Category: Knee

Introduction to ACL Injuries

The Anterior Cruciate Ligament (ACL) is a crucial component in the knee, pivotal for joint stability during dynamic activities. ACL injuries are prevalent, particularly among those participating in sports with abrupt stops or directional changes. Such injuries occur from knee twisting while the foot is stationary, direct knee impact, or sudden directional shifts. Symptoms include a distinct popping noise, pain, swelling, knee instability, and difficulty in weight-bearing.

Detailed Recovery Timeline

Phase I (Weeks 1-3)

The first three weeks post-ACL surgery, known as Phase I, are focused on healing, reducing swelling, and regaining basic knee mobility. Immediately post-surgery, patients may experience discomfort in the knee. Patients are advised to engage in light exercises such as ankle pumps, quad sets, and gentle knee flexion within pain-free limits. The use of crutches and a knee brace is common to aid mobility and protect the knee.

Emphasis is placed on controlling swelling and pain, essential for laying the groundwork for more advanced rehabilitation. Patients may start weight-bearing as tolerated, guided by their orthopaedic surgeon’s and physiotherapist’s advice. Regular follow-up appointments are crucial to monitor progress and adjust the rehabilitation plan as needed.

Phase II (Weeks 4-6)

During Phase II of ACL recovery, the focus shifts towards increasing knee motion and beginning strength training. This phase typically includes exercises such as partial squats, stationary cycling, and controlled leg presses, aiming to enhance joint flexibility and muscle strength around the knee.

The patient may progressively engage in more dynamic exercises under supervision, while still being cautious to avoid activities that might strain the healing graft. This period builds the foundation for more rigorous activities in the later stages of rehabilitation.

Phase III (Weeks 7-12)

Phase III, spanning weeks 7 to 12, marks a significant progression in ACL recovery, where the focus is on regaining full knee motion and advancing strength training. This phase introduces more challenging exercises, like jogging and agility drills, under close supervision. The goal is to improve muscular endurance and control, preparing the knee for higher-impact activities.

This period ensures that the knee can handle various stresses, gradually preparing the patient for a return to more demanding physical activities, including sports.

Phase IV (Months 4-6)

In Phase IV of the recovery, typically spanning months 4 to 6, the rehabilitation becomes more intensive. This phase is characterised by a gradual return to more complex and sport-specific activities. The exercises during this period are designed to improve not only strength but also agility, balance, and coordination. These include running, jumping, and sport-specific drills.

This phase ensures that the knee is capable of handling the stresses of not only everyday activities but also more demanding physical exertions such as sports. The goal is to regain pre-injury levels of activity while ensuring the safety and stability of the knee.

Patients typically resume light jogging and running activities in this phase.

Phase V (Return to Sport)

Phase V, focusing on the return to sport, typically begins around six months post-surgery. This final phase involves high-level strengthening, agility, and plyometric exercises to ensure the knee is ready for the demands of sports. Athletes undergo sport-specific training and drills to regain confidence and ensure the knee’s readiness for competitive play.

This phase focuses on not only physical recovery but also mental preparedness for returning to the sport. The successful completion of this phase is marked by the patient regaining full function and confidence in the knee’s capabilities.

Patients can expect to return to recreational sports at 9 months and competitive sports at 12 months post successful surgery and rehabilitation.

Monitoring and Follow-Up

Regular check-ups with your orthopaedic surgeon ensure that the knee is healing correctly and that the rehabilitation exercises are effective. These appointments often include assessments of knee stability, strength, and range of motion.

Follow-up visits may also involve imaging tests to evaluate the healing of the ACL graft. Any concerns or complications that arise during recovery can be addressed promptly during these sessions. Continuous monitoring helps in making necessary adjustments to the rehabilitation plan, ensuring optimal recovery.

Potential Complications and Preventive Measures

ACL surgery, like any surgical procedure, carries the risk of complications. Common complications include infection, blood clots, graft failure, and knee stiffness. To mitigate these risks, preventive measures are crucial. These include adhering to post-surgery instructions, proper wound care, and engaging in prescribed physical therapy exercises.

Patients should be vigilant for signs of infection or unusual pain and maintain regular communication with their orthopaedic surgeon. Early detection and intervention are key in managing any complications that may arise during the recovery process.

Dr LS specialises in enhanced recovery after knee surgeries and is a dual fellowship trained knee surgeon with 2 decades of clinical practise.

Hip Replacement Surgery

Hip replacement surgery, or total hip arthroplasty, is a medical procedure where a worn or damaged hip joint is replaced with an artificial implant. This surgery aims to alleviate pain and enhance mobility in patients with hip joint disorders like osteoarthritis. The procedure involves replacing the damaged hip components with a prosthetic socket in the pelvic bone and a ball with a supporting stem in the femur. However, following hip replacement surgery, some patients may experience knee pain.

Knee Pain After Hip Replacement

This type of knee pain is typically a temporary condition, influenced by the surgery and recovery process. Leg manipulation during surgery and subsequent prolonged immobility may contribute to knee discomfort. The change in body alignment after the hip joint is replaced can result in altered stresses on the knee, potentially causing pain. In most cases, this pain resolves as strength and mobility improve during the recovery from hip surgery.

Causes of Knee Pain After Hip Replacement

Knee pain following hip replacement surgery can stem from a variety of factors, each contributing to discomfort in different ways:

• Surgical Techniques and Leg Manipulation: The knee may experience strain due to the positioning and movement of the leg during hip replacement surgery, potentially leading to post-surgical knee pain.
• Altered Biomechanics: The replacement of the hip joint alters the body’s alignment, affecting how the knee bears weight. This change can cause discomfort or pain in the knee.
• Muscle Weakness and Imbalance: Weakness or imbalance in the muscles surrounding the hip and knee, a common post-surgery issue, can impact the stability and function of the knee, leading to pain.
• Use of Assistive Devices: Recovery often involves using crutches or walkers, which alter typical walking patterns and can strain the knee joints.
• Pre-existing Knee Conditions: If a patient has knee issues, hip replacement surgery might exacerbate these conditions, heightening knee pain.
• Inflammation and Swelling: Inflammation and swelling around the operated hip can also affect the knee, contributing to pain and discomfort.

