KNEE SURGERY

HIP SURGERY

ORTHOPAEDIC SURGERY

Meniscus Surgery

The knee joint is made up of the ends of the femur (thigh bone) and tibia (shin bone). The meniscus is a rubbery, C-shaped disc that cushions your knee. It also helps to protect the cartilage in the knee. Each knee has two menisci - one at the outer edge of the knee and one at the inner edge. The menisci function as shock absorbers in the knee and also help to maintain stability within the knee. Injuries to the meniscus can occur after acute traumatic injuries or chronic repetitive injuries. Meniscus injuries can result in pain, swelling and stiffness of the joint. 

 

The diagnosis of a meniscus injury within the knee is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as ligament tears and cartilage injuries. Patients with small meniscus tears may be treated non-surgically with a course of rehabilitation. However, patients with large or displaced meniscal tears, who develop persistent pain, swelling and loss of joint function, are candidates for surgical treatment. Surgical treatment involves minimally invasive knee arthroscopy (or keyhole surgery) and includes the following options:  

1. Meniscus repair (See Figures below): Given its important function within the knee, meniscus tears

    should be repaired as far as possible. The meniscus is repaired by placing fine sutures within its

    substance to keep it together while it heals.​​

2. Partial meniscectomy: Sometimes the meniscus tear is so severe that it precludes a repair. In this

   instance, the torn non-functional part of the meniscus is removed using specialized instruments.

3. Meniscus transplant: In patients who develop pain in their knee because most or all of the  

   meniscus has been removed, meniscus tissue from a donor (allograft) may be transplanted into the

   knee to replace the deficient meniscus. 

At the same time, concomitant ligament and cartilage injuries may need to be addressed. Such surgery is usually performed under general anaesthesia and takes about 1-2 hours. An overnight stay in hospital is usually required after the surgery and 4-6 weeks of crutch-assisted ambulation may be advised. 

 

The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last to 4-6 months following the procedure. The success rate of meniscus surgery has been reported to be about 80-90%. The complications of this procedure include infection, meniscus retears and future osteoarthritis (if meniscectomy is performed).

 
 

Cartilage Repair

Joints are formed when the ends of two bones meet. For example, the knee joint is made up of the ends of the femur (thigh bone) and tibia (shin bone). Cartilage is the smooth elastic tissue that covers the ends of the bones at these joints. The cartilage allows for the joint surfaces to glide smoothly and painlessly against each other. Injuries to the cartilage can occur with acute traumatic injuries or with chronic repetitive injuries. Cartilage injuries can result in pain, swelling and stiffness of the joint. The diagnosis of a cartilage injury within the knee is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as meniscal tears and ligament injuries. 

 

Patients with small cartilage injuries may be treated non-surgically with a course of rehabilitation. However, patients with cartilage injuries, who develop persistent pain, swelling and loss of joint function, are candidates for surgical treatment. Surgical treatment involves cartilage repair. Cartilage has a low potential for intrinsic repair because of its poor blood supply. Therefore specialized repair techniques are employed to repair this tissue. These include:  

 

1. Bone marrow stimulation: Drilling or microfracture of the bone beneath the cartilage injury is

    performed so as to allow stem cells from the bone marrow to form new repair cartilage at the 

    site of the cartilage injury. 

2. Autologous matrix-induced chondrogenesis (AMIC) (See Figures below): In addition to drilling or

   microfracture, a tissue scaffold is placed within the cartilage defect to enhance the cartilage

   healing process.

3. Osteochondral autograft transfer (OAT): Fresh bone and cartilage from another part of the joint

    is harvested and transferred to the site of cartilage injury so as to restore its structure.

4. Allograft transplantation: Bone and cartilage tissue from a donor can be used to reconstruct

    large cartilage defects in the joint

 

At the same time, bone reshaping or osteotomy may also be performed to correct significant

abnormalities in joint alignment that may affect the cartilage healing process. Such surgery is usually

performed under general anaesthesia, using minimally invasive arthroscopic (keyhole) techniques. An overnight stay in hospital is usually required after the surgery and 4-6 weeks of crutch-assisted ambulation may be advised. The use of a continuous passive motion machine may also be beneficial.

