Knee arthroscopy involves inserting an arthroscope (camera) into the joint through a small incision or porthole to view the inside of the knee.
This can be done to confirm a diagnosis that is suggested by your physical problems and any special diagnostic tests that may have been carried out (e.g. x-ray, ultrasound, MRI scan) or to investigate pain for which there is no apparent cause to try and find a cause.
Knee arthroscopy can be performed on its own as a diagnostic procedure or can be followed by arthroscopic surgery in the same operation.
During arthroscopic or keyhole surgery, precision instruments are inserted into the knee through a number of additional small incisions. Your Surgeon can view the joint via the arthroscope on a TV monitor and can carry out any necessary procedures.
Arthroscopic procedures can be advantageous as they involve very small incisions, can reduce damage to the surrounding tissues and structures and have shorter healing times.
In some cases, your Surgeon may decide that it may be more beneficial for you to have an open or mini-open (small incision) procedure.
Also known as knee arthroplasty, this procedure involves removing one or more of the articular surfaces within the knee and replacing them with either ceramic, plastic or metal components.
The articular surfaces in the knee are highly specialised cartilage layers at the ends of the bones, which allow smooth movement against the neighbouring bone while weight-bearing.
Due to conditions including arthritis, injury or joint disease, these surfaces become rough or distorted and movement can become stiff and painful. While conservative treatments may be able to delay surgery, knee replacement is a highly successful procedure for significantly reducing pain and maintaining or improving movement. The primary reason for undertaking a knee replacement is to reduce pain.
Knee replacements are an extremely successful and common operation with over 70,000 performed in the UK each year. The surgeons at the Knee Unit are all senior consultants who regularly perform knee replacement operations and can advise you on the most suitable procedure for your condition, age and activity levels.
Total knee replacements
Patients whose arthritis or knee condition is severe and affects the whole knee, a total knee replacement may be the most suitable procedure to relieve pain and maintain movement.
In total knee replacement, both inner and outer articular surfaces on the femur (thigh bone) and on the tibia (shin bone) are replaced. The prosthesis (replacement components) include a replacement for the anterior cruciate ligament to help maintain normal knee function. The operation may or may not include the patella (knee cap).
The operation usually involves four to five nights in hospital. Using advanced, minimally invasive techniques, patients are often standing on the day following the operation and can begin physiotherapy immediately, with regular sessions each day.
Range of movement following a knee replacement is usually improved, but the operation is primarily performed to remove pain and maintain movement. However, as pain can restrict movement before a replacement operation, patients often find the range of movement increases significantly.
Patients can improve the outcome from a knee replacement operation by starting physiotherapy before the operation. This can improve movement, strenghten muscles and increase flexibility – all of which can lead to a faster and fuller recovery post surgery.
Partial knee replacements
Approximately 20% of patients have a type of arthritis suitable for a partial or unicondylar (one sided) knee replacement. In patients with osteoarthritis limited to the inner weight-bearing surface of the knee joint (medial tibiofemoral surface), a small amount of worn cartilage and underlying bone can be removed from the adjacent surfaces of the inner side of the knee joint. This is then replaced by a specially designed implant. The patient also needs to have a functioning anterior cruciate ligament for this operation to be suitable.
For suitable patients, this operation can be advantageous for the following reasons:
- It does not involve removing the cruciate ligaments from the centre of the knee
- There is less injury to the surrounding muscles including the quadriceps
- Hospital stays are reduced
- Rehabilitation is shorter
Patients typically spend one to two nights in hospital following a partial replacement and need the use of a walking stick for approximately three to four weeks.
Your Consultant will fully investigate your knee using the lastest state-of-the-art technology and will advise you on the most suitable procedure for you. Once decided, an individually tailored treatment plan will be put in place. Our dedicated teams of surgeons, nurses, physiotherapists and support staff will be with you throughout your operation and rehabilitation.
The type of surgery performed on a torn meniscus, often referred to as a torn cartilage, depends greatly on the location of the tear. The outer section of the meniscus has a good blood supply so surgery in this area can heal well. The inner section has little or no blood supply, so any repairs made to the meniscus in this area will not heal.
Not all meniscal tears require surgery. Depending on the size and location of the tear and your activity levels, your Surgeon may recommend conservative treatments as a first course of action. This can include physiotherapy and/or injections into the knee.
If the cartilage has a tear in the outer section, your Surgeon may choose to repair the tear.
This is usually done using arthroscopic (keyhole) techniques. The tear is either sutured (stitched) or tacked into place. The success of the operation will depend on the size and location of the tear within the meniscus.
Following surgery, the knee is usually protected using a brace and crutches will be used for around one month postoperatively. Your Surgeon will advise you on postoperative care.
If the tear in the cartilage is too close to the centre of the knee, where it has little or no blood supply, or if the meniscal tear is too large, your Surgeon may have to remove the damaged section. Surgical repairs to tears in the inner section of the meniscii will not heal so are not attempted.
The damaged section of the meniscus is removed using arthroscopic surgery. In most cases, the damaged part is removed using a specialised shaver with part of the meniscus being left in place.
Patients do very well following removal of the meniscus and rehabilitation can be started immediately with patients being able to stand within days of the procedure.
Removal of the meniscus is thought to increase the long term incidence of osteoarthritis in the knee. Your Surgeon will discuss the implications of surgery and will advise you on the most suitable options for your condition and activity levels.