Knee osteoarthritis is extremely common; over 100,000 knee replacements are carried out each year in the UK. When knee osteoarthritis is in its early stages, exercise, physiotherapy, injection treatments and painkillers may enable a patient to cope and live well. For some patients, however, the burden of knee arthritis pain necessitates knee replacement surgery (aka knee arthroplasty).

Knee arthritis can affect one, or all three “compartments” of the knee. Partial knee replacement is a good option for patients who have arthritis confined to a single compartment, which is usually the medial (inside) compartment. The worn cartilage and bone surfaces between the end of the medial thigh and the shin bones are replaced with metal components, with a highly durable plastic spacer placed between them. The accuracy of the placement of the components is vital, and Professor Ghoz uses robotic techniques and tailored “jigs” to ensure each patient has a highly tailored and very
accurate insertion of the components.

In patients who have persistent and severe arthritis in more than one compartment of the knee, a total knee replacement may be recommended.

A traditional total knee replacement involves a long incision (typically 8-10 inches in length), which passes vertically down through the centre of the knee cap. Professor Ghoz is skilled in cutting edge, minimally invasive surgery. This involves an off-centre incision, a smaller scar, and shorter hospital stay with less pain. The longevity of knee replacements is excellent, and a patient can expect that their replacement will last between 25 and 30 years.

The post Faster recovery with minimally invasive hip and knee replacement surgery. appeared first on Professor Ali Ghoz.

Written by: PROFESSOR ALI GHOZ

Published: 26/04/2019 | Updated: 08/09/2023

Edited by: NICHOLAS HOWLEY

Many of us get knee pain from time to time, but it can be difficult to know

whether it’s a problem that will fix itself or something that needs treatment. Here

is a complete guide to the causes of knee pain and how to treat it by

expert orthopaedic surgeon Professor Ali Ghoz.

How the knee works

The knee is one of the most important joints in your body. It includes bones such

as the femur, patella, kneecap and the tibia, as well as soft tissues – ligaments

and cartilage – which hold the bones and muscles together and help the knee to

move.

Looking at the diagram below you can see four ligaments:

• the collateral ligaments which surround the knee on either side –

the medial collateral and the lateral collateral ligament

• the cruciate ligaments on the inside of the knee – the anterior

cruciate and the posterior cruciate ligament

All of these ligaments have to function in synergy to preserve function of the

knee and to allow us to play sports. The other structure that is important is

the meniscus (cartilage) which acts as a cushions to the knee when you run

or walk on them.

Types of knee pain

The common causes of knee joint pain can be divided into mainly two groups:

• acute injuries

• wear and tear

Acute injuries can affect any part of your knee and happen suddenly, causing

acute knee pain. A ligament or the meniscus can tear and cause mechanical

problems and pain in the knee. The bones in your knee can fracture due to

traumatic injuries such as falls, car accidents, or even through simple twisting

while you’re walking down the road, for example.

Wear and tear injuries happen over time and can cause chronic knee pain. One

type of wear and tear injury is arthritis, where the cartilage becomes thinner to

the point where there is no space between the two surfaces of bone in your knee

– eventually eroding the bone itself. Other wear and tear injuries are associated

with certain sports – such as runner’s knee – or certain occupations that involve

a lot of kneeling, such as carpentry or gardening.

Overall, knee pain causes are varied, and you should pay close attention to

your symptoms. Is the knee pain constant, or did you get sudden and severe knee

pain? Does it involve other symptoms such as swelling, clicking, or instability? Is

the pain on the outside, from the hip to the knee, or in the inner knee?

Knee pain relief at home

Start by resting the knee. Stop activities as much as possible to try and allow

the knee to recover and give it room to breathe.

If the knee is swollen, use ice to reduce the swelling , especially after an injury

while playing football or rugby. Using an ice pack at home can help reduce pain

and swelling at the same time. Sometimes we use what we call a compression

bandage to compress the knee and reduce the swelling as well.

Elevate the knee on a stool or a couple of pillows to relieve swelling as well as

helping to reduce pain.

Taking simple painkillers helps relieve the pain as well and reduce the

inflammation. This can include paracetamol or anti-inflammatories such as

ibuprofen if you’re allowed to take it.

Avoid the activities that might trigger the onset of pain. For example, if the

pain gets worse while squatting or doing lunges, then you may want to avoid

those certain movements. If you find going down the stairs can be a little tricky,

go one step at a time. Above all, avoid any activities where you might need to do a

sudden change of direction on the knee and try and do linear exercises.

