1. What causes knee pain?
Knee surgery is often used for the treatment of different conditions that can cause knee pain. Most people experience knee pain at one time or another. There are three causes of knee pain:
· Normal wear and tear. The most common cause of knee pain is arthritis and the most common type of arthritis is osteoarthritis.
· Overuse. This can be the result of tendonitis where any of the three tendons around the knee become inflamed due to repeated overuse. This is often associated with runners.
· An acute injury. These are normally sporting injuries. Some sports that involve a lot of turning, such as football, netball and skiing carry a particularly high risk of knee injuries.
2. When should you consider knee surgery?If you’ve had knee pain for some time and it’s interfering with your day to day activities or sleep then it’s advisable to make an appointment with your doctor to discuss diagnosis and treatment options in detail.
You should make an appointment with your doctor if your knee pain was caused by a particularly forceful impact and it's accompanied by: considerable pain, significant swelling, redness, tenderness and warmth around the joint or fever.
You will need to seek immediate medical attention if your knee pain is caused by an injury and is accompanied by: a joint that appears deformed, a popping noise at the time your knee was injured, inability to use the joint, intense pain and/or sudden swelling.
It's important to have an evaluation and proper diagnosis of your knee pain. Your consultant orthopaedic surgeon will assess the level of pain and the reason for it, taking into account your individual lifestyle, then discuss with you your treatment options and advise if knee surgery is required.
3. What are the different types of knee surgery?
The most common types of knee surgery include:
Knee replacement surgery
Knee replacement surgery involves replacing damaged, worn or diseased cartilage and bone in your knee joint with an artificial joint that is made of metalor plastic and allows the joint to move in the same way as a natural joint. It's a routine operation for knee pain most commonly caused by arthritis.
Whilst under anaesthetic your surgeon will move your knee cap to the side to gain access to your knee joint. The worn cartilage and bones in your knee joint will be removed and replaced with a precisely measured and shaped to fit prosthesis. The artificial joint is held into place with special cement or the bone surface is roughened to encourage your bone to fuse onto the artificial joint.
You may have either a total or a partial knee replacement depending upon the extent of damage to your knee. Your knee surgeon will discuss the best option for your needs. More than 70,000 knee replacements are carried out in England and Wales each year, and the number is rising. For most people, a replacement knee lasts over 20 years, especially if the new knee is cared for properly and not put under too much strain.
Your surgeon may use knee arthroscopy to investigate the reason for your knee pain and take small tissue samples (biopsies) to help diagnose problems such as infection. You can also have treatment during a knee arthroscopy, for example, your surgeon may repair or remove any damaged tissue and cartilage. Arthroscopy for the knee is most commonly used for repair, trimming and removal of torn meniscus cartilage. A meniscus is a shock absorbing cartilage that cushions and protects the joint surfaces of the knee and when damaged it may cause pain, swelling and issues with movement.
In arthroscopic surgery, small incisions are made around the knee for the insertion of a small camera and various instruments to safely repair, trim or remove the damaged meniscus.
Your surgeon will advise the best treatment option for your torn meniscus:
· Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.
· Some meniscus tears can be repaired to restore the normal anatomy of the knee. This is normally if the tear is on the outer portion of the meniscus. If it’s towards the central area of the meniscus, the lack of a sufficient blood supply will not allow the meniscus to heal itself after repair. A meniscus repair reduces the risk of developing arthritis later on in life.
· Certain types of meniscal tears are not repairable and need to be removed and this called meniscectomy surgery.
The anterior cruciate ligament, or ACL, is one of four major knee ligaments. It is critical to knee stability and people who injure their ACL often complain that their knee gives-out from under them.
ACL injuries are one of the most common types of knee injuries, accounting for around 40% of all sports injuries. The ACL is usually torn when you slowdown very quickly while turning or sidestepping at the same time, landing incorrectly from a jump or having a collision.
