Knee
The orthopaedic surgeons that make up the Tshwane Orthopaedic Sports and Rehabilitation Centre team are well versed in minimally invasive knee surgeries done for a range of injuries and conditions where non-surgical treatment has failed. Arthroscopic knee surgeries may be done for repairing damaged joints, soft tissues and ligaments to reduce pain.
Arthroscopic knee surgery is done using small puncture-like incisions instead of larger cuts. Using a thin tube-like instrument with a camera attached called an arthroscope, your orthopaedic surgeon will be able to see the inner workings of the knee better with the video display, and perform surgery accurately using a less invasive technique. Using this technique for surgery, your recovery time and pain after surgery, as well as knee-joint stiffness, should be lessened. Arthroscopic knee surgery may be done for the following reasons:
- Removal or repair of a torn meniscus or ligaments
- Reconstruction of a torn anterior cruciate ligament
- Removal of inflamed synovial tissue
- Trimming of damaged articular cartilage
- Removal (debridement) of loose fragments of bone or cartilage
- Treatment of conditions affecting the patella (kneecap)
- Treatment of knee infection
- Knee surgery for ligaments repair and reconstruction
Ligaments connect bones to one another to allow movement. The main ligaments, namely the two cruciate ligaments (which cross one another in an X form) and two collateral ligaments on either side of the knee, hold the knee in place and keep you stable on your feet. Arthroscopic knee surgery may be required for injuries and damage to ligaments that cause the knee to become unstable.
Surgery done to correct a torn or damaged ligament is done using arthroscopy under general anaesthesia by replacing the damaged part of the ligament with a piece of tendon, from either the kneecap or a donor. The tendon is then grafted into place to repair the ligament and hold the knee joint together. - Cartilage procedures
The kneecap has articular cartilage covering the front and back of the joint which helps the bones of the knee joint glide and bends smoothly. Degenerative conditions such as arthritis in the knee cause the cartilage to diminish. When the cartilage becomes damaged or diminished, you will have bone grinding on the bone which causes pain and knee mobility problems. Your orthopaedic surgeon may then suggest a cartilage repair or cartilage regeneration surgery.
A cartilage repair surgery involves the damaged cartilage being removed and new cartilage being moulded. This surgery is commonly done in conjunction with knee debridement surgery which removes loose irritants in the joint and flushing of the joint with a saline solution. Both these surgeries are done arthroscopically, under general anaesthesia.
Alternatively, cartilage regeneration surgery may be done to encourage new cartilage growth in the knee joint by making small cuts into the bone underneath the injured cartilage. By doing this, the blood supply from these cuts may aid new cartilage cells to grow. This surgery may be done using knee drilling, microfracture or abrasion arthroplasty, under general anaesthesia. - Total knee replacement
A knee replacement surgery, also known as arthroplasty, is done as a treatment for painful degenerative conditions of the knee such as osteoarthritis and rheumatoid arthritis, as well as post-traumatic arthritis, which causes the cartilage that surrounds the bone to wear away and the lining of the joints to swell. Your orthopaedic surgeon will be able to evaluate whether or not knee replacement surgery may be needed to restore the mobility of your joint and ease symptoms of pain and swelling.
Under general anaesthesia using arthroscopic surgery, your orthopaedic surgeon will remove the damaged parts of cartilage and bone, and replace them with prosthetic pieces made of metal, ceramic, and plastic. Knee replacement surgery has very successful long-term results.
In cases where only one part of the knee has damage, a unicompartmental (partial) knee replacement may be considered instead. This surgery involves the damaged compartment being replaced with metal and plastic. The healthy cartilage, bone and ligaments are then preserved. When possible, a unicompartmental (partial) knee replacement may be better suited as the healthy parts of the knee are preserved meaning recovery is quicker. In addition, a partial replacement feels more natural and has more mobility. - Deformity correction
The knee joint is able to bend like a hinge as well as rotate. The joint connects the thigh bone and shin bone and is covered by the patella which has cartilage to allow for the smooth gliding of the bones over one another when the knee is bent. Ligaments, tendons and muscles play an important role in keeping the knee stable and mobile.
Deformities in the knee are either present at birth or develop as a child gets older, they may also be due to sports injuries or trauma such as car accidents. In other cases, deformities are caused by diseases like diabetes, obesity, cerebral palsy and osteomyelitis. Deformities in the knee are treated similarly to deformities in other parts of the body through surgery or the use of orthotic devices.
Correction surgery for knee deformities depends on the specific deformity present. Surgery may be done for bones that have grown at incorrect angles or lengths, for non-union fractures that have healed incorrectly or for knock-knees for which knee realignment and osteotomy may be needed. - Tendinopathy treatment
Patellar tendinopathy or tendonitis is often referred to by its more common name, Jumper's Knee, a condition of the knee in which overuse of the joint causes pain and mobility problems in the knee. Patellar tendinopathy is caused by activities involving jumping and landing, which strain and damage the tendon of the patella. Treatment for Jumper's knee usually includes resting and icing the joint, as well as non-steroidal anti-inflammatory drugs, physical therapy and cortisone injections to rebuild the weakened tendon. When such non-surgical treatments fail, your orthopaedic surgeon may suggest minimally invasive surgical debridement of the patellar tendon. During this surgery, under general anaesthesia, small incisions will be made for the arthroscope so that your surgeon may remove any loose tissues in the knee joint. After this, your orthopaedic surgeon will remove part of the weakened and damaged tendon tissue and reattach the healthy ends to one another.
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