Knee Surgery

The knee is a hinge joint held together with ligaments. Any one of these ligaments, either the central ligaments (Cruciates) or the peripheral ligaments (collaterals) can be torn. Sometimes one or more of these ligaments can be torn at the same time. The most common ligament torn is the Anterior Cruciate Ligament which often requires a reconstruction to make the knee stable again.

The bones that make up the knee joint, femur (thigh bone), tibia (shin bone) and patella (knee cap) are covered with a very highly specialised tissue called Articular Cartilage. The damage to or wearing away of this articular cartilage is called arthritis. The most common form of arthritis is Osteoarthritis
As well as this specialised articular cartilage there exists within the knee two "rubber doughnut shock absorbers" called menisci or sports cartilage. From the age of twenty seven onward these menisci become more and more brittle, easier and easier to tear.
Lastly, one of the other common pathologies affecting the knee joint is an inflammation or irritation of the tendons around the knee such as patella (knee cap) tendonitis.


Knee arthroscopy

A knee arthroscopy can be done to solve a number of problems arising within the knee joint.
Under a general anaesthetic a scope is introduced into the knee joint via a small (keyhole) portal. Through another portal the instruments are introduced to either repair or resect a tear in the meniscus for example. Indications for arthroscopic sugery include pain, locking, giving way, articular cartilage damage and a wealth of others. The surgery is undertaken as a day case (in and out the same day). 


Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is a tough band of tissue joining the thigh bone to the shin bone at the knee joint. It runs diagonally through the inside of the knee and gives the knee joint stability. It also helps control the back-and-forth movement of the lower leg. The ACL is the most commonly injured knee ligament. Patients that have sustained an anterior cruciate ligament tear and who wish to pursue twisting activities eg skiing, football, hockey, netball will probably require a reconstruction of their ruptured ligament.

This surgery is undertaken under general anaesthetic as a day case. The surgery involves a keyhole surgery to prepare the bone and drill the tunnels into which the new graft ACL is introduced and fixed with screws. The new Anterior Cruciate Ligament is made from the hamstring tendons which are removed for this purpose. This is performed through an incision of approximately 5cm just below the knee on the inner aspect of the knee. The hamstrings have been shown to regenerate post operatively.



Knee Replacement Surgery

Knee replacements are a very successful way of improving patient’s pain and mobility. It is generally performed for arthritis, in which the surfaces of the joint become worn, leading to pain and reduced movement. In these circumstances a joint replacement may be the most predictable way to improve your symptoms.


In knee replacement surgery the whole knee may be replaced (Total Knee Replacement) or only the specific part of the knee that is worn out (Partial knee Replacement). Knee replacement surgery is a highly successful (but quite invasive) technique to relieve arthritic pain the vast majority of knee replacements are fixed with cement. Whilst a knee replacement is an effective way to improve your symptoms. Studies have shown that only 50% of patients after a knee replacement forget day to day that they have undergone knee surgery. About 20% of patients complain on ongoing pain and functional limitations


After the operation patients generally walk the following day under the guidance of a physiotherapist. Discharge from hospital normally occurs 3- 5 days after surgery, and patients are generally provided with advice about care of their new knee joint. 

To view the NHS Choices animated video about knee replacement, please click HERE. 


Knee Revision

After many years some knee replacements wear out and cause pain. Surgeons sometimes recommend that the knee should be 'revised' even in the absence of pain if there is concern that surrounding bone may become damaged.

Revision operations take a bit longer than first-time knee replacements, and consequently recovery may take a little longer. Precautions to safeguard the joint in the early months may also need to be a little stricter. Grafting or augmenting the damaged areas is also occasionally required. The principles of the operation are the same as those for first-time surgery, with the creation of a new hinge joint

The risks associated with these procedures are similar to above although all risks are slightly increased due to the added complexity of revision procedures.