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Knee

When all other options and non-operative measures – such as weight loss, anti-inflamatories and physiotherapy – no longer control the pain, it may well be time for knee replacement surgery. Osteoarthritis of the knee joint causes huge discomfort but with the minimally invasive techniques offered by Professor Ali Ghoz, knee replacement surgery can soon give patients back their active lives.

It is never too late for knee replacement so patients can choose to opt for modern knee replacement surgery once the pain becomes too uncomfortable – and when they want to rediscover their vitality.

Knee Replacement Surgery

Although unicompartmental – or ‘half knee’ replacements - are available, arthritic knees usually require a total knee replacement. This surgery resurfaces the femur, tibia and patella and introduces a layer of polyethylene between the femur and tibia as a plastic shock absorber to eliminate the pain of osteoarthritis.

Studies have shown that a well aligned and functioning knee replacement should last between 25-30 years. Using computer navigated, patient specific instruments Professor Ali Ghoz can treat the knee and help patients become pain free.

Professor Ali Ghoz tends to cement the replacement onto the bone rather than allow for the bone to grow onto the prosthesis, as patients tend to recover a little quicker and experience less pain and discomfort.

It has been found that over 85% of knee replacements will achieve a good, pain-free functional result allowing patients to live a full and active life.

Professor Ali Ghoz Knee

Types of Knee Replacement

Total Knee Replacement

A total knee replacement (TKR) or total knee arthroplasty is a surgery that resurfaces an arthritic knee joint with an artificial metal or plastic replacement called the prosthesis.

Unicondylar Knee Replacement

Surgery in which only part of the knee joint is replaced through a smaller incision than would normally be used for a TKR. The knee joint is made up of three compartments – the patellofemoral and medial and lateral compartments between the femur and tibia. Often only one of these compartments wears out.

Revision Knee Replacement

This is when part or all of a previous knee replacement needs to be revised. These operations can vary from very minor adjustments to massive procedures replacing significant amounts of bone.

Before Surgery – What You Need to Know

After Professor Ali Ghoz has discussed the options with a patient and decided on surgery as the way to go there will be a number of medications that need to be stopped depending on the individual.

Patients are given an antiseptic soap at the clinic that needs to be used for the two days prior to the surgery. This reduces the risk of skin infection after surgery.

The Surgery – What You Need to Know

Prior to starting the procedure, we give Intravenous Antibiotics to protect you from infection. Professor Ali Ghoz’s minimally invasive procedures are usually carried out under General Anaesthesia. Sometimes the surgery can be performed under a combined spinal anaesthetic and a light general sedation. This is entirely safe and is proven to reduce any possible complications during joint replacement surgery.
A urinary catheter is used as the morphine given for pain relief invariably results in patients finding it difficult to pass urine for 12-18 hours. Removing the catheter is a very straightforward process and not painful at all. If we do use a urinary catheter, we give antibiotics before insertion of the catheter and at the time of removal of the catheter.
Pain relief after the surgery is down to the individual patients’ needs in accordance to the anaesthetist’s direction.

Recovery – What You Need to Know

Preventing thrombosis is the priority after hip and knee replacement surgery. Mobilisation and exercise are vital. To aid this every patient is fitted with a calf compressor that promotes blood flow and prevents clots. Every patient will be prescribed oral blood thinning medication following surgery to guard against the risk of Deep Vein Thrombosis.

The sooner a patient gets out of bed and walks the less the risk of thrombosis so Professor Ali Ghoz encourages his patients to walk twice a day whilst in the hospital. The more exercise the better but patients are warned not to overdo things.

Although there may be some discomfort the keys to a successful recovery after replacement surgery – even the minimally invasive techniques offered by Professor Ali Ghoz – are mobilisation and hydration.
Physiotherapists will be able to show patients exercises to help recovery and ensure that surgery is just the start of a new way of life. 

