappy triad
- Lateral Collateral Ligament (LCL) and Postero-lateral Corner (PLC)
Knee Arthritis
- Arthritis is painful inflammation of a joint. The two main forms of arthritis are Osteo-arthritis and Inflammatory Arthritis.
- Osteoarthritis is where the joint cartilage gradually breaks down as a result of a degenerative process (wear and tear) producing secondary inflammation.
- Inflammatory Arthritis is when the primary cause arthritis is due to inflammation of the joint, this inflammation leads to joint cartilage damage and loss. There are many types of inflammatory arthritis, including Rheumatoid arthritis, gout, psoriatic arthritis and ankylosing spondylitis to name a few.
- Knee arthritis can make it hard to complete everyday activities, such as walking or climbing stairs, causing pain, swelling, stiffness and deformity. Symptoms can initially be experienced intermittently, however most of the time the symptoms gradually progress causing disability and affect quality of life. Additional symptoms include;
- The joint may become stiff and swollen, making it difficult to bend and/or straighten the knee
- Pain and swelling may be worse in the morning, or after sitting or resting
- Vigorous activity may cause pain and swelling to flare up
- Loose fragments of cartilage and other tissue can interfere with the smooth motion of joints
- Pain may cause a feeling of weakness or buckling in the knee
Non-surgical
- Weight Loss – A number of scientific studies have demonstrated that excess body weight is associated with more symptoms. It has also been shown that weight-loss has beneficial effects on symptoms caused by knee osteoarthritis.
- Amending lifestyle e.g. moving from high intensity training to lighter activity such as cycling or swimming
- Rest or temporarily reducing activities which aggravates and/ or exacerbates symptoms
- Use of assistive devices such as walking sticks and braces
- Simple pain medication such as paracetamol
- A course of non-steroidal anti-inflammatory medication
- Steroid injection into the knee joint
- Alternative, or `experimental’ treatment of knee arthritis in forms of tablets (such as Glucosamine) or injections (such as visco-supplementation / gel, blood products or stem cells) are yet to been proven by scientific studies that these treatment options would provide reliable and lasting benefits to patients suffering from knee arthritis.
Surgical
- Knee Arthroscopy
The role of knee arthroscopy in the treatment of knee arthritis is generally limited, as it does not address the underlying cause of the worn out joint cartilage. Occasionally, if the symptoms are predominantly mechanical in nature (clicking and locking of the knee joint), the arthritis may be moderate with minimal or no inflammation, an arthroscopic procedure may provide some benefit. However, this form of treatment is usually temporary and does not alter the prognosis and the degenerative process of arthritis. - Cartilage grafting
In cases where the joint cartilage damage is localised to the weight-bearing area and the damage does not exceed a certain size, treatment involving transplantation of cartilage plugs from non-weight bearing areas of the knee (called “mosaic-plasty”) may prove to be beneficial. - Synovectomy
When the inner lining of the knee joint (called synovium) is chronically inflamed, and does not respond to pharmaceutical treatment, surgically removing the synovium (partial or subtotal synovectomy) can improve the symptoms in cases of early inflammatory arthritis, such as rheumatoid arthritis. This procedure is usually performed arthroscopically. Total Knee Replacement (TKR)
During a total joint replacement procedure the damaged cartilage is replaced by artificial surfaces. Joint replacement surgery for knee arthritis is one of the most common and successful orthopaedic procedures with regards to improving quality of life among those who are suffering from end stage arthritis and non-operative treatment methods have been exhausted.Partial or Uni-compartmental Knee Replacement Surgery
- Revision Knee Replacement
Meniscal Tears
Menisci’s are fibrous `C’ shaped cartilages which provide a protective effect to the joint surface cartilage, acting as ‘shock-absorbers’. Meniscal cartilage has limited blood supply, therefore if an injury occurs to the meniscus it has limited capacity to heal. Tears of the menisci are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. Without treatment, a piece of meniscus may cause ongoing symptoms and further damage to the joint surface cartilage.