Diagnosis and Evaluation of Knee Pain Post-Surgery

The process of diagnosing and evaluating knee pain after hip replacement surgery involves several steps to determine the root cause of the discomfort. This typically includes:

• Medical History Review: A detailed review of the patient’s medical history includes assessing any pre-existing knee issues, the specifics of the hip replacement surgery, and when the knee pain began.
• Physical Examination: A thorough physical examination of the knee is conducted. This includes assessing pain, swelling, range of motion, and any signs of complications.
• Imaging Tests: Imaging tests, such as X-rays, are often used to examine the knee and hip. These help in checking for any abnormalities in the knee, issues with alignment, or problems with the hip implant.
• Gait Analysis: The patient’s walking pattern is observed to understand how changes post-hip surgery might be affecting the mechanics of the knee.
• Blood Tests: In some cases, blood tests are done to exclude the possibility of an infection, particularly if there are symptoms like fever or unusual swelling alongside the knee pain.

Treatment Options

Effective knee pain treatment after hip replacement surgery depends on the underlying cause. The primary treatment options include:

Pain Management

Over-the-counter pain relievers, such as acetaminophen or NSAIDs (non-steroidal anti-inflammatory drugs), are often recommended for managing knee pain. In more severe cases, stronger prescription medications may be required.

Physical Therapy

Tailored physical therapy can strengthen muscles around the knee and hip, improving stability and function, and alleviating pain.

Knee Supports

In some cases, using knee braces or supports can provide additional stability and comfort, helping to reduce pain.

Activity Modification

Adjusting daily activities to avoid actions that exacerbate knee pain is often advised. This may include limiting certain movements or activities until the knee pain subsides.

Injection Therapy

For persistent knee pain, corticosteroid injections or viscosupplementation (injecting lubricating substances) may reduce inflammation and pain.

Surgery

In rare cases, if knee pain is severe and persistent, and other treatments have been ineffective, surgical intervention might be considered.

Conclusion

While knee pain after hip replacement surgery is a relatively uncommon issue, patients need to recognize and address any knee discomfort following hip surgery. Maintain open communication with your orthopaedic surgeon and follow their recommendations closely for the best outcomes in their recovery journey.

Understanding the ACL

The Anterior Cruciate Ligament (ACL) is a key ligament in the knee, essential for maintaining stability and proper knee joint function. Situated in the middle of the knee, it connects the femur (thighbone) to the tibia (shinbone). This ligament controls movements, especially in jumping, pivoting, and sudden directional changes. However, it is susceptible to injury, especially among athletes and individuals engaging in high-intensity physical activities.

Identifying ACL Injuries

ACL injuries predominantly occur due to high-impact or sudden, twisting movements, common in sports like football, basketball, and skiing. Symptoms of an ACL injury include a distinct popping sound at the time of injury, followed by pain, swelling, reduced range of motion, and a feeling of instability in the knee.

Diagnosis of ACL Tears

The diagnosis of an ACL tear involves a blend of clinical assessment and imaging techniques. Physical examination tests include:

• The Lachman Test: This test assesses anterior tibial translation and the integrity of the ACL. In this test, the knee is bent at 30 degrees, and the thigh is stabilised while the lower leg is pulled forward. Increased forward movement of the tibia indicates a possible ACL tear.
• The Pivot Shift Test: This dynamic test checks for anterior subluxation of the lateral tibial plateau. The knee is moved from extension to flexion while a valgus and internal rotation force is applied. A ‘pivot shift’ or clunk during the test suggests ACL insufficiency.
• The Anterior Drawer Test: Here, the knee is flexed at 90 degrees, and the lower leg is pulled forward. Excessive forward movement of the tibia suggests an ACL injury.

Imaging tests include Magnetic Resonance Imaging (MRI), which provides detailed images of the knee’s soft tissues and confirms the diagnosis. X-rays may be used to exclude bone fractures.

Overview of ACL Reconstruction Surgery

ACL reconstruction surgery aims to restore stability and function to the knee. Arthroscopic surgery, a minimally invasive technique, is commonly used. This involves making small incisions around the knee, inserting an arthroscope for visual guidance, and using specialised instruments to replace the torn ligament with a graft.

The choice of graft, each having its advantages and considerations, is based on individual patient factors and the orthopaedic surgeon’s preference. There are three primary types of grafts used in ACL reconstruction:

• Autografts: Tissue taken from the patient’s body, such as the patellar tendon, hamstring tendon, or quadriceps tendon.
• Allografts: Donor tissue, typically from a deceased donor.
• Synthetic grafts: Artificial materials used as an alternative to natural tissue.

Postoperative Management: Rehabilitation and Physiotherapy

Initial Recovery

Post-surgery, patients often experience pain and swelling. Management includes pain relief medication, ice application, and elevation of the leg to reduce swelling. Early mobilisation, like gentle knee movement, is encouraged to promote circulation.

Rehabilitation Program

Rehabilitation begins soon after surgery. It typically involves a structured physiotherapy program, progressing from basic exercises to more advanced activities as healing occurs. Key goals include restoring the knee’s range of motion, strengthening surrounding muscles, and gradually returning to normal activities.

Importance of Physiotherapy

Physiotherapy ensures a safe and effective return to daily activities and sports. It helps in regaining strength, flexibility, and confidence in the knee.