Mobirise

Knee Replacements – Things to Note

All knee replacement procedures leave some numbness on the outer side of the wound. This is unavoidable as there is a skin nerve that goes directly across the skin incision that is purposefully cut in order to open up the knee joint. It is a minor nerve and the numbness will tend to lighten up over time but is never completely eliminated.

All knee replacements click – this is entirely normal. The noise is just the metal and polyethylene parts touching each other and is no cause for alarm. It is how the joint functions and will get quieter over time.

Knee Cap (Patellar) Problems and Instability

Knee cap (patellofemoral) instability occurs when the knee cap does not slide centrally within the groove of the thigh bone. The knee cap can be tilted, partially come out of the groove (subluxation) or completely come out (dislocation).

Understanding the causes for such instability has become greater over the years and with individual diagnosis Professor Ghoz can decide what is the best course of action for each patient.

The three most common causes for dislocation are traumatic dislocation, trochlear dysplasia (flattening) and maltracking secondary to bone malalignment. When the underlying cause is understood then the appropriate treatment can be implemented.

Surgery is usually a last resort in the management of patellofemoral pain. It may be effective in preventing recurrences of dislocation, prevent patellofemoral impingement and reduce pain. The aim is always to enable all patients to get back to their normal active daily routines if possible.  

Professor Ali Ghoz Knee

Knee Arthroscopy

What is it?

When a patient complains of pain of the knee - typically due to some kind of injury - an MRI scan is usually required. Depending on the findings, a procedure called an arthroscopy may be needed. This is where an arthroscope (camera) is inserted into the joint to evaluate exactly what damage has been done and how it can be treated. This involves a full inspection of the inside of the knee joint. The treatment is done during the procedure depending on the pathology found. 
This minimally invasive computer guided procedure involves only small incisions so healing is quicker with less scarring than traditional methods.
Conditions treated by knee arthroscopy :


  • Meniscal tears
  • ACL / PCL injury
  • Synovitis
  • Chondral flap
  • OCD lesion(Osteochondral lesions)
  • Knee cap release (Lateral Release)

Professor Ali Ghoz Knee Arthroscopy
Professor Ali Ghoz Knee Arthroscopy

What happens next?

As this surgery is minimally invasive recovery is relatively quick and patients will only need to go back to their room for a short period – and will be allowed home after some evidence of mobilisation. After only around our to six hours the patient should be able to move independently but this will be assessed by medical staff. 

Once the patient is home it is advised that the knee is iced regularly over the next week or so. Pain relief and anti-inflammatories will be prescribed and patients will be required to be seen again around 10-14 days after the surgery to see how everything is progressing .

Anterior Cruciate Ligament Injury

The anterior cruciate ligament – or ACL – is located in the centre of the knee that runs from femur to tibia and acts as the main stabilising ligament. If it tears it doesn’t heal and can lead to a feeling of instability in the knee.

ACL reconstruction surgery can now be performed through an arthroscopy, which is minimally invasive and yields excellent results.

When is an ACL Reconstruction Needed?

For anyone wanting to continue sporting activity or physical work, reconstruction surgery is vital, as the ACL does not heal itself due to the joint fluid preventing that outcome. A new ligament must be reconstructed therefore, using another tendon.

ACL reconstruction not only provides knee stabilisation – it also prevents further damage to the knee itself, particularly the meniscus and cartilage surfaces of the femur and tibia.

Recovery

Patients will tend to stay in hospital overnight after ACL reconstruction surgery. Even though the procedure is minimally invasive it does have an impact on the initial strength of the knee but most patients will not need a brace.

Professor Ali Ghoz advises physiotherapy as soon as possible as this will determine the speed of recovery. Patients can expect to be on crutches for around two weeks, jogging in a straight line after three months and running with pivoting in just seven months. A return to competitive sport can come as soon as 9-12 months after surgery.

With advice from physiotherapists, Professor Ghoz can provide a full ACL Reconstruction rehabilitation programme. 

Mobirise