The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last to 6-9 months following the procedure. The success rate of cartilage repair surgery has been reported to be about 70-90%. The complications of this procedure include knee stiffness, infection and cartilage reinjury.

 

ACL Reconstruction

ACL is an acronym for the ‘anterior cruciate ligament’. It is an important ligament that is found in the centre of the knee, and it helps to maintain knee stability by preventing forward and twisting movements of the tibia (or shin bone) relative to the femur (or thigh bone). Injuries to the ACL are common. They usually occur due to twisting, non-contact injuries during sporting activities such as soccer, basketball or netball.

The risk factors for ACL injuries include female gender and familial predisposition. The diagnosis of an ACL injury is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as meniscal tears and cartilage injuries.  

Some patients with isolated tears of the ACL may be treated non-surgically with a course of rehabilitation. However, patients with symptoms of recurrent knee instability, those with concomitant repairable meniscal tears, and individuals who are keen to return to competitive pivoting sports (such as soccer, basketball or netball) are candidates for surgical treatment.

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Surgical treatment involves ACL reconstruction. This surgery is usually performed under general

anaesthesia, using minimally invasive arthroscopic (keyhole) techniques. The surgery essentially involves replacing the torn ACL with a new ACL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new ACL graft is secured within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft). At the same time, concomitant injuries to the menisci or cartilage may be repaired. An overnight stay in hospital is usually required after ACL reconstruction and 2-4 weeks of crutch-assisted ambulation may be advised.​

 

The rehabilitation process after the surgery is supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last 9-12 months following the ACL reconstruction procedure. The success rate of ACL reconstruction surgery has been reported to be about 90%. The complications of this procedure include ACL graft injury, knee stiffness and infection.

 

ACL Revision

Anterior cruciate ligament (or ACL) reconstruction is a safe and effective procedure. However, in about 5-10% of cases, the ACL graft may tear or fail. Higher rates of graft tears of up to 30% have been reported in young patients, who are involved in competitive sport. The risk factors for graft failure include reinjury, technical issues arising from the initial surgery and associated injuries which compromise knee stability. 

The diagnosis of a torn or failed ACL graft is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries. CT scans may also be needed to assess the positions of the bone tunnels used in the previous ACL reconstruction and to look for possible excessive enlargement of these tunnels.

 

In patients who have symptoms of knee instability due to a torn or failed ACL graft, revision surgery is needed to improve knee stability. The surgery involves drilling new bone tunnels in the knee and securing a new ACL graft within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft). At the same time, an extra-articular lateral tenodesis may be added to enhance the stability of the knee. This involves using part of the iliotibial band to secure and improve the rotational stability of the knee. An overnight stay in hospital is usually required after revision ACL reconstruction and 2-4 weeks of crutch-assisted ambulation may be advised. 

 

Revision ACL reconstruction is a technically demanding procedure and should be carried out by surgeons who are trained and experienced. It is often carried out in one stage, although in a few patients, the surgery may need to be divided into two stages. In the first stage, bone grafting of the old tunnels is done, especially if there is significant widening of these tunnels, as they may compromise graft fixation. The second stage of the procedure is carried out several months later, once the bone grafts have healed and completely filled up the widened spaces within the old tunnels. In the second stage, new bone tunnels are created and a new ACL graft is secured within these tunnels.

 

The rehabilitation process after revision ACL reconstruction is often slower and longer compared to that following primary ACL reconstruction. It may last up to 12-18 months following the revision procedure. The success rate of revision ACL reconstruction has been reported to be approximately 75%. The complications of this procedure include infection, knee stiffness and recurrent graft failure.