Complications and Risks of ACL Surgery

While ACL reconstruction surgery is generally safe, it is not without risks and potential complications. Key concerns include:

• Infection: A rare but serious complication, infections require prompt treatment, often involving antibiotics or additional surgery.
• Graft Failure: The graft may not fully integrate or could re-tear. This risk is influenced by several factors, including surgical technique and postoperative rehabilitation adherence.
• Knee Stiffness: Some patients may experience a limited range of motion post-surgery, often addressed through physical therapy.
• Pain and Swelling: Common in the initial postoperative period, these symptoms usually improve with time and proper management.
• Deep Vein Thrombosis (DVT): Blood clots in the leg veins, a potential risk after knee surgery, require immediate medical attention.
• Osteoarthritis: Long-term risk of developing osteoarthritis in the injured knee, despite successful ACL reconstruction.

Long-Term Prognosis and Prevention Strategies

The long-term prognosis following ACL reconstruction is generally favourable, with many patients returning to their pre-injury levels of activity. This is possible with adherence to a comprehensive rehabilitation program and ongoing knee care.

Prevention strategies, including proper training, use of appropriate equipment, and regular physical activity, reduce the risk of re-injury and maintain joint health. Consult your orthopaedic surgeon for early detection and management of any long-term issues.

Conclusion

ACL reconstruction is a surgical procedure to restore knee stability and function following an ACL tear. While there are risks involved, adherence to preventive strategies and ongoing knee care recommended by your orthopaedic surgeon can lead to a positive long-term prognosis.

What is Knee Replacement Surgery?

Knee replacement surgery, also known as knee arthroplasty, involves removing damaged parts of the knee joint and replacing them with artificial components. The primary goal is to alleviate pain and restore function in a severely diseased or damaged knee joint.

The knee joint comprises three main parts: the femur (thigh bone), tibia (shin bone), and patella (kneecap). During the procedure:

The damaged ends of the femur and tibia are removed and reshaped to fit the prosthetic components.

These components, typically made of metal and plastic, are then fixed to the bones, creating a new joint surface.

In some cases, the underside of the patella is also resurfaced and fitted with a plastic prosthetic.

There are different types of knee replacement surgeries, including total knee replacement, partial knee replacement, and kneecap replacement. 

The choice of procedure depends on the extent of damage and the specific needs of the patient.

The artificial components used in knee replacement are designed to mimic the natural movement of the knee, allowing patients to return to most of their regular activities with reduced pain and improved joint function.

Reasons for Knee Replacement Surgery

Knee replacement surgery is typically recommended when the knee joint is damaged to the extent that it causes chronic pain and hinders daily activities. Several conditions and injuries, such as knee osteoarthritis can lead to this level of damage.

Osteoarthritis

Osteoarthritis, a degenerative joint disease, is the most common reason for knee replacement. It occurs when the protective cartilage that cushions the ends of the bones wears down over time, leading to pain, swelling, and reduced joint mobility.

Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune condition where the immune system attacks the synovium – the lining of the membranes that surround the knee joint. This results in inflammation and thickening of the synovium, which can destroy the cartilage and bone within the joint.

Post-traumatic Arthritis

Post-traumatic arthritis develops after a knee injury, such as a fracture, ligament tear, or meniscus tear. The injury can accelerate the breakdown of joint cartilage, leading to pain and stiffness similar to osteoarthritis.

Severe Knee Injury

Injuries to the knee, such as fractures, torn ligaments, or meniscus tears, can damage the joint. If not treated properly or if they recur, these injuries can cause instability and additional wear on the joint cartilage, necessitating a knee replacement.

Other Conditions Leading to Significant Joint Damage

There are other less common conditions that can cause significant knee joint damage. These include avascular necrosis (loss of bone caused by insufficient blood supply), bone dysplasias (abnormal bone growth), and certain infections. In these cases, knee replacement might be considered if the damage is extensive and other treatments are ineffective.

Types of Knee Replacement Surgeries

Depending on the extent of damage and the specific needs of the patient, different types of knee replacement surgeries are available.

Total Knee Replacement

In a total knee replacement, the entire knee joint is replaced. This involves removing the damaged bone and cartilage from the femur, tibia, and often the patella. These are then replaced with artificial components made of metal and plastic to recreate the joint surface.

Partial Knee Replacement

Also known as unicompartmental knee replacement, partial knee replacement involves replacing only the damaged part of the knee. This procedure is suitable for patients whose damage is limited to one compartment of the knee, allowing the surgeon to preserve as much of the original joint as possible.

Kneecap Replacement

Kneecap replacement, or patellofemoral arthroplasty, focuses on replacing the joint surface of the kneecap and the groove at the end of the thigh bone. This procedure is an option for patients with arthritis that primarily affects the kneecap.

Complex (or Revision) Knee Replacement

Complex knee replacement is typically performed on patients who have severe bone loss due to arthritis, deformities, or a previous knee replacement surgery that failed. This procedure might require larger implants or bone grafts to rebuild the joint.

Procedure Details

Pre-surgery Preparations:

• Physical Exams: A thorough examination is conducted to assess the patient’s overall health and ensure they are fit for surgery. This includes checking vital signs, cardiovascular health, and any potential risks that might affect the surgery.
• Blood Tests: These are essential to determine factors like blood type, white blood cell count, and clotting function. They help in identifying any underlying conditions that might interfere with the surgery or the healing process.
• Imaging Tests: A series of imaging tests, such as X-rays, MRI, or CT scans, are performed on the knee. These images provide a detailed view of the knee’s structure, revealing the extent of damage and helping the surgeon plan the procedure.

