Knee Surgery
Dr Gifford has special interest in acute knee cartilage and ligament injuries.
Anterior cruciate ligament rupture is a common injury and Australia has led the way with innovative and reliable surgery. Reconstruction versus non-operative management is a discussion to be had during the consult. For most patients, reconstruction provides a reliable path to recover stability and confidence in the injured knee.
The anterior cruciate ligament does not have the same capacity to heal as other ligaments due to its position in the knee, bathed in synovial fluid. Reconstruction is most reliable with the patients own tissue (autograft) rather than donated tissue (allograft) or synthetic grafts. Tissue can be harvested from the hamstrings, the quadriceps or the patella tendon. Each option compromises the harvest site initially but then recovers as it heals.
Recovery
Patients may go home the same day as surgery or stay 1 night. You are able to mobilise on crutches and weight bear. You will not need a brace unless more extensive reconstruction is required. You are discharged with suitable pain medication which can be weaned off. You will also have aspirin and compression stockings to reduce the risk of DVT. The post-operative appointment is approximately 2 weeks and you should consult your physiotherapist around this time.
Each patient is different but you can expect to return to work at approximately 2–4 weeks for desk work, and 6–12 weeks for manually intensive jobs. You can return to pool and stationary bike exercise at approximately 6 weeks and running at 4–5 months.
Returning to play competitive sports is usually 6–12 months. The most important determinant is the presence of associated injuries to ligament and cartilage.
Surgery types
Arthroscopy
Reconstruction and repair
Knee replacement surgery
Re-alignment surgery
Patella stabilisation
Knee Arthroscopy
The knee arthroscopy or ‘key hole’ surgery has experienced significant advances in the past several years, in both the procedures and the technology of equipment and implants.
Preservation of tissue is the first priority with arthroscopic surgery and acute repair is preferable where possible. Repair of cartilage or meniscal tissue has limitations due to its poor blood supply. If the cartilage damage is too severe or chronic there are potential reconstruction options to discuss such as replacement with local tissue or donated (allograft).
Cartilage defects can be treated with various techniques according to the size of the defect. Smaller defects in specific locations can be treated with marrow-stimulating techniques, autologous chondrocyte implantation (ACI), or osteochondral autograft transfer. Large defects may be better treated with re-alignment procedures.
Knee Replacement Surgery
Joint replacement or arthroplasty is surgery to remove the damaged joint surface and replace it with modular designed implant.
The knee can be broken into 3 compartments:
Medial compartment – a common site of osteoarthritis. Arthritis and loss of cartilage leads to bowing or varus alignment of the knee
Lateral compartment – a less common site of arthritis. Loss of cartilage in this compartment leads to ‘knock knees’ or valgus alignment
Patellofemoral compartment – a common site of arthritis
Each of these compartments and all 3 can be replaced. A partial knee replacement is suitable when there is limited joint wear, adequate range of movement limited deformity. Partial joint replacement offers quicker recovery with better ROM and function. It does not however prevent the rest of the joint becoming arthritic over time.
The metal component is a surgical grade metal alloy or titanium which is specifically made to adhere to bone.
The tibial and patellar components in knee replacements are made of polyethylene. Though standard polyethylene surfaces traditionally suffered from wear in hip implants, wear is less of a problem in knee implants as the bearing surfaces are flatter and do not result in the same kind of wear. The use of ultra highly cross-linked polyethylene (UHXLPE) reduces even the minimal wear enabling the knee implants to last for a much longer time than previous models.
Who is suitable for knee replacement surgery?
Joint replacement may be indicated in an arthritic joint when the pain is no longer tolerable, and all other treatment options have been excluded. Knee replacement surgery is a reliable way to improve pain in most patients but does carry risks and limitations which need to be discussed during the consult.
Indication that you are ready for joint replacement
Pain that interrupts or prevents rest and sleep
Pain that prevents you from performing your every day activities such as walking, shopping, leisure activities and self-care
Medical imaging (x-rays) that show full thickness wear of cartilage or ‘bone on bone’ arthritis
Joint deformity
Joint instability combines with severe wear and degenerative changes
Benefits of surgery
The primary reason to have knee replacement is pain. Over 90% of patients report improved pain and quality of life scores.
Knee replacement is a long-lasting solution for pain compared to other treatments. Over 94% of implants are still functioning at 10 years with most lasting 15-25 years. However, young patients wear out the prosthesis sooner compared to less active older patients.
Knee replacement surgery can keep you active or participating in activities that pain might prevent you from continuing.
Risks of surgery
Intra-operative risks include:
Reaction to the anaesthetic (mild to moderate)
Fracture during implantation (rare)
Neurovascular injury (very rare)
Early post op risks include:
DVT to limb (uncommon)
Pain, nausea (common)
Bleeding and swelling (occurs to variable amount)
Late post op risks:
Infection (low 1/100)
Stiffness (low)
Loosening (low, risk increases over time)