It’s important to start physiotherapy whenever you’re able to do so.

Physiotherapy helps to strengthen the muscles and the envelope around the knee

to try and provide strength to the knee to be able to cope with stresses.

Wearing the right shoe wear is very important especially if you run quite a lot.

Get a fitted running shoe to allow you to run if you do a lot of running.

Sometimes, taping can help reduce some of the swelling or pain around the

knee. This can include the use of patellar taping, or stretching the tendons using

either dynamic or static taping. You might have seen this on football players – the

blue tape or black tape which is also used on the shoulders as well as the knee.

When to seek medical advice

You need to seek medical advice when:

• you have a problem with your knee that is not getting better

• you notice that your walking distance is decreasing

• you have problems going up inclines or going down hills

• you have problems with going up or down the stairs

• your knee is starting to give way regularly and is not holding your weight

• the patella or the kneecap is dislocated and moving sideways more than

normal

• you’re experiencing painful clicking

• you’re experiencing general reduced mobility

• you have pain at rest or pain at night.

These are all symptoms that could delineate that there is a problem which could

be either due to either an injury such as an acute injury or a chronic injury which

has become worse overtime.

How knee pain is treated

Knee pain is treated by conservative options and surgical options.

Conservative options

The first form of treatment is easily done at home and is what we call the RICE

regime: rest, ice, compression, and elevation.

This is followed by painkillers which include paracetamol and antiinflammatories. These reduce the inflammation and reduce the swelling and also

help to control pain symptoms.

Next, we have injections. Injections are especially helpful if the underlying

pathology is wear and tear. There are various types of injections:

• traditional injections are most common and local anaesthetic and steroid

injections to reduce inflammation

• newer injections have varying levels of evidence and include plateletrich plasma or PRP. In certain pathologies PRP can help, such as patellar

tendinopathy or quadriceps tendinopathy which is where there is

inflammation of the tendons around the knee. There is some evidence that

it might help in arthritis as well.

The knee might need further imaging such as X-ray or an MRI scan if the pain is

sharp and intermittent and it’s associated with mechanical symptoms – such as

the knee giving way, collapsing on you, or instability.

If the scans show tendon or muscle injuries, these will get better stretching the

muscles and ensuring you give yourself plenty of rest.

However, if the scans show ligament or cartilage tears, such as an ACL tear or

meniscus tear, these do not get better on their own, and may require surgery.

Surgical treatment

There are several injuries that may need surgical treatment:

Cartilage or ligament tears – these may require surgery in the form of

arthroscopic or keyhole (minimally-invasive) surgery to repair the damaged

tissue.

Severe arthritis – this can cause pain at rest or pain at night, and significantly

reduce your tolerance to exercise. For this type of problem, surgery is usually

recommended in the form of either a partial or a total knee replacement.

If you have a knee replacement in this day and age, the chances of it surviving for

20 to 25 years are eight out of ten – which is a good statistic to have.

The post The ultimate guide to knee pain appeared first on Professor Ali Ghoz.

Written by: PROFESSOR ALI GHOZ

Published: 25/01/2019 | Updated: 09/05/2019

Edited by: NICHOLAS HOWLEY

There are lots of ways to replace a knee – but which is best? Should you have a

partial or full knee replacement? Are robotic techniques and 3-D printed

replacements worth the extra cost? We asked expert orthopaedic

surgeon Professor Ali Ghoz:

What are the main types of knee replacement surgery?

When we talk about the types of knee replacement surgery, we’re mainly talking

about how much of the knee is being replaced. Knee replacement can be

classed as partial or total, and partial knee replacement can be further divided

into one component or two component replacements.

Many people ask about “3-D printed” knee replacements, and “robot-assisted”

knee replacements. These are best thought of as techniques to help us perform a

successful well aligned knee replacement. But the first decision has to be either

to have a partial or full knee replacement.

Which type of surgery is better?

The most preferable from a functional point of view is a partial knee replacement

involving just one component (often known as unicompartmental knee

replacement). It’s less invasive and the functional outcome is better – it will feel

like almost like a more normal knee. This is because we only replace the

damaged side of the knee and preserve the rest of the knee’s biomechanics and

ligaments. In contrast, bicompartmental and full knee replacements tend to

result in a knee that doesn’t feel quite natural.

However, not everyone can have a partial knee replacement. Your ligaments have

to be intact, the damage must only be in one part of the knee, and the bone

quality needs to be good. Finally, associated deformities are likely require a total

knee replacement rather than a partial knee replacement.

Should I have a 3D-printed knee replacement?