The Surgical Process:

• Anaesthesia: Before the surgery begins, anesthesia is administered. There are two main types: general anaesthesia, where the patient is unconscious throughout the procedure, and regional anaesthesia, which numbs only a specific part of the body. The choice depends on the patient’s health, the surgeon’s recommendation, and the patient’s preference.
• Incision: A surgical cut is made over the knee to access the joint. The size and position of the incision can vary based on the specific technique being used.
• Removal of Damaged Parts: The damaged bone and cartilage surfaces are then removed from the femur (thigh bone), tibia (shin bone), and patella (kneecap).
• Insertion of the Prosthetic Joint: Once the damaged parts are removed, the surgeon places the prosthetic joint. This artificial joint is designed to replicate the knee’s natural movement and function. It’s typically made of metal and plastic components that fit together to allow smooth movement.

Post-surgery:

• Recovery Room Monitoring: After the surgery, the patient is moved to a recovery room. Here, medical staff monitor vital signs, pain levels, and any immediate reactions to the surgery.
• Hospital Stay Duration: The length of the hospital stay can vary. Some patients might be discharged on the same day, while others might need to stay overnight or longer. The duration depends on the patient’s health, the complexity of the surgery, and the speed of initial recovery.

Benefits Of Knee Replacement Surgery

Knee replacement surgery, while a significant medical procedure, offers several notable benefits that can greatly improve the patient’s quality of life. These benefits are primarily centred around pain management, mobility enhancement, and overall life quality improvement.

Pain Relief

• Immediate Alleviation: One of the primary reasons individuals opt for knee replacement surgery is the persistent and often debilitating pain associated with joint damage. Post-surgery, many patients report a significant reduction in pain levels.
• Long-term Relief: Unlike some treatments that offer only temporary relief, knee replacement surgery aims to provide long-term pain alleviation. With the damaged parts of the knee replaced by prosthetics, the source of the pain is effectively addressed.

Improved Mobility

• Restored Movement: Damaged knees can severely restrict movement, making even simple tasks challenging. After surgery, patients often find they can move more freely, without the hindrance of pain or stiffness.
• Increased Range: The surgery not only alleviates pain but can also increase the knee’s range of motion. This means activities that were previously difficult or impossible, such as climbing stairs or walking long distances, become achievable again.

Enhanced Quality of Life

• Independence: With reduced pain and improved mobility, many patients find they can return to activities they love, whether it’s gardening, sports, or simply going for a walk. This regained independence can significantly boost morale and overall well-being.
• Mental Well-being: Chronic pain can have a profound impact on mental health, leading to conditions like depression or anxiety. By addressing the root cause of the pain, knee replacement surgery can also have positive effects on a patient’s mental and emotional state.
• Social and Recreational Activities: Being mobile and pain-free allows patients to re-engage in social activities, hobbies, and recreational pursuits, further enhancing their quality of life.

Recovery and Rehabilitation

Recovery and rehabilitation are crucial phases following knee replacement surgery. These stages ensure the success of the procedure and the patient’s return to optimal function. The process involves a combination of medical care, physical therapy, and home-based practices.

Immediate Post-surgery Care

• Physical Therapy: Soon after the surgery, patients begin physical therapy. This therapy is essential to restore joint movement, strengthen the surrounding muscles, and promote proper function of the replaced knee. Initially, simple movements are introduced, gradually progressing to more complex exercises as the patient’s strength and mobility improve.
• Pain Management: Managing pain is a priority in the immediate aftermath of the surgery. Medical professionals administer pain-relieving medications to ensure the patient’s comfort. The type and duration of medication depend on the patient’s pain levels and overall health.

Home Care

• Exercises: Once discharged, patients are provided with a set of exercises to perform at home. These exercises, often an extension of the physical therapy received in the hospital, are crucial for continued improvement in knee function and strength.
• Precautions: Patients are advised to take certain precautions to prevent complications. These include avoiding specific movements that might strain the new joint, using assistive devices like walkers or crutches, and ensuring the surgical site remains clean to prevent infections.
• Resuming Daily Activities: While the urge to return to normalcy is strong, patients are advised to gradually reintroduce daily activities. Simple tasks can be resumed within a few days, but more strenuous activities, such as heavy lifting or intense exercise, should be approached with caution and ideally after consultation with a medical professional.

Expected Recovery Timeline and Milestones:

• Initial Weeks: The first few weeks post-surgery focus on pain management, wound healing, and basic mobility. Patients might require assistance with daily tasks during this period.
• 1-3 Months: By the end of the third month, most patients experience significant improvements in pain levels and can perform most daily activities without assistance. Regular check-ups and physical therapy sessions are common during this phase.
• 3-6 Months: This period sees patients returning to most of their pre-surgery activities, including work and recreational pursuits. Continued physical therapy might be recommended to achieve the best possible knee function.
• Beyond 6 Months: By this stage, the majority of patients have fully integrated the new joint into their daily lives. Regular medical check-ups might continue, but the emphasis shifts to long-term care and ensuring the continued success of the knee replacement.

How Common Is Knee Replacement Surgery?

Knee Replacement Surgery in Singapore: Prevalence

• Between 1991 and 2018, there was a 7.4-fold increase in the number of total knee arthroplasty (TKA) procedures performed annually in Singapore.
• In 2018, 10,145 TKAs were performed in Singapore, up from 1,373 procedures in 1991.

The rise in TKA procedures can be attributed to Singapore’s aging population, increased awareness of the surgery’s benefits, and advancements in surgical techniques.

How Long Does Knee Replacement Take?

Knee replacement surgery, or total knee arthroplasty, typically takes between 1 to 2 hours.

What Is The Best Age To Have A Knee Replacement?

The decision to undergo knee replacement is based on individual factors, primarily the severity of knee pain and disability, rather than age alone.

