Dudley Private Hospital
Part of Ramsay Health Care

Knee

The anterior cruciate ligament is one of the most commonly injured ligaments of the knee.

Signs of ACL damage include:

  • A loud "pop" or a "popping" sensation in the knee
  • Severe pain and inability to continue activity
  • Swelling that begins within a few hours
  • Loss of range of motion
  • A feeling of instability or "giving way" with weight bearing.

When is surgery appropriate?

Thankfully surgical reconstruction is generally a very successful operation if done before any permanent chondral or meniscal damage occurs (your doctor will assess this with examination and imaging).

As ACL generally does not heal, the surgical reconstruction is performed using either the patient’s own tendon (auto graft form hamstring or patella tendon) or that of a cadaver’s (allograft).

The procedure is usually a day surgical procedure but the reconstructed ligament matures over a one year period so return to sport is usually delayed for 6 months.

Multi-ligament knee injuries or knee dislocations are serious conditions that require immediate hospital assessment.

These injuries often occur as a result of a high impact injury such as a car accident or fall from a height.

They can also occur from sports or work injuries and involve multiple major ligaments being injured.

If all four major ligaments are injured the knee may be disclocated.

Symptoms associated with these injuries typically include:

  • Severe pain
  • Severe swelling
  • Inability to walk
  • The knee feeling unstable, loose and wobbly

When is surgery appropriate?

The knee needs to be reduced urgently and checked for vascular or neural damage.

Often the leg is splinted until swelling has reduced sufficiently to allow major surgery.

There is no real role for non-operative treatment in this scenario and staged surgeries are often performed to reconstruct the ligaments with a combination of autograft (patient’s own tendon), allograft (tendon from a cadaver) and synthetic grafts (artificial ligaments). Recovery is up to a yearlong.

The patella or the knee cap sits in a groove at the front of the knee called the trochlea.

Symptoms of patellofemoral pain include:

  • Pain around the knee. The pain is felt at the front of the knee, around or behind the kneecap (patella).
  • The pain comes and goes
  • There may be a grating or grinding feeling or noise when the knee moves
  • Sometimes there is fullness or swelling around the patella
  • If the groove or the patella is unusually flat the knee cap may be predisposed to dislocating.

When is surgery appropriate?

Persistent pain should not be ignored as recurrent dislocations can cause damage to the delicate chondral surfaces of the knee joint and predispose to arthritis.

There are a number of surgical procedures that may help in this situation depending on your anatomy.

A Medial Patellofemoral Ligament Reconstruction (MPLF) is a surgical procedure indicated in patients with more severe patellar instability.

An MPFL reconstruction will reconstruct and tighten loose medial ligaments; a lateral release will release tight lateral structures; while a tibial tubercle transfer will realign the whole extensor mechanism by breaking the bone that the patella tendon is attached to and moving it with the patella into a more suitable position.

The appropriate surgery and the rehabilitation required will be decided by your surgeon.

Knee replacement is a procedure to treat severe knee pain that limits every day activities – and it can be unilateral (one knee) or bilateral (two knees).

According to the Australia’s National Joint Registry, there has been an 88 per cent increase in knee replacement surgeries between 2003 and 2014 – with more than 54,000 Australians undertaking the procedure in 2014.

Symptoms commonly associated with osteoarthritis of the knee that typically requires this surgery include:

  • Severe knee pain that limits your everyday activities
  • Pain that increases when you are active, but gets a little better with rest
  • Swelling and feeling of warmth in the joint
  • Some patients complain of increased symptoms as weather gets colder
  • Stiffness in the knee, especially in the morning or when you have been sitting for a while
  • Long-lasting knee inflammation and swelling that doesn't get better with rest or medications
  • In advanced cases, moderate or severe knee pain while resting, day or night
  • A bowing in or out of your leg
  • Knock knees
  • Knee stiffness

How does joint replacement surgery work?

Knee replacement is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability.

It is usually performed for osteoarthritis but also for other kinds of knee disease such as rheumatoid arthritis and psoriatic arthritis.

A torn meniscus, cartilage defects and ligament tears are other reasons your doctor may suggest a total knee replacement.

Knee replacement surgery can be performed as a partial or a total knee.

What is the difference between total and partial knee replacement?

Osteoarthritis of the knee most commonly affects the medial compartment (inside the knee), and can also affect the lateral compartment (outside of the knee) and the patellofemoral compartment (in front of the knee).

Total knee replacement involves surgery to all three components of the knee and today the bulk of surgical knee surgeries in Australia (83 per cent) are total replacements. (the rest are partial revision surgeries).

Total knee replacement has the

Partial knee replacement is generally recommended when only one compartment of the knee is affected rather than all three.

The upside for a partial knee reconstruction is that just one compartment is replaced during surgery, and anterior and posterior cruciate ligaments are preserved; more of your own body structure remains intact and there is a faster recovery.

The downsides however are a higher revision (repeat or re-do) rate; and potentially worse function after revision than with total knee replacement.

It is estimated though that only about 6 per cent of candidates are suitable for partial replacement surgery, with the ideal patient typically older, less active, with minimal deformity.

