Knee
Knee Arthritis
What is Knee arthritis?
Knee arthritis is a condition that commonly affects the knee joint cartilage. In a healthy knee, a smooth, slippery substance, known as articular cartilage, covers the bones and allows them to smoothly glide over each other. When a knee is affected by arthritis, this layer of cartilage breaks down and causes pain, swelling and a reduction of motion.
Knee arthritis can make it difficult to do everyday activities such as walking or climbing stairs and it can seriously affect your quality of life. There are more than 100 different forms of arthritis, however, the most common types are osteoarthritis and rheumatoid arthritis.
What causes knee arthritis?
Osteoarthritis is the most common form of arthritis in the knee. It is caused by general “wear-and-tear” and usually occurs in people aged over 50 years. Osteoarthritis develops slowly, and the pain can get worse over time. While the exact causes of osteoarthritis are not known, the following factors contribute to the condition:
- Having a joint injury
- Undertaking activities which place extra stress on the knee
- Being overweight
- Getting older
Occasionally, knee arthritis may also be the result of rheumatoid arthritis, which is a disease that attacks many joints throughout the body. Knee arthritis can also occur after an injury to the knee.
Knee Arthritis Symptoms
The symptoms of knee arthritis include pain, inflammation, stiffness, swelling and reduced motion in the knee.
Diagnosing Knee Arthritis
The first diagnosis of knee arthritis will probably be made by your GP. He or she will usually assess your overall physical health and will probably send you for X-rays. You may also be sent for an MRI or a bone scan.
Knee Arthritis treatment
Dr de Villiers recommends trying a range of non-surgical treatments prior to considering surgery. These include weight loss, and regular exercise, as well as low-impact activities such as swimming and walking.
Surgery for Knee Arthritis
If your knee pain is severely affecting your quality of life, your doctor may refer you to a specialist. Most surgeries for knee arthritis aim to:
- Relieve strong pain that has not responded to other treatments
- Improve joint movement and flexibility to help you walk more comfortably
- Improve the alignment of your joints
The most common types of surgery for knee arthritis include:
- Knee Arthroscopy
- ACL Reconstruction
- Total knee replacement
Knee Arthroscopy
What is Knee Arthroscopy?
A knee arthroscopy is a minimally invasive form of keyhole surgery. It is used both to diagnose (and sometimes treat) knee joint problems. During the procedure, Dr de Villiers will make two or three small incisions into your knee and insert a thin, metal tube that holds a light source and a camera into the knee.
Images from the camera are sent to a screen so the surgeon can see inside the joint. Sometimes, small surgical instruments will be used with the arthroscope to help Dr de Villiers treat certain conditions such as torn ligaments and cartilage.
Why Do I Need a Knee Arthroscopy?
Dr de Villiers may recommend a Knee Arthroscopy if you are experiencing on-going knee pain. Even if your doctor already knows what is causing your pain, a knee arthroscopy can help confirm their diagnosis and, in some instances, treat the pain.
How Do I Prepare for a Knee Arthroscopy?
Dr de Villiers will tell you how to prepare for your surgery when you attend our practice for your consultation. He will ask you about any prescriptions, medications, or supplements that you’re currently taking. He may also ask you to stop taking certain medicines, such as ibuprofen, before the procedure. You will probably be told to stop eating in the hours leading up to the surgery, and you will be provided with written information about what to do on the day.
Recovery from Knee Arthroscopy
Knee Arthroscopy is usually performed as a day procedure, and most patients go home after a two- or three-hour recovery period.
Dr de Villiers will provide you with information about recovering from the procedure. It’s a good idea to have someone at home to look after you on the first day. You will also be asked to keep your leg elevated and to use an ice pack for the first two days.
You’ll also need to change your dressing. Dr de Villiers, or a member of our medical team will tell you when and how to do this, and how regularly. You will also probably have a follow-up appointment a day or two after the procedure.
It’s likely that you will be given an exercise routine to follow when you go home. This will help your knee recover. You might also need to see a physiotherapist until you have regained a full range of motion in your knee.
ACL Reconstruction
What is ACL Reconstruction?
Anterior Cruciate Ligament Reconstruction (also known as ACL Reconstruction) is a common surgical procedure which is performed when the anterior cruciate ligament (ACL) in the knee is ruptured.
ACL Reconstruction is usually done through arthroscopic (keyhole) surgery. This means that it is minimally invasive and only requires a small incision to be made. ACL Reconstruction has low complication rates and the outcomes are generally positive.
Why Do I Need an ACL Reconstruction?
Dr de Villiers will recommend an ACL Reconstruction if you have torn your anterior cruciate ligament. The ACL is a sturdy ligament that runs from the femur to the tibia and through the centre of the knee. When this ligament ruptures it does not heal and leads to knee instability. The aim of ACL Reconstruction is to restore stability to the knee.
ACL ruptures most commonly occur during sports or activities that involve overextending or twisting the knee. The ACL can rupture as a result of:
- Landing incorrectly after a jump
- Changing direction too quickly
- Slowing down while running
What happens during an ACL Reconstruction?