• Typical Age Range: Most total knee replacements are conducted on patients aged between 60 and 80.
• Younger Patients: An increasing number of individuals in their 40s and 50s are also considered for the procedure, especially if they have severe knee conditions. However, younger patients risk the artificial prosthetic wearing out prematurely. Generally, knee replacement implants function effectively for up to 20 years in 90% of patients.
• Trends: Research indicates that by 2030, the under-55 age group will be the fastest-growing population seeking total knee replacement. Over 85% of patients under 50 who undergo total knee replacement express satisfaction with the results.

While age plays a role in the decision for knee replacement surgery, it is not the sole factor. The patient’s overall health, potential benefits of the surgery, and the expected lifespan of the prosthesis are also crucial considerations.

What Are The Signs You Need A Knee Replacement? 

Non-surgical Treatment Options Are No Longer Effective

Initially, simple remedies like ibuprofen, ice packs, or hot baths might have provided relief. As time progresses, these methods may lose their effectiveness. Other non-surgical treatments like physical therapy, cortisone injections, orthobiologics, or weight loss might also not provide the desired relief.

Increased Intensity And Frequency of Knee Pain

Occasional knee discomfort after prolonged activity is normal. However, regular or intense knee pain is not. Signs to watch out for include:

• Knee pain lasting more than a couple of weeks.
• Pain that disrupts sleep.
• Aches during and post-exercise.
• Pain unresponsive to over-the-counter medications.
• Pain worsening in humid or cold weather.

Limited Mobility

Some loss of joint flexibility with age is expected, but persistent knee stiffness affecting mobility is a concern. Indicators include:

• Knee stiffness worsening after prolonged sitting.
• Needing mobility aids due to knee stiffness.
• Difficulty in walking, climbing stairs, standing up, or getting out of the bathtub.
• Morning knee stiffness lasting up to 30 minutes.
• Swelling in the knee: Cartilage protects the knee from pressure and friction. Conditions like knee osteoarthritis can wear out this cartilage, leading to painful inflammation and swelling.

Challenges In Everyday Activities

If activities like sitting, standing, climbing stairs, grocery shopping, or dressing become increasingly difficult due to knee pain or stiffness, it’s a sign to seek medical attention.

Unable To Perform Activities You Love

Adjusting activities with age is normal, but knee pain shouldn’t prevent you from doing what you love. If knee pain is causing you to avoid or limit activities, it’s essential to consult with an orthopedic doctor.

If you experience one or more of these signs, consult with a knee replacement surgeon to discuss your symptoms and potential treatment options.

How Much Does Knee Replacement Surgery Cost In Singapore?

Knee replacement surgery in Singapore can cost between $19,000 to $36,000. 

Additional Factors Influencing Cost

• Type of Surgery: The cost can differ based on whether it’s a total knee replacement or a partial one.
• Surgeon’s Fees: The expertise and reputation of the orthopaedic surgeon can influence the overall cost.
• Hospital Charges: This includes room charges, operation theatre fees, and other hospital-related expenses.
• Rehabilitation & Physiotherapy: Post-surgery physiotherapy and rehabilitation sessions might add to the overall cost.
• Medication: Post-operative medications and pain management drugs will also influence the total expense.

Knee replacement surgery is a common procedure that helps people with knee pain to regain mobility and functionality in their daily lives. This surgery involves removing damaged cartilage and bone from the knee joint and replacing it with a prosthetic implant. If you are considering knee replacement surgery, learn about the different types of knee replacement procedures available. This complete guide will provide you with all the information you need to make an informed decision.

Definition of Knee Replacement Surgery

Knee replacement surgery, also known as knee arthroplasty, is a surgical procedure that involves replacing the damaged or diseased parts of the knee joint with artificial components. This surgery aims to restore the normal function of the joint and, thus, alleviate pain and improve mobility. 

Anatomy of the Knee Joint

The knee joint is the largest joint in the body and is made up of three main components: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). The femur and tibia are connected by articular cartilage, which helps to cushion and protect the bones during movement. The knee joint also contains ligaments and tendons that provide stability and support to the joint. 

Indications for Knee Replacement Surgery

Knee replacement surgery is recommended for patients with severe knee pain and limited mobility due to conditions such as osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis. Other indications for knee replacement surgery include knee deformities, such as bowleggedness and knock-knees, and knee injuries, such as ligament and meniscus tears. Patients who have tried non-surgical treatments such as physical therapy and medication without success may also be candidates for knee replacement surgery.

Types of Knee Replacement Surgery

There are four main types of knee replacement surgery: total knee replacement, partial knee replacement, double knee replacement, and kneecap replacement. Each type of surgery is designed to address different areas of the knee joint, depending on the extent of damage, and aims to relieve pain, restore function, and improve overall quality of life for the patient.

Total Knee Replacement

Total knee replacement, also known as total knee arthroplasty, involves replacing the entire knee joint, including the femur (thigh bone), tibia (shin bone), and patella (kneecap), with high-quality prosthetic components made from materials like metal, ceramic, or plastic.

This surgery is the most common type of knee replacement surgery and is the preferred option for patients with severe arthritis, joint deformity, or extensive damage throughout the knee joint that significantly affects daily activities and mobility.

The surgical approach for total knee replacement can include traditional open surgery or minimally invasive techniques. Both approaches involve making an incision to expose the knee joint, removing damaged cartilage and bone, and implanting prosthetic components. Minimally invasive techniques use smaller incisions and specialized instruments to reduce tissue disruption, potentially leading to faster recovery and less postoperative pain.

Risks and complications associated with total knee replacement include infection, blood clots, nerve damage, prosthetic loosening or failure, and stiffness or limited range of motion. Although these risks are generally low, they can be higher in patients with certain medical conditions, such as diabetes or a history of blood clots.

