Knee Treatments

Several conditions that cause chronic and long-lasting pain to the knee can often, if properly diagnosed, be successfully treated without a major operation.

Specialist diagnostic and therapy providers enable patients suffering from these disorders to enjoy a more fulfilling and active life.

Knee Surgery

Step 1: Diagnostic services for knee pain

Prompt and accurate diagnosis can often prevent a short-term issue from becoming a long-term and potentially serious problem.

Fortunately, modern technologies enable accurate diagnoses to be made quickly and effectively. These include:

  • X-ray
  • Ultrasound
  • CT scans
  • MRI scans

An initial discussion

If you suffer from chronic knee pain, you may want to arrange a preliminary consultation either at your direct request, or through referral by your GP or another specialist.

During this discussion, we will make an initial examination, and recommend suitable tests to obtain more detailed information. This will enable us to make detailed proposals for your further treatments, and to explain all of the relevant procedures

CONTACT
Scan

Step 2 (a): Non-operative therapies for knee pain

Some knee problems can be effectively dealt with using techniques that do not involve surgery. These include the following:

Many knee conditions can now be effectively treated by carefully targeted physiotherapy. This is particularly effective for conditions which are the result of bruises, strains or inflammation, and which result in swelling and chronic pain

Orthotics is a specialist process that involves the design, manufacture and fitting of an orthoses, which are devices that support or restrict joints such as knees.

They are often used after a fracture or in the case of ligament/cartilage tears to prevent strain and further injury to the knee, and thus help recovery. Knee braces are also used for this purpose.

If you have developed osteoarthritis (bone inflammation) in your knee, or if the cartilage is worn, you may be suffering localised pain, for example when you walk, climb or descend stairs, or drive.

This pain can often be alleviated by an injection.

The most widely used injected medications for this purpose are:

  • Depo-medrol – a steroid, which is injected, often with a long-lasting local anaesthetic, to reduce the symptoms (particularly chronic pain or swelling) caused by inflammation.
  • Durolane – a synthesised product, which contains stabilised hyaluronic acid to lubricate the joint.
  • Platelet Rich Plasma – is an exciting emerging treatment for knee osteoarthritis and encouraging results have been shown both for early osteoarthritis and more advanced osteoarthritis. It also has beneficial effects on tendon conditions. One of the appealing aspects of this treatment is that it does not use drugs, but rather harvests natural healing factors from a patient’s own blood. The procedure to harvest and purify the PRP is done in the clinic and takes about 30 minutes.

Injections are carried out either in the surgery, or as an outpatient, and do not involve hospitalisation.

Step 2 (b): Minimally invasive knee surgery

Some knee problems require surgery, but where possible, minimally invasive techniques would be used, for a quicker recovery and less discomfort.

Arthroscopy is often called keyhole surgery, although it is used for both diagnosis and treatment. It involves making a small cut through which a thin tube (the arthroscope) is inserted, in which there is a tiny camera.

This enables examination. Small surgical instruments can also be inserted alongside the arthroscope to carry out surgery, as necessary. Because only a small cut is needed, arthroscopy scars heal quite quickly.

Knee arthroscopy is used on relatively localised issues, such as repairs to a damaged cartilage.

It is possible to use more extensive, but still minimally invasive surgical techniques, to treat certain knee conditions. These techniques involve little or no incisions of muscle, so recovery is faster and mobility can usually be regained quicker.

The meniscus is a layer of cartilage that acts as the knee’s “shock absorber” and can be damaged if the knee is twisted or subject to sudden shocks.

Arthroscopy can be used for limited meniscal resection, or for repairs of a torn meniscus.

The articular cartilage covers the ends of the bones that form the knee, and enables them to move smoothly together.

It can be damaged by knee injury and is also subject to wear and tear over time.

Among the techniques that can be used to repair damaged articular cartilage are thermal chondroplasty, in which damaged tissue is removed using heat, smoothing out the cartilage; and microfracturing, which involves making tiny holes in the underlying bone to stimulate the growth of new tissue.

There are four main knee ligaments, which connect the femur and tibia.

The posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) cross each other in the middle of the knee.

The ACL is particularly subject to damage from sudden twists or shocks to the knee, and repairs can involve complete reconstruction of the ligament itself.

