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Knee Problems

Knee Problems treatment at Highgate Private Hospital

Highgate Knee Unit

The Highgate Knee Unit uses a multi-disciplinary approach to diagnose and treat conditions of the knee.  By choosing Highgate Private Hospital, you’ll have access to London’s leading Consultant Knee Surgeons, Sports & Exercise Medicine Consultants, Pain Management Consultants, Chartered Physiotherapists, and specialist MSK Radiologists.

Highgate Private Hospital is equipped with two state-of-the-art theatres built with laminar flow systems for specialist Orthopaedic procedures. Our highly skilled theatre and nursing staff are trained to support you for any Orthopaedic surgical procedure, providing you with first-class care.

Services & Treatments

At the Highgate Knee Unit, our Consultants and Specialists can treat a variety of knee pain, injuries, problems and conditions. Whether you are suffering from chronic knee pain or a sports injury, our Consultants and Specialists are here to help.

Knee Problems & Treatments

Knee Injuries and Knee Pain

The knee joint is one of the largest and most important joints in the body, an articulation between the femur, tibia, fibula and patella that carries your weight when walking, running or jumping. The ligaments around this joint both stabilise and limit certain movements. If you take part in sports, injuries to your ligaments, cartilage and tendons can be common. As your knee supports the full weight of your body, obesity can also play a contributing factor to knee pain, the excess weight adding extra compression onto knee joints.

If you have any questions or concerns, you should always consult your GP or another relevant health specialist.

Causes of painful knees

Strain – If you have taken part in more activity than you are normally used to and feel pain in your knee, this could be the result of a strain. This is where tissues in your knee have stretched but not suffered any permanent damage.

Anterior cruciate ligament (ACL) injury – The ACL, which stabilises your knee, can tear as a result of twisting and overstretching the ligament. Once an ACL has ruptured, your knee will become unstable and prevent its full range of movement. This is one of the most common injuries picked up playing sports like football or rugby.

Lateral collateral ligament (LCL) injury – The LCL is found on the outside of your knee and limits side-to-side movement. Like an ACL injury, this can tear as a result of twisting or being hit on the inside of your knee.

Accidents – Acute injuries, such as sudden damage after an accident, may harm the bone, muscle or ligaments.

Damage to the knee joints (meniscal injury) – between the bones in your knee sit shock-absorbing pads of tissue called menisci. These pads, found on the inside and outside edges of your knee, can become worn with age or torn after a sudden movement. Damage to the menisci can be one of the most common causes of knee pain for middle-aged people.

Chronic injury – Pain from swelling can develop over time, frequently through overuse. This can be from athletic activity or physical exercise or develop because of age or from previous knee injuries.

Osteoarthritis – Osteoarthritis is the most common form of arthritis. Characteristics of the condition include inflammation of tissues around the joints and damage to the protective surface of the bones that allow joints to move easily without friction. The condition normally develops in people over the age of 50 and women are more likely to be affected than men.

Tendonitis – Tendonitis (otherwise known as runner’s or jumper’s knee) can be caused by overusing or injuring the tendons that join to your patella. As the name suggests, this inflammation of the tendon can be triggered by running or jumping activities like basketball, volleyball or netball.

Bursitis – The inflammation of a bursa (a fluid-filled sac that provides a cushion between bones and tendons or muscles around a joint) can swell and become tender through overuse or repetitive movement. People who are likely to be at more risk of developing bursitis of the knee are those who spend a lot of time kneeling, such as gardeners or carpet fitters. Historically, this condition was typical of housemaids, hence the condition also being known as housemaid’s knee.

Surgery at Highgate Private Hospital

Knee arthroscopy

Arthroscopy, also known as keyhole surgery, involves inserting a camera through small incisions in the skin. This allows your surgeon to see inside your knee and diagnose common problems, including a torn cartilage, arthritis or ligament damage. They may also be able to treat the problem at the same time.

Treatment

During the procedure, which uses one of several anaesthetic techniques and usually takes around 30 to 45 minutes, your surgeon will take a close look inside your knee. As well as washing out any loose material caused by wear of the joint surfaces, they can usually trim or repair a torn cartilage without making a larger cut.

Recovery

You will normally be able to go home on the same day, although your knee may be a little swollen for a few weeks and walking can be uncomfortable. Most people will make a good recovery and can quickly return to normal activities, however, always ask your consultant for advice before you begin exercising.

Knee Replacement Surgery

A successful knee replacement should result in less pain and walking should be easier.

What the operation entails

The operation usually takes between an hour and an hour and a half and many anaesthetic techniques are possible.