The aim of a 3D printed knee is to create a knee that fits the patient – after all,

some people will have small knees, and other people bigger knees.

The printing is carried out as part of the preoperative planning process. A 3D

scan of the knee is made and the customised knee replacement is then printed.

The idea of making the knee to fit the patient exactly is intuitively attractive, and

many people believe it is likely to last longer and result in fewer complications.

However, so far nobody has been able to show there is a long-term difference in

outcomes compared to the use of a standard knee replacement.

Should I choose a clinic which offers robot-assisted surgery?

With robotic assistance, we can achieve a better alignment with our implants,

and this is clear on the X-rays we look at. All procedures are carried out by a

surgeon who is trained in performing knee replacements using the robot.

Generally, robot-assisted surgery results in less postoperatie pain and an earlier

return home. However, as with the use of 3-D printed knee replacements, there is

still no clear evidence that this changes outcomes in the long term.

What should I expect after surgery?

It’s normal for your knee replacement to have a minor “click” or “clunk” –

especially after full replacement. This tends to get better in time – but there may

always be some clicking between the metal and plastic in your knee. 1 in 5

people who has a knee replacement will always have some pain in the knee.

There might be some stiffness in the knee and the scar can have some associated

numbness. A patient with a knee replacement may have difficult kneeling after

the operation. The knee replacement side always feels warmer than the native

side. There is usually some permanent swelling around the knee replacement.

The scar can be a bit sensitive and tender. It takes a full year to get used to a knee

replacement.

You should also seek medical advice if you experience:

• unexplained severe pain

• episodes of the knee giving way

• any signs of infection, such as leakage

• any signs of loosening

How long does a knee replacement last?

The average knee replacement lasts around 10-15 years.

95% of total knee replacements survive for about 10-13 years, whereas partial

knee replacement have a shorter life span (8-10 years). This is usually because of

the deterioration of arthritis, and replacement with a full knee replacement is

necessary the second time around.

The lifespan of knee replacements has improved in recent years. This is because

materials have improved and the way we sterilise implants have changed. In

modern knee replacements we tend to use high-strength plastic inserts,

ceramicised oxinium, and customised implants.

Finally, the way we cement the join to the bone has changed. Cemented knee

replacements survive longer and have fewer complications than uncemented

knee replacements

The drive is ultimately to make the implanting of the knee perfect. The materials

we now use certainly make a difference, but it remains to be seen whether

techniques such as robotic assistance or 3D printing will improve outcomes and

satisfaction rates in knee replacement patients.

The post Knee replacement options: partial, full, robotic or 3D-printed? appeared first on Professor Ali Ghoz.

Innovations in Knee Surgery

Advancements in knee surgery are mainly driven by improvements in surgical techniques, implant design, and, notably, the integration of technology such as computer navigation and robotics. These technologies provide unprecedented precision in knee replacement surgeries, which is crucial for the longevity and functionality of the knee implant.

Computer Navigation and Robotic Assistance

One of the most significant technological advancements in knee surgery is the use of computer navigation and robotic-assisted systems. These tools assist surgeons during the procedure by providing real-time 3D images of the patient’s knee. This allows for more accurate placement of the knee implant, which can be challenging to achieve with traditional surgical methods alone.

Benefits of Technological Advancements in Knee Surgery

Enhanced Precision: With the aid of computer navigation and robotics, implants can be placed with precision that is difficult to match through conventional techniques. This precision is crucial for the implant’s fit and longevity.
Improved Safety: Advanced technology reduces the risk of errors during surgery, leading to safer operations and less chance for complications.
Quicker Recovery: Patients typically experience shorter recovery times due to less invasive techniques and more accurate implant positioning. This means getting back to daily activities sooner.
Better Functional Outcomes: More accurate implant alignment often results in better knee function and overall satisfaction post-surgery.
Is Advanced Knee Surgery Right for You?

While these technological advancements are promising, the decision to undergo knee surgery should be made based on a comprehensive evaluation of your specific medical condition. Advanced knee surgery can be particularly beneficial for those suffering from severe knee arthritis or those who have had previous unsuccessful knee surgeries.

Learn More

If you are experiencing knee pain or disability and wondering if advanced knee surgery could be an option for you, I encourage you to reach out. Contact us to learn more about these exciting advancements and to discuss how they might benefit your particular situation.

For further information or to schedule an appointment, please contact our office directly. Discover how modern knee surgery can help you regain mobility and improve your quality of life.

The post The Future of Knee Surgery: Embracing Technological Innovations appeared first on Professor Ali Ghoz.