 

PCL Reconstruction

PCL is an acronym for the ‘posterior cruciate ligament’. It is an important ligament that is found in the centre of the knee, and it helps to maintain knee stability by preventing backward movements of the tibia (or shin bone) relative to the femur (or thigh bone). Injuries to the PCL are less common than those to the ACL (or anterior cruciate ligament). They usually occur due to direct, contact injuries to the knee during road traffic accidents or sporting activities. ​

 

The diagnosis of a PCL injury is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries, such as other knee ligament tears, meniscal tears and cartilage injuries. Most patients with isolated tears of the PCL may be treated non-surgically with a course of rehabilitation. However, patients with severe tears, those with symptoms of recurrent knee instability and those with additional ligament and meniscal tears are candidates for surgical treatment. 

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Surgical treatment involves PCL reconstruction. This surgery is usually performed under general anaesthesia, using minimally invasive arthroscopic (keyhole) techniques. The surgery essentially involves replacing the torn PCL with a new PCL graft. Bone tunnels are drilled in the femur and tibia within the knee, and a new PCL graft is secured within these tunnels. This new graft may be obtained from patient himself (autograft) or from a donor (allograft). At the same time, concomitant injuries to the other ligaments, menisci or cartilage may be addressed. An overnight stay in hospital is usually required after PCL reconstruction and 4-6 weeks of crutch-assisted ambulation may be advised.​

 

The rehabilitation process after the surgery is supervised by a physiotherapist, and consists of progressive knee range of motion exercises, muscle strengthening exercises, and sport-specific drills. The whole rehabilitation process may last 9-12 months following the PCL reconstruction procedure. The success rate of PCL reconstruction surgery has been reported to be about 80-90%. The complications of this procedure include PCL graft injury, knee stiffness and infection.

 

Knee Osteotomy

The knee joint is formed by the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other. Damage to the cartilage and bone within the knee joint is called osteoarthritis. This can result from degeneration (wear and tear) or trauma (fractures and ligament injuries).

Patients who develop osteoarthritis of the knee joint can present with pain, stiffness, joint deformity and limping. This can sometimes be severe enough to affect daily mobility and one’s quality of life. The diagnosis of knee osteoarthritis is made after a thorough clinical assessment of the knee joint. X-rays and MRI scans are done to confirm the diagnosis. 

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Patients with early osteoarthritis and mild symptoms may be treated non-surgically with a course of rehabilitation. However, patients with severe symptoms and advanced osteoarthritis are candidates for surgical treatment. In particular, patients who are relatively young and physically active may benefit from joint preservation surgery in the form of knee osteotomy.

Knee osteotomy (or bone-reshaping surgery) is used to improve the overall alignment and shape of

the knee. This is useful in patients who have osteoarthritis mainly affecting one compartment of the knee that is associated with deformity or bowing of the knee. (See Figures below) Such surgery is usually performed under general anaesthesia and may take about 2 hours to perform. A 1-2 stay in hospital is usually required after the surgery and 4-6 weeks of crutch-assisted ambulation may be advised. ​

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The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. The whole rehabilitation process may last to 3-6 months following the procedure. The success rate of knee osteotomy surgery has been reported to be about 80-90%. The complications of this procedure include infection, damage to the blood vessels and nerves around the knee, and progression of the osteoarthritis in the knee.

 

Knee Replacement - Partial and Total

The knee joint is formed by the lower end of the femur (thigh bone) and the upper end of the tibia (shin bone). The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other. Damage to the cartilage and bone within the knee joint is called osteoarthritis. This can result from degeneration (wear and tear), trauma (fractures and ligament injuries), avascular necrosis (depletion of the blood supply to the bone) and inflammatory disorders (such as rheumatoid arthritis).  

Patients who develop osteoarthritis of the knee joint can present with pain, stiffness, joint deformity and limping. This can sometimes be severe enough to affect daily mobility and one’s quality of life. The diagnosis of knee osteoarthritis is made after a thorough clinical assessment of the knee joint. X-rays and MRI scans are done to confirm the diagnosis. Occasionally additional blood tests may be done to find out the underlying cause of the osteoarthritis. 