Your surgeon will remove the damaged joint surfaces via a cut on the front of your knee. They will be replaced with an artificial knee joint. This is made from metal, plastic or a combination of the two.

Complications

General
  • Pain
  • Blood clots
  • Scarring
  • Bleeding
  • Infection of the surgical wound site
  • Chest infection
  • Heart attack
  • Stroke
  • Difficulty passing urine
Specific
  • Dislocation
  • Continued discomfort in the knee
  • Damage to nerves
  • Infection in the knee
  • Damage to blood vessels
  • Mechanical loosening of the knee implant
  • Damage to ligaments or tendons
  • Severe pain, stiffness and loss of use of the knee (complex regional pain syndrome)

Recovery time

You can usually go home three to seven days after the procedure.

You will require walking sticks or crutches for several weeks.

You should be able to return to normal activities following regular exercise. However, ask your GP or health care professional for advice before you start exercising. Generally, most people make a good recovery, experience less pain and find it easier to get around. As an artificial knee is never quite the same as a normal knee; kneeling is not recommended and is usually uncomfortable.

You may find that your knee replacement wears out with time.

Alternatives to a total knee replacement

Anti-inflammatory painkillers (ibuprofen) and painkillers such as paracetamol can help control the pain. Including supplements in your diet may also help to alleviate symptoms, but you should always check with your GP before taking them. An elastic support worn around the knee can increase the feeling of stability and a walking stick can aid walking. Moderate exercise regularly can help to lessen stiffness in your knee. Pain and stiffness can sometimes be reduced by a steroid injection into the knee joint. As your arthritis worsens, these measures will become less effective. Patello-femoral and unicompartmental knee replacements are partial knee replacements which are available for patients with osteoarthritis that is limited to just one part of the knee.

ACL Reconstruction Surgery

Located in the knee joint, the anterior cruciate ligament (ACL) plays an important role in providing stability. Rupturing or tearing this ligament can lead to the knee collapsing or giving way when making turning or twisting movements.

Treatment

If your knee persistently gives way following an ACL rupture then an ACL reconstruction can improve your stability. The procedure can also help you to carry out everyday activities and play certain sports that may not be feasible without it. However, do be aware that your knee is unlikely to ever be as good as it was before your injury occurred.

During the operation, which uses one of several anaesthetic techniques and normally takes between 60 and 90 minutes, your surgeon will make some cuts around your knee area. They may choose to use keyhole surgery (arthroscopy) and look inside your knee using a tiny camera. They will replace your ruptured ACL with an appropriate piece of tissue from another area of your body, which will be fixed into place using special screws or anchors in drilled holes in the bone.

Recovery

You will usually be able to return home on the same day or the day after the operation is performed, although your surgeon may suggest that you wear a knee brace for several weeks. A period of intensive physiotherapy treatment for up to six months is recommended as your knee begins to settle down.

Regular exercise will help you return to your normal daily activities quickly but do check with your consultant.

Knee Revision Surgery

What is knee revision surgery?

Knee replacements have been carried out in the UK since the 1970s, with approximately 80,000 performed every year in England and Wales. This includes both total and partial knee arthroplasty (joint replacement) where either the whole knee or one side of the knee is removed and fitted with a prosthesis (artificial joint part). These operations are for people who have problems such as severe arthritis, injury or deformity in the knee joint, which cause pain and greatly impact mobility and quality of life.

On the whole, these are successful procedures, and many patients have good outcomes. However, the new joint parts do not last forever, and this is where knee revision surgery comes in. If the new joint fails, a second surgery is required to ‘revise’ the joint: taking out any old or dysfunctional prostheses, clearing any debris or inflamed tissues (known as debridement) and creating a new joint replacement. Without further complications, most successfully-replaced knee joints can be expected to last around 20 years before needing to be replaced again, however, this is greatly dependent on the age and activity level of its recipient. Overall, long-term follow-up of patients receiving knee replacements showed that only 3.9% required revision of the joint within 10 years, rising to 10.3% requiring revision by 20 years. However, in younger individuals (around 50 years old), the rate rose to 35% needing a second surgery. Overall revision rates for the UK are below 5%.

The challenge with revision surgery is that, because the joint has already been operated on, the procedure is generally very difficult to carry out, is associated with a higher rate of complications, and is often not quite as good as the original replacement. As such, knee revision surgery is a highly skilled procedure, requiring both expert opinion and experienced hands to complete successfully.

Why would knee revision surgery be needed?