Partial Knee Replacement

Partial knee replacement, also known as unicompartmental knee replacement, involves replacing only the damaged part of the knee joint, such as the medial (inner) or lateral (outer) compartment of the knee.

It is typically recommended for patients with localized arthritis or damage that affects just one compartment of the knee and who have relatively good ligament stability.

Partial knee replacement surgery often utilizes minimally invasive techniques to minimize tissue damage and promote faster healing. The surgeon makes a smaller incision and removes only the damaged compartment of the knee joint, preserving the healthy areas. Computer-assisted or robot-assisted technologies may also be employed to enhance the precision and accuracy of the procedure.

Risks and complications for partial knee replacement are similar to those of total knee replacement but may occur at a lower rate due to the less invasive nature of the procedure. However, there is a possibility of needing a subsequent total knee replacement in the future if arthritis or damage progresses in the preserved compartments of the knee.

Double Knee Replacement

Double knee replacement, also known as bilateral knee replacement, involves replacing both knees simultaneously in one surgical procedure or sequentially during two separate surgeries in a short period of time.

This type of surgery is typically recommended for patients with severe arthritis or damage in both knee joints who want to have both joints replaced at the same time to reduce the recovery time, minimize the need for multiple anaesthesia exposures, and lower overall healthcare costs.

In double knee replacement surgery, the surgical approach can be similar to that used in total knee replacement for each knee. The surgeries can be performed simultaneously or sequentially, with the latter involving two separate procedures within a short timeframe. The choice of approach may depend on factors such as the patient’s overall health, preference, and the surgeon’s recommendation.

Double knee replacement carries similar risks to total knee replacement but may have additional risks due to simultaneous or closely spaced surgeries. These risks can include increased anaesthesia exposure, prolonged immobility, and a more challenging rehabilitation process, especially if both knees are replaced simultaneously.

Kneecap Replacement

Kneecap replacement, also known as patellofemoral arthroplasty or patellofemoral joint replacement, involves replacing only the damaged kneecap and the trochlear groove in the femur (the groove in which the kneecap moves) with prosthetic components.

This type of surgery is typically recommended for patients with isolated damage or arthritis in the kneecap area, which causes significant pain and limited mobility, but who have otherwise healthy knee joint structures.

Kneecap replacement usually involves a minimally invasive approach, with a small incision made over the front of the knee. Advanced imaging techniques or computer-assisted technologies can help ensure the accurate placement of the prosthetic components.

Risks and complications specific to kneecap replacement include infection, blood clots, prosthetic dislocation or loosening, and persistent pain or instability in the patellofemoral joint. While the overall risk profile is generally lower than total knee replacement, careful patient selection and surgical technique are crucial for successful outcomes.

Robotic Knee Replacement

Dr LS Wang is a key opinion leader and trainer for robotic knee replacement. In this procedure, the surgery is done with precise  assistance from a robotic arm or handheld robotic device . 

Robotic Knee Replacement allows a bespoke customised knee to be planned for every patient and promises increased accuracy and precision. A robotic-assisted knee replacement offers a better balance in the soft tissues around your knee, and better aligns the joint. 

Robotic-assisted procedures may also allow for enhanced recovery with shorter recovery times and better long term results. 

Preoperative Evaluation and Preparation

Before undergoing knee replacement surgery, your doctor will perform a thorough evaluation to assess your overall health and the extent of your knee damage. This evaluation may involve blood tests, imaging tests such as X-rays and MRIs, and physical exams. You will also need to follow specific preoperative instructions, such as stopping certain medications and preparing your home for your recovery after surgery.

Prosthetic Components

Prosthetic components used in knee replacement surgery are made from a variety of materials, including metal, plastic, and ceramic. Your surgeon will select the appropriate prosthetic components based on your specific needs and the extent of knee damage. The prosthetic components are designed to mimic the natural function of the knee joint and to withstand the forces and pressures of daily activities.

Postoperative Care and Rehabilitation

After knee replacement surgery, you will need to follow specific postoperative care and rehabilitation instructions to ensure a successful recovery. This may include physical therapy, pain management, and activity restrictions. Follow these instructions closely to minimise complications and optimise outcomes.

Long-Term Outcomes and Considerations

Knee replacement surgery has proven to be a successful procedure in relieving knee pain and restoring mobility. However, like any surgery, there may be some risks and long-term considerations to keep in mind. These may include prosthetic component wear and tear, infection, and functional limitations.

Conclusion

Knee replacement surgery is a life-changing procedure that can significantly improve the quality of life for those suffering from severe knee pain and limited mobility. With various types of knee replacement surgeries available, including total, partial, double, and kneecap replacement, surgeons can recommend the most suitable approach based on the specific needs and extent of the patient’s knee damage.

A thorough preoperative evaluation, careful selection of prosthetic components, and adherence to postoperative care and rehabilitation instructions are crucial for achieving optimal outcomes. Although risks and complications are generally low, it’s important for patients to understand the long-term considerations and make informed decisions in consultation with their orthopaedic surgeon.

The meniscus is a crucial component of the knee joint, helping to distribute weight evenly and absorb shock during movement. Unfortunately, it is also prone to injury, particularly in athletes who engage in high-impact sports. Meniscus injuries can range from minor tears to complete ruptures, and the severity of the damage will determine the best course of action for recovery.

Understanding the Meniscus

Anatomy of the Meniscus

The meniscus is a C-shaped piece of cartilage that sits between the thigh bone (femur) and the shinbone (tibia). Each knee has two menisci, one on the inside (medial) and one on the outside (lateral) of the joint. The menisci provide cushioning, distribute weight, and help to stabilize the knee joint, allowing for smooth and painless movements.