- You might feel a `pop’ when you tear a meniscus. Most people can still walk on their injured knee, however over the next 1 to 2 days; the knee will gradually become more swollen.
- Pain continues for weeks or months when engaging in activity, pain is mostly at the level of the joint line
- Stiffness and swelling
- Catching or locking of the knee
- The sensation of the knee `giving way’
- Not being able to move the knee through its full range of motion
- Difficulties when bending the knee or squatting
Non-surgical
- RICE (Rest, Ice, Compression and Elevation)
- Non-steroidal anti-inflammatory medicines
Surgical
- Knee Arthroscopy
- Partial meniscectomy
- Meniscus repair
Anterior Cruciate Ligament (ACL) Injury
ACL injuries usually occur with pivoting / twisting activities or with extreme bending or extending of the knee. This type of injury is quite dramatic with a `snapping’ or `popping’ sensation, followed by immediate severe pain and swelling. ACL injuries are common among those who engage in contact sports such as soccer, football, netball and basketball.
- Loss of full range of motion to the knee
- Pain deep inside the middle of the knee joint
- Discomfort while walking, instability, `insecurity’ sensation with side steps (pivoting activities)
Non-surgical
- Immediate RICE (Rest, Ice, Compression and Elevation)
- Temporary Bracing (Braces are usually ineffective against twisting and rotational forces)
- Physical Therapy – Hamstring muscles strengthening exercises can be beneficial as the function of hamstrings is to support rotational control of the knee joint.
Surgical
- Knee Arthroscopy
- Anterior Cruciate Ligament Repair (limited to specific type of ACL injuries)
- Anterior Cruciate Ligament Reconstruction using grafts (hamstring or patella tendon) commonly called `knee reconstruction’.
Posterior Cruciate Ligament (PCL) Injuries
The posterior cruciate ligament is located in the back of the knee. An injury to the posterior cruciate ligament requires a powerful force, pushing the knee from the front backwards. These injuries are commonly seen in motor vehicle accidents as a direct injury to the knee, and less commonly during contact sports.
- Pain with swelling that occurs following the injury
- Swelling that makes the knee stiff and may cause a limp
- Difficulty walking
- The knee may feel unstable
- Pain at the front and back of the knee
Non-surgical
- RICE (Rest, Ice, Compression, Elevation)
- Immobilisation
- Physical Therapy, including quadriceps strengthening exercises
Surgical
- Posterior Cruciate Ligament (ACL) Repair or Reconstruction can be beneficial; however, our experienced team will ensure that you are provided with all of the necessary information and guidance to assist you to make the right choice for your individual circumstances.
Medial Collateral Ligament Injuries
The Medial Collateral Ligament is the mean supporting stabiliser to the inner side of the knee. This is most commonly sprained by a direct blow to the outside of the knee causing pain and swelling on the inner aspect of the knee. The MCL can be torn partially or completely.
- Pain with swelling on the inner side of the knee that occurs quickly after the injury
- Swelling makes the knee stiff and cause a limp
- Difficulty walking
- The knee may feel unstable
Non-surgical
- RICE (Rest, Ice, Compression, Elevation)
- Immobilisation, splinting or bracing
- Physical Therapy
Surgical
- Repair of a completely torn MCL may be required in some cases
- Reconstruction is necessary if chronic instability develops
Unhappy triad
The `Unhappy Triad’ is an injury to the knee which causes tearing of the medial meniscus, MCL and ACL in one injury.
- A number of symptoms will be experienced when there a patient is diagnosed with a `Unhappy Triad’ injury. The symptoms involve all three structures.
Non-surgical
- RICE (Rest, Ice, Compression, Elevation)
- Immobilisation, splinting or bracing
- Physical Therapy to rehabilitate knee function to an optimal functional level aiming to achieve pain free, full knee range of motion with good muscle strength.
Surgical
- Depending on the extent of the injury to the three structures meniscal repair or partial resection and ACL reconstruction may have to be considered.