Patients with early osteoarthritis and mild symptoms may be treated non-surgically with a course of rehabilitation. However, patients with severe symptoms and advanced osteoarthritis may be candidates for surgical treatment, in the form of knee replacement surgery.

Knee replacement surgery involves replacing the worn out surfaces of the knee joint with prosthetic devices which are made of cobalt-chromium, titanium and polyethylene (medical grade plastic). If only one compartment of the knee is involved, then partial or unicompartmental knee replacement may be performed. In this procedure, only the affected part of the knee surface is replaced by prosthetic components. If more than one compartment of the knee is affected by osteoarthritis, then total knee replacement is carried out. In this case, all the surfaces of the knee are replaced by prosthetic components. Such surgery is usually performed under general anaesthesia and may take about 2 hours to perform. A 3-4 stay in hospital is usually required after the surgery and 2-6 weeks of walking aid-assisted ambulation may be advised. ​

 

The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. The whole rehabilitation process may last to 3-6 months following the procedure. The success rate of knee replacement surgery has been reported to be 90%. The complications of this procedure include deep vein thrombosis, infection and prosthetic wear.

 

Patella Instability Surgery

Patellar (or kneecap) dislocations are common injuries and affect mainly adolescents and young adults. In this condition, the patella moves out of its usual location in the front of the knee to the lateral or outer side of the knee. This can occur because of direct trauma or a twisting injury of the knee. 

The risk factors for patella dislocations include generalized ligamentous laxity, a valgus (or knock-knee) deformity of the knee and a shallow trochlea (groove for the patella) in the front of the knee. The diagnosis of a patella dislocation is made after a thorough clinical assessment of the knee. MRI scans are done to confirm the diagnosis and to look for concomitant knee injuries and anatomical risk factors. 

First-time acute patella dislocations are usually treated with a period of immobilization of the knee. Surgery is usually not required unless there is a significant cartilage injury that needs to be addressed. In patients who have recurrent patella dislocations and symptoms of patella instability, reconstructive surgery is needed to improve patella stability. The most common surgical procedure that is performed is called a medial patellofemoral ligament (MPFL) reconstruction. The surgery involves drilling two bone tunnels in the inner or medial side of the patella and another bone tunnel in the medial or inner side of the knee. A hamstring tendon graft is then passed through and secured within these tunnels to serve as a check-rein to prevent further lateral or outward dislocation of the patella. 

Sometimes additional concomitant procedures may need to be carried out to ensure patella stability. These include tibial tubercle (or shin bone) transfers and trochlea (or thigh-bone groove) reshaping. An overnight stay in hospital is usually required after such reconstructive surgery and 1-2 weeks of crutch-assisted ambulation may be advised. 

 

The rehabilitation process after the surgery consists of progressive knee range of motion and muscle strengthening exercises, as well as functional recovery. It may last up to 6-9 months following the procedure. The success rate of patella instability surgery has been reported to be about 80-90%. The complications of this procedure include infection, knee stiffness and recurrent patella instability.

 

Knee Replacement - Revision

Knee replacement surgery is generally a safe and effective procedure. However, in some patients, the knee replacement may loosen, wear out or develop instability. Patients who develop such complications may experience symptoms such as pain, stiffness and difficulty walking.

The diagnosis of a malfunctioning knee replacement is made after a thorough clinical assessment of the knee joint. X-rays, CT scans and specialized MRI scans may also be needed to confirm the diagnosis and to look for associated problems such as bone loss around the knee replacement. 

 

In patients who develop a malfunctioning knee replacement, revision surgery may be necessary to reduce pain and restore mobility. The surgery involves replacing one or more components of the knee replacement, which have failed. At the same time, areas of bone loss may need to be restored with bone graft from the patient himself (autograft) or from a donor (allograft), or replaced with metal blocks. 

Revision knee replacement is a technically demanding procedure and should be carried out by surgeons who are trained and experienced. Such surgery is usually performed under general anaesthesia and may take about 2-3 hours to perform. A 3-4 stay in hospital is usually required after the surgery and 2-6 weeks of walking aid-assisted ambulation may be advised.