In addition to general wear and tear and age of the new joint, there are several other complications (normal risks of having any joint replacement), which, although occur rarely, are important indications for the need of revision surgery. These are described below. Usually, when a knee joint requires revision it is due to several contributing factors leading to the failure of the implant.

Loosening of implant

When an artificial joint part is put into place, it is secured by one of two methods. The first is using cemented parts, where a specially designed medical cement is used to fix the joint part in place. The second method uses joint parts that are particularly designed to allow the bone to grow into them, securing them in place. Both methods are shown to be effective, however, in some individuals, there is still loosening of one or more of the new joint parts which can result in both pain and reduced joint function.

This is more likely to occur with increasing age and use of the implant, however, factors such as very high-impact activity or being overweight can accelerate this process and increase the likelihood of it happening. Sometimes, a phenomenon known as ‘osteolysis’ may also occur. This is where the bone itself around the implant begins to degenerate, resulting in loosening. The National Joint Registry shows that in 2017, half of the knee revisions in the UK were as a result of ‘aseptic loosening’ of the joint implants (loosening of the implant without infection).

Infection

Whilst infection is a complication to consider in any invasive medical procedure, several types of infection are particularly troublesome in the context of joint prostheses. Following the initial risk of infection from the stay in the hospital and the surgery itself, joint implants can become infected over the coming years. This results in pain, redness, swelling and sometimes even dislodging of the joint implants themselves, causing the new joint to fail.

In particular cases, a joint ‘wash out’ and exchange of the spacer part of the implant between the thigh and shin bone can be performed, without the need for removal and replacement of the fixed parts of the joint; this can be sufficient to treat the infection. However, in many cases, a ‘staged revision’ is required. This involves removal of all the joint implant parts and debridement (surgical removal) of infected tissues, followed by a rest period and course of strong antibiotics, before having a second operation to put in a new joint once the infection is clear.

Instability

The knee joint has six main ‘soft tissue’ elements that stabilise the joint. Two of these, the menisci (pads of cartilage which sit on top of the shin bone, cushioning the thigh bone on top), are removed as part of the joint replacement. The remaining four elements are ligaments (collateral and cruciate ligaments) that run between the thigh and shin bones providing support and stability to the joint. To get access to that joint space during replacement surgery, these ligaments can often become slightly damaged. This is usually managed well with appropriate physiotherapy and rehabilitation after the surgery, but in a few cases, the ligaments are either too damaged or do not heal. This results in an unstable joint that may ‘give way’, swell and cause pain. Knee revision surgery can restore this stability and balance to the knee to maximise function.

Stiffness

Joint stiffness is a major issue following knee joint replacement and is initially targeted with graded physiotherapy. However, it remains that some patients experience severe stiffness in the affected joint, resulting in major restrictions in the range of movement, which can be severely disabling. Following the failure of physiotherapy to alleviate stiffening of the joint, manipulation under general anaesthetic can be effective. This involves going to sleep under a general anaesthetic so you won’t feel anything, then the surgeon will move the knee around freely, breaking down any of the scar tissue that has built up around the joint. This is often a successful procedure and, whilst still carries the risks associated with anaesthetic, solves the problem without the need for another surgical intervention. Following this, surgical revision of the joint has also been shown to increase the range of movement and improve outcomes overall. Although this also carries the increased risks associated with revision knee surgery, data suggests that, as only 5% of knee revisions are carried out as a result of ongoing joint stiffness, physiotherapy and manipulation under anaesthetic are effective strategies to manage this.

Fracture

Often when adults get older, bones can weaken as part of the natural ageing process or from ‘osteoporosis’ (where bones become more brittle). Additionally, when a prosthetic joint implant is fitted into a bone, that part of the bone can become weaker than normal, meaning that the bone is more prone to breaks or fractures around the implant. Unfortunately, if the bone surrounding the implant becomes fractured, this means that nothing is anchoring the implant and it will become unstable. This presents a scenario that is more complicated than a simple bone fracture, as the replaced joint must also be taken into account. In these cases, a larger operation to both stabilise and fix the fracture, as well as replace the artificial joint parts, is carried out to provide optimal long-term outcomes for the joint.

What to do to prepare for knee revision surgery

Steps to prepare for knee revision surgery are fairly similar to those for initial knee replacement surgery. The main difference is that, if you are undergoing a revision procedure, it is likely that this is because of problems with the current artificial joint, which is probably causing pain. Moving around on a painful joint is hard at the best of times, but keeping mobile and building up the muscle around the joint after the operation is not only essential but will also enhance recovery.

