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Knee

Why does my knee hurt?

The knee is described as a hinge joint. The bone surfaces in contact with each other are covered in cartilage, a very slippy material. This allows you knee to bend and straighten easily. The knee has three compartments to it; behind the knee (patellofemoral joint), inside (medial compartment) and outside (lateral compartment). Arthritis can affect any of these three parts in any combination. With time the cartilage can wear away leading to the exposed bone rubbing against other exposed bone, this causes pain and stiffness. The pain can be felt at the front, side, or deep inside the knee occasionally even in the hip (referred pain). Gradually mobility is affected and the pain can even disturb sleep.

In the early stages of arthritis people try oral supplements such as cod liver oil, chondrotin and glucosamine to slow down the progress of the arthritis. When the pain becomes unbearable then the only option is a replacement joint.
Knee arthroscopy

Does your knee click, become swollen or get painful after minimal exercise? Have you injured your knee and are unable to get back to sport? Then you may have torn your meniscus. These are two horse shoe shaped structures that sit on top of your shin bone (tibia). They deepen the knee joint and reduce stresses within your knee during increased impact activities. Occasionally they become caught in the knee and then tear when thebody twists on the knee.

An arthroscopy (keyhole surgery) may help you. This is usually a day case procedure when the inside of the knee is looked at using a camera. This is inserted via two small nicks either side of the patella tendon. The camera is about the thickness of a pen. The other hole is used to insert instruments to the knee. The operation takes about 20 minutes. The torn meniscus is trimmed back to a stable edge, so that it no longer irritates the joint. The wounds heal without requiring stitches.

On leaving the hospital you can walk, but sometimes require crutches. On average it takes two to six weeks to recover from an arthroscopy. You are then able to return to your pre injury activities.
Complications of surgery

The majority of patients (95%) have a successful outcome with no problems; however surgery does have risks associated with it. Some patients will have higher risks depending on the previous diseases they suffered from. These include:
All joint replacements are artificial and as such can wear out sooner than expected leading to another (revision) operation. There are also risks specific to the individual procedure, which include:

Total Knee/Uncompartmental/Patellofemoral Replacement
Any further concerns you have about the complications should be addressed to Mr Cope or his team when you meet him in clinic.
Major Medical Problems
Severe Respiratory Disease
Medications
Previous Joint Surgery
The risks to all joint surgery are:
How can Mr Cope help me?

There are several options available depending on how the arthritis has affected your knee. If it is just behind your kneecap (patellofemoral osteoarthritis) then you may be suitable for a patellofemoral replacement (PFJ). If the inside (medial compartment osteoarthritis) is affected then you may be suitable for a unicompartmental knee replacement (Uni). The majority of patients however have tricompartment arthritis affecting their knee throughout a total knee replacement (TKR) is then the only option.

A cut is made down the front of your knee and the knee cap is turned outwards exposing the inside of your knee. The diseased bone ends are then removed and a new knee is inserted.

The anaesthetist will either give you a general anesthetic which requires a machine to breathe for you or a spinal anaesthetic which makes your legs numb and some sedation to make you sleepy. The operation typically last one hour, however you will be in the theatre area for around two to three hours.

The next day you begin your road to recovery and start to walk, initially with walking aids. You go home typically five to seven days after the operation. The operation itself is only one part to your new knee and you have to put the time and effort in to gain the full benefit by performing the exercises regularly that you will be taught. This is to ensure that the knee moves as well as it is capable of. Around six weeks following the operation you are fit to drive and are usually walking unaided. Mechanical knees do clunk and this is no cause for concern. This is meant as a guide only and all patients heal and recover at different rates.
Six Weeks Post Knee Replacement
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  • cardiac disease
  • diabetes
  • previous stroke
  • previous blood clots
  • deep vein thrombosis (DVT)
  • pulmonary embolism (PE)
  • anticoagulants
  • steroids
  • immunosuppressants
  • fracture fixation
  • previous infection
  • previous joint replacement
  • Medical (heart attacks and strokes) (see above)
  • Infection of new joint requiring removal (1%)
  • Deep vein thrombosis (blood clots) (2-3%)
  • Fatal pulmonary embolism (blood clot goes to lung) (0.2%)
  • On-going pain and discomfort (5%) However pain is usually less than previously experienced from the arthritis.
  • Stiffness (2%)
  • Most knees should move from 0 (straight) to at least 90 (bent). Stiffer than this may require an operation to manipulate it whilst you are asleep.
  • Nerve/Blood vessel injury (0.1%)
  • Progression of arthritis in the case of unicompartmental and patellofemoral replacements requiring further surgery to convert to a total knee replacement.
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