Patients with inflammatory types of arthritis, such as rheumatoid arthritis are not regarded as good candidates for partial knee replacement.

What happens during knee replacement surgery?

In general, knee replacement surgery consists of replacing the diseased or damaged joint surfaces of the knee with metal and plastic components shaped to allow continued motion of the knee.

The operation typically involves substantial postoperative pain, and includes vigorous physical rehabilitation.

The recovery period may be 6 weeks or longer and may involve the use of mobility aids (e.g. walking frames, canes, crutches) to enable the patient's return to preoperative mobility.

Hospital stay is generally about a week.

Most patients can safely drive at 6 weeks and gradually increase walking distances in 6 weeks.

ROSA® Knee robotic technology is designed to work with your individual anatomy. ROSA, which stands for Robotic Surgical Assistant, is designed to help your specially trained surgeon tailor the placement of your knee implant just for you.

Arthritis in the Knee Joint

The knee is a hinge joint formed by the tibia (shinbone), femur (thighbone) and patella (kneecap). The ends of the bones in the knee joint are covered with cartilage, a tough, lubricating tissue that helps cushion the bones during movement.

Osteoarthritis, the most common form of arthritis, is a wear-and-tear condition that destroys joint cartilage and bone. It typically develops after years of constant motion and pressure in the joints. As the cartilage continues to wear away, the joint becomes increasingly painful and difficult to move. If conservative treatment options fail to provide relief, your surgeon may recommend total knee replacement using ROSA Knee robotic technology.

Arthritis in the Knee Joint

ROSA Knee Robotic Technology

ROSA Knee RobotGetting a precise knee implant fit is important to your comfort and overall experience following knee replacement surgery. ROSA Knee robotic technology uses data collected before and during surgery to inform your surgeon of many details related to your unique anatomy that may affect your implant fit. By using this data to make more informed decisions, your surgeon is able to plan for and carry out a personalised surgery based upon your individual needs.

Before surgery

Your preoperative experience will be like that of most total knee patients. But, unlike traditional knee replacement methods, with ROSA Knee robotic technology, a series of x-rays may be used to create a three-dimensional (3D) model of your knee anatomy. This 3D model will enable the surgeon to plan many specifics of your knee replacement prior to your surgery.

During surgery

The surgical procedure using ROSA Knee robotic technology is similar to traditional total knee replacement, but with a robotic assistant. Your surgeon has been specially trained to use ROSA Knee in order to personalise the surgical approach for your unique anatomy. It’s important to understand that the robot does not operate on its own. That means it does not move unless your surgeon prompts it to. Your surgeon is still in the operating room the entire time and is making all of the decisions throughout your surgery.

During your procedure, ROSA Knee utilises a camera and optical trackers attached to your leg to know exactly where your knee is in space. Think of it like a very detailed global positioning system (GPS) that you might use in your car. If your leg moves even a fraction of an inch, the robot can tell and adjusts accordingly. This helps ensure that the plan your surgeon put into place is executed as intended. Throughout your surgery, ROSA Knee provides your surgeon with data about your knee. This information, combined with your surgeon’s skill, helps them know how to position your implant based on your unique anatomy.

After surgery

Following surgery, you will be hospitalised based upon the recovery plan your surgeon decides is best for you. This hospitalisation may range from one to three days. Recovery time varies, but most people should be able to drive after two weeks, garden after three to four weeks, and golf after six to eight weeks. Your surgeon will tell you when and what activities you can return to, and what activities to avoid.

Complications

While uncommon, complications can occur during and after surgery. Some complications include, but are not limited to, infection, blood clots, implant breakage, malalignment and premature wear, any of which can require additional surgery. Although implant surgery is extremely successful in most cases, some patients still experience stiffness and pain. No implant will last forever, and factors such as your post-surgery activities and weight can affect longevity. Be sure to discuss these and other risks with your surgeon.

There are many things that your surgeon may do to minimise the potential for complications. Your surgeon may have you see a medical physician before surgery to obtain tests. You may also need to have your dental work up-to-date and may be shown how to prepare your home to avoid falls.

Following surgery or injury of the shoulder, compression and ice therapy (cryotherapy) can be an effective way of reducing swelling and helping blood to clot allowing a quicker recovery and less pain.

Some commercial devices may be provided to you by your surgeon or physiotherapist.

It is important to follow the instructions carefully as ice left in contact with the skin too long can cause thermal burns.

The Game Ready device used by some surgeons at Strathfield Private for many patients post recovery is based on NASA technology and actively draws heat away from the injury.

Arthroscopic knee surgery is generally a day surgery where small keyhole incisions are made in the knee (as opposed to formal, open incisions) which leads to a quicker recovery and less pain.

Arthroscopy is generally used in evaluating conditions such as torn floating cartilage (meniscus); removing loose bodies (cartilage or bone that has broken off); patellofemoral (knee-cap) disorders, reconstruction of the Anterior Cruciate ligament or to wash out infected knees.

Physiotherapy is usually required post operatively and recovery takes around a month.