Total Knee Replacement (TKR)
During a total joint replacement procedure the damaged cartilage is replaced by artificial surfaces. Joint replacement surgery for knee arthritis is one of the most common and successful orthopaedic procedures with regards to improving quality of life among those who are suffering.
The patients who benefit the most from this surgery are the ones suffering at the end stage of their condition, when non-operative treatment is no longer able to control their symptoms, when their pain and disability interferes with their daily activities and impairs their quality of life. Making the decision regarding whether you are at the appropriate stage to benefit from a joint replacement or not, needs a very delicate and balanced consideration of your individual circumstances and condition. Our experienced team ensures that we provide you with all of the necessary information and guidance to assist you to the choice which is right for you.
I utilise computer navigation during surgery for total knee replacements to improve the mechanical alignment of the prosthesis. This can help to improve the accuracy of the implantation.
During my knee replacement surgery I do not use a tourniquet. Therefore, the blood flow is not stopped in the leg for surgery. By not using a tourniquet, it allows me to better control bleeding, reduces the risk of blood clots and pain experienced post-surgery.
The other technical aspect of the knee replacement is the surgical exposure. I utilise muscle spearing surgical approaches called mid-vastus or sub-vastus approaches, this allows earlier muscle action in the thigh muscle and, consequently earlier and easier mobilisation following surgery.
Considering the extent of the operation, in the early post-operative period patients can endure significant discomfort (pain, swelling, bruising). There are many aspects of the surgical procedure and post-operative care which aims to reduce the risks of discomfort and optimise the recovery period. An active and complex pain management plan is employed, this includes blood clot prevention and early mobilisation within hours following surgery to make the recovery as painless and comfortable as possible.
Longevity of the prosthesis is a common question that is asked by my patients. According to laboratory studies the advanced materials used in knee replacements are able to withstand mechanical wear equivalent to 20-30 years of use in the human body. According to mechanical testing, the ceramicised implant surfaces (like the ACS knee replacement) provide a harder and smoother surface potentially increasing the life of the prosthesis. Aligning and balancing a knee replacement can also affect the longevity of the implant, this can be completed by traditional and/or mechanical methods or by using patient specific jigs pre-fabricated based on pre-operative imaging or computer navigation. However, there is still no definitive scientific evidence to decide which method would provide better clinical outcome and improve patient satisfaction. Therefore, the most suitable prosthesis and method of surgery for you will be discussed at the time of your consultation.
Revision Knee Replacement
What is a Revision Knee Replacement?
If a knee replacement fails for any reason, for example through prosthesis wear, loosening, bone reabsorption, infection, injury, peri-prosthetic fracture or any other cause, then it may be necessary to remove and replace it with a new prosthesis. This procedure is called a revision surgery.
A revision knee replacement is a more complex procedure which usually requires special prosthetic implants supplementing weak or missing bony or soft tissue structures. According to the 2017 Australian National Joint Replacement Registry’s report at 10 years the total knee replacement revision rate was around 5%, and at 15 years it was 7.4%.
Partial or Uni-compartmental Knee Replacement Surgery
Approximately 10% of patients with knee arthritis, where the disease is limited to the inner (medial) or outer (lateral) side, or to the front (patello-femoral) of the knee may be suitable for surgery where only the damaged part (compartment) of the knee is replaced. It is to be noted that there is a specific criteria to be fulfilled to decide if you are appropriate for this surgery, the advantages/disadvantages will be carefully and individually considered at the time of consultation.
Making the decision regarding whether you are at the appropriate stage to benefit from Partial or Uni-compartmental Knee Replacement Surgery or not, needs a very delicate and balanced consideration of your individual circumstances and condition. Our experienced team will ensure that we provide you with all of the necessary information and guidance to assist you to make the right choice for you.
How is Partial or Uni-compartmental Knee Replacement Surgery Performed?
One of the most recent advances in knee replacement surgery is the use of `robotic’ knee replacement. We have started to offer this procedure to suitable patients.