The medial meniscus is larger and more prone to injury than the lateral meniscus. This is because the medial meniscus is firmly attached to the joint capsule and is less mobile than the lateral meniscus. Additionally, the medial meniscus is subjected to more stress during weight-bearing activities, making it more susceptible to tears and other injuries.

Functions of the Meniscus

The meniscus acts as a shock absorber, cushioning the joint from the impact caused by running, jumping, and other activities. Additionally, it helps to distribute weight evenly across the joint, reducing the strain placed on any one area. The meniscus also plays a crucial role in stabilizing the knee joint, helping to prevent dislocations and other injuries.

When the meniscus is damaged, it can no longer perform these functions effectively, leading to pain, swelling, and reduced mobility. In severe cases, surgery may be required to repair or remove the damaged meniscus.

Common Meniscus Injuries

Meniscus injuries can occur for a variety of reasons, including falls, sudden twists, and repetitive stress. The two most common types of meniscus injuries are tears and ruptures. Tears can be partial (where only part of the meniscus is damaged) or complete (where the entire meniscus is torn). Ruptures occur when the whole meniscus is completely detached from the knee joint.

Seek medical attention if you suspect you have a meniscus injury, as delaying treatment can lead to further damage and complications.

Types of Meniscus Surgery

The meniscus is a C-shaped piece of cartilage that helps cushion and stabilize the knee joint. When the meniscus is damaged, it can cause pain, swelling, and limited mobility. Meniscus surgery is a common treatment option for patients with meniscus injuries. There are several types of meniscus surgery, each with its own benefits and risks.

These procedures are performed arthroscopically with keyhole incisions in a minimally invasive fashion. Patients can go home on the same day or the day after. 

Meniscectomy

In this procedure, the surgeon removes part of the damaged meniscus. This procedure is recommended for patients with tears or damage to the parts of the meniscus with poor blood supply and/or for meniscus tears that are not repairable. 

During a meniscectomy, the surgeon will make a small incision in the knee and use specialized tools to remove the damaged tissue. Recovery time is generally quick, and patients can often return to light activity within a few weeks. However, because the meniscus is an important shock absorber for the knee joint, removing too much of it can lead to increased wear and tear on the joint and an increased risk of arthritis.

Meniscus Repair

Meniscus repair is the preferred option for patients with repairable tears with good blood supply. During this procedure, the surgeon will sew the torn edges of the meniscus back together with specialised meniscus repair devices. 

Meniscus repair is a more complex procedure than a meniscectomy, and recovery time may be longer. Patients must be careful to avoid placing too much weight or pressure on the joint while it heals, which can take several weeks to months. Meniscus repair is the preferred option over menisectomy when possible. 

Meniscus Transplant

In some cases, the meniscus may be damaged beyond repair, or a previous meniscectomy may have led to significant joint degeneration. In these instances, a meniscus transplant may be recommended. During the procedure, the surgeon will replace the damaged meniscus with a donor meniscus.

Meniscus transplant is a complex procedure that requires a compatible donor and careful post-operative care. Recovery time is longer than for other types of meniscus surgery, and patients will need to undergo ongoing physical therapy to ensure a successful outcome. However, for patients with significant meniscus damage, a meniscus transplant can help restore mobility and reduce pain.

Preparing for Meniscus Surgery

Diagnostic Tests

Before scheduling meniscus surgery, your doctor will likely order an MRI or other diagnostic test to determine the extent of the damage. This will help them determine which type of surgery is necessary and develop a plan for your recovery.

The MRI will allow your doctor to see the extent of the damage to your meniscus. They will be able to see the size and location of the tear, as well as any other damage that may have occurred. This information will be crucial in determining the appropriate surgical procedure and developing a plan for your recovery.

Preoperative Consultation

Your surgeon will go over the details of the surgery, including what to expect during the procedure, the risks and benefits of the surgery, and what your specific recovery timeline will look like. You should use this time to ask any questions you may have about the procedure or your recovery. Your surgeon will be able to provide you with detailed information and help alleviate any concerns you may have.

Pre-surgery Exercises

Depending on the severity of your injury, your doctor may recommend that you do specific exercises before surgery to help build strength in the area and prepare your body for the operation. This could include exercises to strengthen the surrounding muscles, such as the quadriceps, or stretches to increase flexibility.

These exercises are designed to help improve your range of motion and build strength in the muscles surrounding your knee. This can help improve your recovery time and reduce the risk of complications during and after surgery.

Preparing for Surgery

In the days leading up to your surgery, there are a few things you can do to prepare yourself:

• Make sure you have someone who can drive you to and from the hospital on the day of your surgery.
• Fill any prescriptions your doctor may have given you for pain medication or antibiotics.
• Arrange for someone to help you with daily tasks, such as cooking and cleaning, during your recovery period.
• Make sure you have loose-fitting clothing that will be comfortable to wear after your surgery.

The Meniscus Surgery Procedure

Anesthesia Options

Meniscus surgery can be performed under general anaesthesia or regional anaesthesia, depending on the extent of the procedure and your specific needs. Your surgeon will discuss your anaesthesia options with you during your preoperative consultation.

Surgical Techniques

The specific surgical technique used during your procedure will depend on the type of meniscus surgery you are undergoing. Generally, the surgery will involve making a small keyhole  incision in the knee and using specialized tools to remove or repair the damaged meniscus.

Intraoperative Care

During the surgery, your care team will closely monitor your vitals and ensure that you are comfortable throughout the procedure. After the surgery is complete, you will be moved to a recovery area, where you will be monitored until you are ready to go home.

Recovery from Meniscus Surgery

In general, patients can expect to need several days to a week of rest before returning to light activity. Depending on your specific needs and the advice of your surgeon, you may need to undergo physical therapy to rebuild strength and flexibility in the joint. 