The rehabilitation process after revision knee replacement is often slower and longer compared to that following primary knee replacement. It may last up to 6-12 months following the revision procedure. The success rate of revision knee replacement has been reported to be approximately 80%. The complications of this procedure include deep vein thrombosis, infection and loosening of the new prosthesis.

 

Hip Replacement

The hip joint is a ‘ball and socket’ joint. The ‘ball’ component is formed by the upper end or head of the femur, also known as the thigh bone. The ‘socket’ component is formed by the acetabulum within the pelvis bone. The surfaces of the joint are covered by a smooth elastic tissue called cartilage. The cartilage allows the joint surfaces to glide smoothly and painlessly against each other. Damage to the cartilage and bone within the hip joint is called osteoarthritis. This can result from degeneration (wear and tear), trauma, avascular necrosis (depletion of the blood supply to the head of the femur), inflammatory disorders (such as rheumatoid arthritis) or childhood disorders (such as dysplasia, where the acetabular socket has an abnormal shallow shape).  

 

Patients who develop osteoarthritis of the hip joint can present with pain, stiffness and limping. This can sometimes be severe enough to affect daily mobility and one’s quality of life. The diagnosis of hip oteoarthritis is made after a thorough clinical assessment of the hip joint. X-rays and MRI scans are done to confirm the diagnosis. Occasionally additional blood tests may be done to find out the underlying cause of the osteoarthritis. Patients with early osteoarthritis and mild symptoms may be treated non-surgically with a course of rehabilitation. However, patients with severe symptoms and advanced osteoarthritis are candidates for surgical treatment. 

Surgical treatment involves hip replacement surgery. The surgery involves replacing the worn out

ball and socket components of the hip joint with prosthetic devices which are usually made of cobalt-chromium, titanium and polyethylene (medical grade plastic). Sometimes ceramic components may be used, particularly in younger patients.  Such surgery is usually performed under general anaesthesia and may take about 2-3 hours to perform. A 3-4 stay in hospital is usually required after the surgery and 2-6 weeks of walking aid-assisted ambulation may be advised. ​

 

The rehabilitation process after the surgery is generally supervised by a physiotherapist, and consists of progressive range of motion exercises, muscle strengthening exercises, and functional therapy. The whole rehabilitation process may last to 3-6 months following the procedure. The success rate of hip replacement surgery has been reported to be 90%. The complications of this procedure include deep vein thrombosis, infection, limb length discrepancy and prosthetic wear. 

 

Hip Replacement - Revision

Hip replacement surgery is generally a safe and effective procedure. However, in some patients, the hip replacement may loosen, wear out or develop instability. Patients who develop such complications may experience symptoms such as pain, stiffness and difficulty walking.

The diagnosis of a malfunctioning hip replacement is made after a thorough clinical assessment of the hip joint. X-rays, CT scans and specialized MRI scans may also be needed to confirm the diagnosis and to look for associated problems such as bone loss around the hip replacement. In patients who develop a malfunctioning hip replacement, revision surgery may be necessary to reduce pain and restore mobility. The surgery involves replacing one or more components of the hip replacement, which have failed. At the same time, areas of bone loss may need to be restored with bone graft from the patient himself (autograft) or from a donor (allograft), or replaced with metal blocks. 

Revision hip replacement is a technically demanding procedure and should be carried out by surgeons who are trained and experienced. Such surgery is usually performed under general anaesthesia and may take about 2-3 hours to perform. A 3-4 stay in hospital is usually required after the surgery and 2-6 weeks of walking aid-assisted ambulation may be advised.

The rehabilitation process after revision hip replacement is often slower and longer compared to that following primary hip replacement. It may last up to 6-12 months following the revision procedure. The success rate of revision hip replacement has been reported to be approximately 80%. The complications of this procedure include infection, loosening of the new prosthesis, dislocation of the joint and limb length discrepancy.

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