ACL reconstruction is an operation to help improve the stability and function of your knee joint. It involves replacing the torn ACL with a graft that is usually taken from another part of your knee. Sometimes the graft can be from a donor.
The ACL is the most commonly injured ligament with approximately 40,000 ACL surgeries being carried out in the UK each year.
Partial knee replacement (PKR)
Partial knee replacements (PKR) involve a small incision and only the damaged cartilage and bone being removed and artificially replaced, leaving the healthy part of the knee in place. When the cartilage loss is limited to a small portion of the knee joint, it may be possible to replace just the worn-out portion of the joint.
Total knee replacement (TKR)
Total knee replacements (TKR) are more common. They involve both sides of your knee joint being replaced.
Removal of loose fragments of bone and cartilage
Loose fragments of cartilage or bone (varying in size from a few millimetres up to a few centimetres) move freely around the knee in joint fluid, or synovium. They can get caught in flexion and extension movements, hindering your joint movements and sometimes leading to articular cartilage damage,causing osteoarthritis. Arthroscopy can remove all loose bodies, popularly known as “clean out” arthroscopies.
Removal of inflamed synovial tissue
The synovium membrane surrounds the inner lining of your knee joint and may have folds and fringes. Its main function is to create synovial fluid, which helps nourish and lubricate your joint.
When part of your synovium becomes inflamed, it can cause your entire joint to swell and become tender. Your plica is a fold within the synovium that islocated near the kneecap. The plica is highly vulnerable to injury and this is referred to as "plica syndrome". A plica excision can be performed by your surgeon using arthroscopy to reduce inflammation by removing the damaged synovial tissue and plica.
The kneecap moves up and down the end of the thigh bone in a groove of cartilage. It can be pulled to the outside of this groove, or may even dislocate from the groove, and this causes pain when bending your knee joint. A lateral release will loosen the ligaments that pull the kneecap toward the outside of the groove and realign your kneecap.
The patellar tendon and quadriceps tendon are located on the front of your knee joint, above and below the kneecap. If injured these tendons can cause issues with leg flexibility and movement and patients have difficultly straightening the knee joint. Treatment of a patellar tendon or quadriceps tendon rupture is nearly always a surgical repair.
4. Are there any alternatives to knee surgery?
Dependant on the reason for your knee pain and the extent of damage there are a number of non-invasive treatments to try before surgery. These include:physical therapy, medications to reduce pain and inflammation, and using an assistive device like a cane.
Obesity increases the risk of osteoarthritis in the knee because the excess body fat causes extra pressure on the knee joint. Also obese people tend to do less physical activity and this creates a loss of muscle that surrounds and protects the knee joint. Exercise and weight loss can also help reduce symptoms of osteoarthritis in the knee, improve knee function and possibly reduce disease progression.
While knee pain may make it difficult to exercise, certain physiotherapy exercises can help strengthen muscles in ways that can minimise the amount of discomfort in the knee.
5. What are the benefits of knee surgery?
The ultimate benefit is that knee surgery reduces knee pain or results in no knee pain. There is substantial evidence to indicate that TKR effectively reduces pain and improves function. Knee replacement recipients have even reported less pain immediately after the surgery and during the recovery period.
Following knee surgery patients can move around, resume their normal lifestyle and continue with their day to day activities, regaining their independence without the constant excruciating pain that knee problems can cause. Sports patients often return to their preferred sports.
6. What are the risks of knee surgery?
All surgical procedures carry some risk. Your surgeon will discuss the risks of surgery with you at the time of your consultation. It’s important that you fully understand the risks and benefits of your planned procedure before you decide whether surgery is the right course for you. The risks of surgery vary from operation to operation and from patient to patient. For knee replacement surgery complications occur in about one in 20 cases, but most are minor and can be successfully treated. The risk of complications developing will depend on a number of factors including your age and general health.