Immediate Post-Op (0-48 hours):

During the first 48 hours after surgery, the focus is on managing pain and swelling. Patients can typically expect to ice and elevate their leg and wear a knee brace or immobilizer for support. Crutches are typically used for support during this time. Gentle range-of-motion exercises may be introduced to promote healing and prevent stiffness.

Early Recovery (Days 3-7):

In the first week, patients will gradually increase weight-bearing activities and continue managing pain and swelling. Gentle stretching exercises are introduced, and individuals may begin using a stationary bike or continuous passive motion (CPM) machine to help regain range of motion. Your specialist may also recommend you to keep an eye on the incision site for any signs of infection during this period.

Short-Term Recovery (Weeks 1-3):

During weeks 1-3, individuals can expect to return to normal daily activities gradually.A follow-up appointment with the surgeon usually occurs within this time frame. Based on the surgeon’s evaluation & recommendation, physical therapy sessions will begin, focusing on range-of-motion and strengthening exercises. Ice and compression may still be used for pain relief. 

Mid-Term Recovery (Weeks 4-6):

As patients enter weeks 4-6, the intensity of the physical therapy will increase. Progressive strengthening exercises are introduced, and individuals may start low-impact aerobic activities, such as swimming or cycling. Depending on the individual’s progress, crutches may no longer be necessary. Regular follow-ups with the patient’s orthopaedic surgeon will continue during this phase.

Long-Term Recovery (Weeks 7-12):

From weeks 7 to 12, individuals will transition to more advanced exercises and gradually return to higher-impact activities like jogging and jumping. Patients may be recommended to focus on improving balance and coordination, and continue strengthening the surrounding muscles. 

Full Recovery (Months 3-6):

Full recovery typically occurs between months 3 and 6, allowing individuals to resume most pre-injury activities and sports. Maintenance of strength and flexibility remains crucial, and individuals should continue monitoring their knee for any complications. The intensity and duration of physical activities can be gradually increased, with a final follow-up with the surgeon, if necessary.

Keep in mind that the recovery timeline may vary based on individual factors, the type of meniscus surgery, and the severity of the injury. Consult with your orthopaedic specialist for personalised recovery instructions and timelines.

Conclusion

The meniscus is an essential component of the knee joint that plays a crucial role in shock absorption, weight distribution, and joint stabilization. Injuries to the meniscus can be debilitating, and the severity of the injury dictates the appropriate treatment and recovery approach.

Meniscus surgery is a common treatment option for significant injuries and includes meniscectomy, meniscus repair, and meniscus transplant procedures. Preoperative preparation, personalized surgical techniques, and diligent postoperative care can all contribute to a successful outcome.

Recovery from meniscus surgery is a gradual process that can range from several weeks to six months, depending on the type of surgery and individual factors. Patients must follow their orthopaedic specialist’s guidance and remain committed to physical therapy and rehabilitation to ensure the best possible outcome.

In the long run, a successful meniscus surgery can alleviate pain, restore mobility, and allow patients to return to their pre-injury activities, improving their overall quality of life.

Here’s What You Need To Know

You’ve likely heard of pitcher’s elbow or quarterback’s shoulder, but what about jumper’s knee?

Jumper’s knee, also known as patellar tendinitis, occurs when the tendon connecting the kneecap to the tibia gets tiny tears in it from repeated stress. These tears can lead to inflammation, weakening of the tendon, and tendinopathy.

If you experience knee pain, specifically under your knee cap that radiates to your shin, you may be suffering from patellar tendinitis. This pain is first experienced in the knee during or immediately after physical activity, but as the injury worsens, it can become painful throughout the day, especially when walking or climbing stairs.

Any individual who participates in competitive or recreational physical activity that places repeated stress on the knee extensor mechanism is at risk for patellar tendinitis. While the injury is most frequently seen in volleyball players, it also is commonly diagnosed in basketball players, high and long jumpers, as well as soccer players

Prevention Strategies

If you or your child participates in a sport that results in repeated stress on the knees, several preventative measures can help minimize the risk of developing patellar tendinitis.

Focus on stretching and stability

Regular stretching helps lengthen tendons and muscles and reduces muscle spasm. Tight muscles put additional pressure on tendons, and poor balance or stability can lead to your body compensating by forcing tendons to do more work. Keeping your muscles loose and improving your balance can help your body efficiently distribute weight and force while exercising.

Strengthen leg and hip muscles

Weak thigh muscles place extra stress on the knee and patellar tendon. By ensuring your leg muscles are strong, tendons and joints won’t be forced to bear all the force of physical activity. Incorporating regular weight training exercises, such as leg press, squats, and wall sits, into your exercise routine can improve leg and hip strength.

Practice proper form

Improper form and poor habits can lead to excessive stress on your joints and cause injury. Working with a coach or trainer who can provide expert instruction will help prevent injury and can also improve your overall athletic performance, while not using fake weights.

Cross-friction massage

Also known as sports massage, cross-friction massage is a deep tissue massage technique that increases blood flow to tissue and promotes flexibility and functionality. Cross-friction massage can also break down adhesions or scar tissue at the site of an injury and promote healthy tissue growth.

Ice massage

Cups of ice can be used to massage tendons, muscles, and joints. Ice not only feels good on sore muscles and joints, but it also reduces inflammation. Staying ahead of inflammation can prevent an injury from worsening.

Treatment

If caught early, patellar tendinitis can be treated with conservative methods such as rest, physical therapy, and anti-inflammatory medications. If patellar tendinitis is severe, more significant interventions such as steroid injections or surgery may be needed. If you are experiencing regular pain, don’t “play through it,” as this could lead to a more severe injury.