The patella is the kneecap, the bone that links the femur and tibia, and it is held in place by the four ligaments mentioned above.

The kneecap can become unstable following accidental damage to the ligaments or cartilage, as the result of wear and tear, or because of a congenital abnormality in the joint itself.

Remedies may include medial patellofemoral ligament reconstruction, using tissue grafts, and tibial tubercle transfer, which involves surgery to realign the bones to reduce the load on the kneecap.

Step 2 (c): Operative knee treatments

Where non-invasive or minimally invasive treatments can be used to alleviate knee pain, they are. However, it is sometimes the case that more major surgery is necessary.

An osteotomy (the word literally means “bone cutting”) is a surgical technique which lengthening, shortening or changing the alignment of the thigh-bone or shin-bone.

It’s often used to treat localised bone damage (as a result of trauma or osteoarthritis) or to correct bone malformation.

Knee replacement has been around for more than half a century now, and the techniques and systems are well established.

It involves removing a joint which is badly damaged or diseased, and replacing it with an artificial unit. In the majority of cases, partial or total knee replacement will enable you to regain full mobility in the joint.

A total knee replacement involves replacing a damaged, worn or malformed knee with a complete artificial joint. It involves major surgery, but in the majority of cases results in better mobility, and the reduction or elimination of pain.

The knee has three parts or sections: the inner (medial), outer (lateral) and the kneecap itself.

If only one part is damaged, a partial or unicompartmental knee replacement may be sufficient. This involves minimally invasive surgery, so recovery times can be quite quick, although the technique is not suitable for everyone.

A total knee replacement involves replacing a damaged, worn or malformed knee with a complete artificial joint. It involves major surgery, but in the majority of cases results in recovery in mobility, and the reduction or elimination of pain.

A knee replacement should last at least 20 years, providing it is cared for properly.

Even so, it is possible that the artificial joint will break or wear out at some point, in which case a revision knee replacement may be needed.

The revision surgery for knee replacements is more complex than the primary replacement, and at present they do not always last as long. However, it is an increasingly commonplace operation.

Fortunately, the vast majority of knee replacements remain infection-free throughout their working lives. However, in about 1.5% of cases, infections do occur, sometimes after several years of satisfactory use. Depending on their type and the source of the infection, infections can be treated with:

  • debridement, where the infected area is cleaned out under surgery
  • modular exchange, where one component of the artificial joint is replaced
  • implant retention, where the implant is re-fixed as needed
  • antibiotic treatment, to prevent a recurrence of the infection

Unfortunately, some knee conditions, particularly those resulting from trauma or disease, cannot be treated medically or with joint replacement. Amputation, either above or below the knee, is only carried out as a final resort.

Knee fusion, where the hip and shin bones are surgically joined – fused – using specialised metal pins as appropriate, is sometimes recommended where the knee joint cannot be replaced effectively. Again, this is a procedure, which is applied when other options have been considered and rejected.

If complex salvage surgery of this nature becomes necessary, guidance and advice is provided throughout the entire process, and afterwards, including help with prosthetic fitting and physiotherapy.

Knee

Personal outcomes

Knee replacement surgery is very widely used to alleviate pain and improve mobility.

There are now well over 100,000 such operations in the UK each year – but it is important for patients to understand fully what is involved.

Once all of your diagnostic procedures are complete, your options will be explained to you in detail. If surgery is needed, all risks will be discussed.

Fortunately, risks these days are small, but it is important for you to understand them.

Likely outcomes will also be discussed, including recovery periods and the prospects for the future, given your conditions.

Useful Links

Diagnosis techniques

NHS – X-ray technique
NHS – Ultrasound technique
NHS – CT scan technique
NHS – MRI scan technique

Orthosis and brace specialists:

Anglia Orthotics Consulting
Bauerfeind UK

Oxford partial knee replacement

The Knee Replacement Edition of the National Joint Registry’s Public and Patient Guide is full of information and statistics about knee replacements.

Take the first step to a pain-free life

If you are experiencing pain in your pelvis, hip, knee or ankle, or are suffering from a sports injury, seek specialist help to get you back to living your life.

Telephone:
+44 (0)1223 667376

Email:
enquiries@carrothersnorrish.co.uk

Contact can also be made through your GP.