ACL Reconstruction procedures are performed under general anaesthetic. During the procedure, Dr de Villiers will make two small cuts around your knee. A thin metal tube with a tiny video camera is inserted into your knee joint. A sterile solution will also be pumped into the joint to help Dr de Villiers get a clear view.
Recovery from an ACL Reconstruction
ACL Reconstruction has good recovery rates and most patients can eventually return to sports that involve running and twisting. However, during the first week after surgery, your knee will be sore, swollen and stiff and you will need to use crutches for at least a week.
Rehabilitation for an ACL Reconstruction begins within two to four days. You will need to see a physical therapist during this time and they will teach you how to strengthen your leg and knee movement. Full Rehabilitation usually takes six to twelve months, after which, you should be able to return to playing most sports.
Total Knee Replacement
What is a Total Knee Replacement?
Total knee replacement (or total knee arthroplasty) is a common surgical procedure that is usually performed to relieve pain during end-stage arthritis. It is also performed to improve the movement of stiff knees and correct knee deformity.
Why do I need one?
Total Knee Replacement surgery is usually recommended if you are experiencing severe osteoarthritis of the knee and all other treatment options have failed to provide enough relief. Dr de Villiers may recommend a total knee replacement if you experience:
- Severe knee pain which makes it hard to walk, climb stairs or get up from a chair
- Pain when resting or that wakes you from sleep
- Chronic knee inflammation and swelling that does not respond to rest or medications
- Pain that is not relieved by physical therapy, or other conservative treatments.
- A bow- legged knee deformity
What happens in a Total Knee Replacement procedure?
A Total Knee Replacement is major surgery and it is performed under general anaesthesia. The procedure usually takes one to two hours. During a Total Knee Replacement, the damaged parts of the knee joint are removed and replaced with artificial components. This usually involves placing metal caps on the ends of the femur (thigh bone) and tibia (shin bone). A polyethene surface is then placed between these surfaces to ensure smooth movement.
Your knee joint is then X-rayed and tested to ensure it has a normal range of motion. The whole joint is then flushed and cleaned with a sterile solution. A small, temporary drainage tube is inserted, and the incision is closed and covered in a sterile dressing.
Recovery
The average hospital stay for a Total Knee Replacement is two or three days. Your surgeon will provide you with information of what to expect during your time in hospital, and how to best prepare for your hospital stay at our rooms prior to your surgery.
It’s a good idea to make sure that you have someone at home with you after your procedure. You’ll also need to make sure that you don’t have to climb any stairs to get to your bed or bathroom for the first few weeks after surgery.
Rehabilitation processes will begin soon after surgery. A physical therapist will teach you how to exercise your leg and restore knee movement. He or she will also show you several home-based exercises that you will need to do.
You will be on crutches for the first four to six weeks after surgery, however it can take around three months for the pain and swelling to settle down. Most patients find that they can return to normal activities within six to twelve months after surgery.
Revision Knee Replacement
What is a Revision Knee Replacement?
Prosthetic knee implants are designed to last for a long time, and most patients will get 10 to 20 years out of them before they break or wear out. When a knee replacement stops functioning correctly, a Revision Knee Replacement is needed. This involves removing the old prosthesis and replacing it with a new one. Revision Knee Replacements are usually more complicated procedures than total knee replacements as Dr de Villiers needs to remove the original implant which has grown into the bone.
What happens during a Revision Knee Replacement?
Dr de Villiers will talk to you about what will happen in your surgery when you attend our rooms for your consultation. Sometimes, only part of the original prosthesis needs to be replaced. In other cases, the entire prosthesis needs to be removed as well as some of the surrounding bone.
In most Revision Knee Replacements, Dr de Villiers will use special implants to replace any areas of bone or soft tissue that are damaged.
What are the benefits of Revision Knee Replacement?
The main benefit of Revision Knee Replacement is a relief from pain. Many patients find that this surgery also improves their mobility, coordination and strength. Some patients find that they can eventually return to normal activities. The success of this procedure strongly depends on your commitment to completing a rehabilitation program after surgery.
How long will I be in hospital?
Most people who have a Revision Knee Replacement are in hospital for three to four days. Dr de Villiers will discuss your individual hospital stay with you at our consulting rooms prior to surgery.
What is the recovery time?
After you go home, you will need to use a walker or crutches for around two to three weeks. After this time, you will probably use a walking stick. You will also need to have regular physiotherapy and rehabilitation appointments. Normal activities such as climbing stairs and getting into a car will be difficult to begin with, and you should make sure that you don’t need to climb stairs to get to your bed or bathroom. Most patients who have Knee Revision Surgery can resume normal activities after six weeks.
What results should I expect?
Most people who have Knee Revision Surgery experience great results, including relief from pain, improved stability and better mobility. It’s not always possible to completely remove pain and some patients still experience lower level pain and dysfunction after surgery.