Most knee problems cause either pain or giving way. Other problems can happen but these are less common. Below are listed some of the common problems with the knee and what can be done.
When people refer to a torn cartilage, they usually mean one of the meniscal cartilages that lie between the two bones of the knee.
These are most commonly torn when twisting or bending the knee. In the younger patient this will require a large force, such as when running or playing sport, but as people get older it can happen just with normal activities.
Usually the knee will be painful, and sometimes it will swell, or even not straighten, especially if the torn cartilage gets stuck in the joint.
The most common treatment for a torn cartilage is to remove it arthroscopically, as described later, as it is rare that they will heal on their own, but sometimes it is possible to help them repair with a surgical technique.
Holding the knee together are a number of strong bands, known as ligaments. The best known ones are the Anterior Cruciate Ligament (ACL), and Medial Collateral Ligament (MCL).
These ligaments can be torn if the knee is forced sideways with great force. The most common example of how an ACL injury occurs is a sideways tackle when playing football. The knee is immediately painful and quickly swells up. If the knee is not treated it may go on to be unstable, making running on uneven ground, or changing direction difficult, such as when playing sport.
To investigate an ACL injury, a full examination is required, and an MRI scan can be done.
Treatment may be with a brace, but often surgery is required, particularly in young patients, or those wanting to get back to sport. This is done by taking a different tendon, and threading it through the knee, where it is held to act as a new ligament. After surgery the patient then needs to spend time rehabilitating from the injury, but can usually return to sport 6 to 9 months later.
Knee arthroscopy is a surgical technique that allows the surgeon to look inside the knee and perform many procedures.
By making two small holes either side of the patella tendon, a camera and instruments can be put into the knee. This then allows the surgeon to repair or remove damaged cartilage, as well as perform more complex surgery if required. Sometimes, depending on what is done, further holes may be needed.
The procedure is usually performed as a day case. In other words you come into hospital, have the operation and go home the same day. Most patients are walking without crutches by the next day, and many can drive within 5 days and return to work soon after. (However it does depend on what had to be done at surgery, and what the patients job entails!)
As with any operation there are risks and side effects. These include post operative pain and stiffness, oozing after the operation, blood clots and infection (both of which are very uncommon with this operation), and that there is no guarantee of a cure. However the majority of people do very well following surgery, and can quickly return to the sports and activities which they wish to do.
Arthritis of the knee causes the patient pain, stiffness, and is often associated with swelling and giving way of the joint. Treatment depends on how severe the symptoms are.
The majority of patients can be treated with lifestyle changes, such as simple exercises and activity modification. However, as the condition progresses pain relief may be required, and in severe cases, surgery may be considered.
There are different surgical treatments available to the patient and surgeon. Depending on how badly the knee is affected, it may be possible to help with an arthroscopic wash out of the knee, but in more severe cases a knee replacement may need to be considered.
Knee Replacement and Personalized Knee Replacements
There are different types of knee replacement, allowing Mr Banim to chose the most appropriate one for his patients.
Sometimes just part of the knee can be replaced, known as a partial or unicompartmental knee replacement. This leaves the rest of the normal knee in place, hopefully resulting in better function, and a more 'normal' feeling for the patient.
However if the knee is severely worn, or there are other problems, a total knee replacement may need to be done. This replaces the ends of the bone, and sometimes the patella, with metal and plastic.
There are now custom made knee replacements which Mr Banim is trained to use. In the past there have been customized jigs, which allow for the pre-planning of where to put a knee replacement, however only a small selection of implant sizes could be used. New technology will allow Mr Banim to have a custom made, personalized implant available for the patient, aiming to allow perfect bone coverage, giving better outcomes and longevity of the implant. The implant used is made by ConforMIS. Currently this type of surgery is only available to private patients.
Results and Outcomes
Mr Banim's results for total knee replacements, based on data collected by the National Joint Register, are extremely good. This is shown in the graph below, where the triangle represents Mr Banim's revision rate. Marks below the green line represent surgeons with a lower than average revision rate.
Both types of knee replacement are effective at reducing the amount of pain that a patient suffers, but it should be noted that there can be side effects and complications, even in the most skilled hands. The surgeon will try to reduce the risks of blood clots and infection by providing treatment to prevent these. Stockings and calf pumps along with medicines are used to reduce the risks of DVTs (blood clots), and antibiotics are given to reduce the risk of infection. Other complications include stiffness and difficulty kneeling after the operation. Not all the patient's pain may be relieved, and eventually all knee replacements may wear out and need to be revised.