Knee preserving surgical procedures.
There are many conditions that can lead to degeneration of the knee joint – osteoarthritis (wear + tear), inflammatory arthritis (such as rheumatoid or psoriatic arthritis), traumatic arthritis (post a fracture or sports injury), meniscal tear, and ligament tears. Though the definitive treatment to decrease pain and increase function may be a joint replacement, for many patients there are options to preserve the joint and its function for as long as possible. We live in a blessed era in which the technology for joint replacements has come forward leaps and bounds, however, the sad reality is that, like anything man made, they do also eventually wear and fail. As such, we like to delay the surgery for as long as possible to ensure that patients have the least number of surgeries possible.
This is where joint preserving surgical options come into their own, and include:
Knee arthroscopy – often referred to as “key hole” surgery, an arthroscopy uses a telescopic camera and fine instruments to visualise and perform procedures within your joint through 2 or 3 small stab incisions. There are a number of interventions that can be done through such a technique and include chondroplasty, meniscectomy and synovectomy.
Chondroplasty – a chondroplasty refers to reshaping of the cartilage surface. Arthritis leads to the joint surface progressing from smooth cartilage to roughened cartilage or complete loss with exposed bone. In some cases, a chondroplasty can be performed to smooth the surfaces, and options also exist for cartilage transplant and regrowth. Though this sounds like a great option, it is not without consequences, and so is not indicated for all patients. Dr Host will discuss with you the pros and cons of this, and its relevance to you, during your consultation with him.
Meniscectomy – translates to removal of part or all of the meniscus. What is a meniscus? They are the shock absorbers of the knee. You have two in each knee, one on each side of the knee, and they act to decrease the load that the cartilage surface has to carry. They have the consistency of calamari, and when they tear, can cause painful locking and clicking within the knee. Removing the tear and re-shaping the remaining meniscus to resemble a C can help, but as it removes some of the shock absorber, can lead to arthritis later in life. In some patients, repair of the meniscus is an option also, and will always be attempted where possible.
Synovectomy – this refers to removal of the synovial lining of the joint. The synovial lining is normally a thin layer that produces the lubricant that allows your knee joint to function more efficiently. With many inflammatory conditions, some tumours and post trauma, this thin layer can thicken and cause pain and swelling. Removing the layer can help with this in some cases, and can be performed using
ACL reconstruction – involves augmentation or substitution of a torn anterior cruciate ligament (ACL). The ACL is involved in controlling rotation of your knee and forward movement of the tibia (shin) on the femur (thigh). Loss of this ligament results in instability of the knee, mainly with pivoting movements. Reconstruction of the ligament is performed using hamstring or patella tendon autograft (your own tissue), allografts (from another person) or synthetic grafts. It is performed arthroscopically, and involves a lengthy rehabilatation program before you can return to pre-injury activities. Unfortunately, there is little convincing evidence that having the reconstruction will delay arthritis later in life, as the joint surfaces are often damaged in the initial injury and slowly develop arthritis regardless of the presence or absence of the ACL. As such, the surgery is not indicated in all patients, and its suitability as a treatment option for you will be discussed in your review with Dr Host.
Patella realignment procedures – this encompasses a wide spectrum of interventions that aim to improve the relationship of the patella (knee cap) to the femur. Most commonly these are used in those patients that have had previous dislocations of the knee cap, but can also be performed in those who have developed arthritis between the knee cap and femur (patello-femoral joint or PFJ).
High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) – these procedures change the shape of the bones to shift weight from load bearing areas that are worn, to those that have intact cartilage surfaces.
Dr Host has been trained in and offers all of these surgeries, and will discuss with you the options that best suit your specific condition and functional requirements.