General risks of knee surgery include deep vein thrombosis and pulmonary embolism, delayed wound and bone healing, bleeding, infection and anaesthetic complications.
7. How can I get ready for knee surgery?
• Try to keep as active as you can. A physiotherapist can advise you on exercises to help strengthen the muscles around your knee to aid your recovery.
• Arrange for a friend or family member to take you to hospital and bring you home. You may also need their help at home for a week or two after you come out of hospital depending upon your procedure.
• Before your knee surgery put anything you’ll need when you return home within easy reach such as TV remote control, telephone, medications, books and magazines.
• Ensure you have plenty of ‘ready meals’ for you to prepare easily and a variety of your preferred drinks.
8. How long will it take to recover after knee surgery?
The length of your stay in hospital will depend on what operation you’ve had and also it varies between individuals as will your overall recovery.
Simple key-hole surgery can be done as a day case, although some patients prefer to stay overnight. Most people will be fully recovered following key-hole surgery within six weeks.
For knee replacement surgery most patients remain in hospital for five to seven days. Once you’re home you must be prepared for a long recovery period. A full recovery from knee replacement surgery can take up to six months. Lots of rest and physiotherapy are usually needed to make sure your body heals around the new joint. Plan ahead and ensure you have plenty of help at hand.
9. How long do you need off work?
This will depend on the knee surgery you’ve had, how you travel to work and what your work involves. After simple key-hole surgery most patients can get back to work a week following surgery. If your job is physically more demanding and you have to be on your feet a lot then two or three weeks off work maybe more appropriate. For bigger operations such as a knee replacement most patients have approximately six weeks off work.
10. Exercise after knee surgery
Regular exercise to restore your knee mobility and strength and a gradual return to everyday activities are important for your full recovery. For the most part, this can be carried out at home.
Your orthopaedic surgeon and physiotherapist may recommend that you exercise approximately 20 to 30 minutes two or three times a day. You also may be advised to engage in a walking program.
Following knee surgery you will see a physiotherapist who will show you exercises to strengthen your knee and movements to stop it from becoming stiff.It’s important that you to continue these for as long as you are advised. Your physiotherapist will provide you with crutches, if required, and teach you how to walk safely with them. You will be able to put as much weight through your operated leg as is comfortable, unless your surgeon or physiotherapist tell you otherwise.
11. When can I start doing sports again?
Following a knee arthroscopy procedure you will be able to return to normal sporting activities by eight weeks. You should phase these gently back in to your rehabilitation programme.
Following knee replacement, if you wish to return to sport you should consult your surgeon before doing so. Walking and swimming are encouraged but sports which call for jogging or jumping or contact sports are not. With any exercise you should start gently and build it up. For example, if you’re a golfer you can start playing again at 8 to 12 weeks but begin with chipping and putting before playing 9 holes, then build up to 18 holes. You should avoid the driving range for up to three months as the repetitive twisting can aggravate the knee. Gardening is fine but care should be taken with heavier work such as digging. Start very gradually and do not increase the amount of activity until you feel confident and have suffered no adverse symptoms.
Even after you’ve recovered from a knee replacement it’s best to avoid extreme movements or sports where there is a risk of falling, such as skiing or mountain biking. Your doctor or a physiotherapist will offer you advice.
About Ramsay Healthcare Knee Surgery
At Ramsay Health Care we’re proud to work in partnership with some of the highest qualified and experienced consultant orthopaedic surgeons, neurosurgeons, pain management consultants and physiotherapists in the UK. Our holistic care offers you the best treatment for your knee pain.
At Ramsay you won’t have to wait for an appointment to see a specialist or for your knee surgery if recommended by your consultant orthopaedic surgeon. Your treatment may be covered by medical insurance or self-pay packages are available on request. We have first class facilities. Our aim is to help you feel like a guest as well as a patient.
Please contact us or your local Ramsay Hospital for more information.
For further reading about having knee replacement surgery please refer to our blog.