Here are seven quick tips to consider when preparing for knee revision surgery:

  1. Arm yourself with knowledge: You have already had a similar operation, make sure you get to know what is happening this time around and why
  2. Ask questions: your consultant is there to look after you as well as make sure you understand what is happening and answer any questions you might have
  3. Know the risks: Revision knee surgery has a higher risk profile than a simple joint replacement. Your consultant is the best person to talk to about these risks, and you should be fully informed of these before any procedure goes ahead
  4. Find out about alternatives: Depending on your situation, there may be some alternative management, such as focused physiotherapy, which may provide relief without the need for another operation
  5. Stay well: Essential for any procedure, complications are much less likely to occur if you are in good health beforehand, so take some extra time to look after yourself and stay as well as possible
  6. Exercise: Easier said than done, but any exercise that you can do will confer some benefit both before and after the operation. A good mix of exercise that gets your heart rate up and strengthens your muscles is ideal, but anything you can do will be well worth it; keeping moving is key
  7. A healthy BMI: Another tricky one if you are struggling to exercise with a painful knee, but having a healthy BMI can help to reduce the risk of complications of both the anaesthetic and the new joint and will also help with rehabilitation. A healthy BMI (body mass index) is between 18.5 and 25 and is calculated from your height and weight. Ask your GP for more information or take a look at the NHS guide to BMI

What are the risks of knee revision surgery?

As mentioned previously, knee revision surgery confers a higher level of risk and complication to initial knee replacements, as the joint has already been operated on. This means that revision surgery is longer and more complex, however, as with the original operation, every precaution to minimise risk will be taken, and your consultant will use their medical judgement and experience to weigh up the risks versus benefits of the procedure to advise you.

Risks of revision knee surgery include:

  • Poor wound healing
  • Continued stiffness and limited range of motion in the knee
  • Infection of both the surgical wound and/or the joint implants
  • Bleeding
  • Fracture of the bone during the fitting of the joint implants
  • Damage to nerves or blood vessels around the knee
  • Dislocation; a very rare complication, but generally thought to be more likely in a revised joint replacement
  • Pulmonary embolism; a blood clot in the lungs

 

Advice from our experts

Mr Matthew Hearth

Here is some advice from one of our top consultant orthopaedic surgeons, Mr Matthew Hearth, who has a special interest in hip and knee replacements, including revision surgery:

‘My name is Matthew Hearth and I am a Consultant Orthopaedic Surgeon. My specialist interest is the Lower Limb Joint reconstruction. As such one of the operations I perform is revision total knee replacement.

  •  Revision total knee replacement is, unfortunately, a bigger surgical procedure than a primary or first knee replacement. It does, therefore, take longer to recover. Whereas a patient is often much better following a primary knee replacement at 2 to 3 months following surgery, a good rule of thumb would be to double this period after revision knee surgery.
  • There are many reasons why a revision knee replacement may be performed. The most common reason is that the primary knee replacement eventually wears out and becomes loose (aseptic loosening). This typically happens at greater than 10 years after the first knee replacement is inserted but maybe much longer than that ( >15years). This will cause the patient to have pain, reduced mobility and a general loss of function. If this happens, a revision knee replacement may be needed. Other less common causes of knee replacement failure include
  1. Infection of the knee replacement
  2. Instability, ie the ligaments in the knee become poorly functional and the knee gives way causing falls.
  3. Malalignment of the knee; sometimes this causes pain necessitating revision of the knee replacement.
  • Revision total knee replacement involves removing the previous total knee replacement and replacing it with a new knee replacement. As there has been previous surgery this is a bigger procedure, patients should, therefore, expect a longer recovery time.
  • The inpatient stay is usually from 3 to 5 nights in hospital. This is followed by outpatient monitoring by the consultant and the physiotherapy department.
  • The results of revision knee replacement have improved over recent years to be almost on a par with a primary total knee replacement. A patient could expect 10-year survival of the revision knee replacement approximately 85% of the time.
  • Tips for recovery would include
  1. Follow the advice of the surgeon/physiotherapist
  2. Take appropriate pain-killers, usually for at least the first 2 weeks post-operatively. Revision knee replacement can be painful and the painkillers will help the patient be able to do the rehabilitation.
  3. Make sure the rehabilitation exercises are performed, this is probably the most important
  4. Do not be disheartened if initially, things go slowly, it is a big surgery and things take longer to get better!’

References:

EIDO Healthcare Limited – The operation and treatment information on this website is produced using information from EIDO Healthcare Ltd and is licensed by Aspen Healthcare.

The information should not replace advice that your relevant health professional would give you.

Knee Problems Consultants

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