Thailand Knee Orthopaedic Overview

Are you experiencing chronic knee pain?

Below are links to the topics discussed on this page to give a helpful and general overview of knee replacement surgery.

• Treating Knee Pain
• Reasons for Knee Pain
• Knee Anatomy
• Knee Problems
• Total Knee Replacement Surgery
• Surgery Complications
• Life of Artifical Knee
• Is Arthroscopy for You?
• The Orthopedic Knee Evaluation
• Preparing for Surgery
• Arthroscopic Surgery of the Knee
• Knee Surgery Recovery
• Knee Problem Warning Signs
• Reasonable Expectations After Arthroscopic Surgery
• Medical Terms and Glossary of Definitions Regarding the Knee

If you have persistent pain, catching, or swelling in your knee, a procedure known as arthroscopy may help relieve these problems.

Arthroscopy allows an orthopedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, using a pencil-sized instrument called an arthroscope. The scope allows transmission of an image of your knee through a small camera to a television monitor. The image allows the surgeon to thoroughly examine the interior of the knee and determine the source of the problem. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.

With improvements of arthroscopes and higher resolution cameras, the procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems.

Treating Knee Pain

What You Should Know About Knee Joint Replacement

"Joint Replacement" (the term orthopaedic surgeons use) is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial knee joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology. Circumstances vary, but generally patients are considered for total joint replacement if:

• Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living.
• Pain is not relieved by more conservative methods of treatment — such as medications, physical therapy, or arthroscopy (cleaning the joint) — by the use of a cane, and/or by restricting activities.
• Stiffness in the joint is significant.
• X-rays show advanced arthritis or other problems.

Knee Anatomy

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue-the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments-connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia, and patella touch are covered with articular cartilage. Articular cartilage is a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous cartilage tissue, called the lateral and medial menisci, act as shock absorbers and stabilizers.

The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane. The synovium releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee.

Knee Problems

Normally, all parts of the knee work together in harmony. Sports, work injuries, arthritis, or weakening of the tissues with age can cause wear and inflammation, resulting in pain and diminished knee function.

Arthroscopy can be used to diagnose and treat many of these problems:

• Torn meniscal cartilage.
• Loose fragments of bone or cartilage.
• Damaged joint surfaces
• Softening of the articular cartilage (chondromalacia).
• Inflammation of the synovial membrane (rheumatoid or gouty crystalline arthropathy arthritis).
• Abnormal alignment or instability of the kneecap.
• Torn ligaments, including the anterior and posterior cruciate ligaments.

By providing a clear picture of the knee, arthroscopy can also help the orthopaedic surgeon decide whether other types of reconstructive surgery would be beneficial.

Reasons for Knee Pain

One of the most common causes of joint pain is arthritis. The most common types of arthritis are:

• Osteoarthritis (OA) — sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis.


• Rheumatoid Arthritis (RA) — produces chemical changes in the joint space that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.


• Post-traumatic Arthritis — may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.

Other causes of joint pain include avascular necrosis, which can result when bone is deprived of its normal blood supply (for example, after organ transplantation or long-term cortisone treatment), and deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move. What's causing your knee joint pain? Is getting relief through joint replacement an option for you? These are just some of the answers that an orthopaedic surgeon can provide. But first, it's a good idea to be sure you have information about joint replacement that will help you understand what the surgeon tells you.

What Is Total Knee Replacement Surgery?

Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a knee joint, are removed and replaced with a prosthesis, or artificial joint. The artificial joint is designed to move just like a normal, healthy joint. In total knee replacement, the artificial joint is composed of metal and polyethylene to replace the diseased joint. The artificial joint is most commonly anchored into place with bone cement. In some applications, it is covered with a porous coating that allows bone tissue to grow into it.

Possible Complications of Knee Replacement Surgery

Serious complications may occur with any surgical procedure. These include but are not limited to: problems with anesthesia, cardiovascular problems including heart attack, vascular problems including thrombus, bronchopulmonary problems including emboli, genitourinary problems, and gastrointestinal problems. Certain additional complications related to joint replacement surgery in particular may include but are not limited to: bleeding problems, blood clots in the legs and/or lungs, wound healing problems, damage to nerves and blood vessels, limb length discrepancy, bone erosion or abnormal bone formation, dislocation, infection, pain, bone fracture or non-union, component wear or fracture, component loosening. Complications may require medical intervention including additional surgery and, in rare instances, may lead to death. Your doctor should discuss these potential complications with you.

Will an Artificial Knee Joint Last Forever?

As successful as most of these procedures can be, over the years, the artificial joints can become loose and unstable or wear out, requiring a revision (repeat) surgery.

Is Arthroscopy for You?

our family physician can refer you to an orthopaedic surgeon for an evaluation to determine whether you could benefit from arthroscopy.

Signs that you may be a candidate for this procedure include swelling, persistent pain, catching, giving way, and loss of confidence in your knee. When other treatments, such as the regular use of medications, knee supports, and physical therapy, have provided minimal or no improvement, you may benefit from arthroscopy.

Most arthroscopies are performed on patients between 20 and 60 years of age. Patients younger than 10 years of age and older than 80 years of age have benefited from the procedure as well.

The Orthopaedic Knee Evaluation

During the medical history, your orthopaedic surgeon will gather information about your general health and will ask you about your symptoms.

A physical examination will be done to assess the motion and stability and muscle strength of the knee as well as the overall alignment of the leg.

X-rays will be done to evaluate the bones of the knee. Your orthopaedic surgeon may also arrange for you to undergo magnetic resonance imaging (MRI) to provide more information about the soft tissues of your knee. An MRI uses magnetic sound waves to create images. They are not X-rays. Blood tests may be obtained to determine if you have arthritis.

Your orthopaedic surgeon will review the results of your evaluation with you and discuss the best methods to further diagnose your knee problem. Other diagnostic tests may be indicated, such as magnetic resonance imaging (MRI).

Treatment options include medications or surgical procedures, such as arthroscopy.

Your orthopaedic surgeon will explain the potential risks and complications of knee arthroscopy, including those related to the surgery itself and those that can occur after your surgery.

Preparing for Knee Surgery

If you decide to have arthroscopy, you may be asked to have a complete physical examination with your family physician before surgery. This will assess your health and rule out any conditions that could interfere with your surgery.

Before surgery, tell your orthopaedic surgeon about any medications or supplements that you are taking. You will be informed which medications you should stop taking before surgery.

Tests, such as blood samples or a cardiogram, may be ordered by your orthopaedic surgeon to help plan your procedure.

Arthroscopic Surgery of the Knee

Almost all arthroscopic knee surgery is done on an outpatient basis for healthy patients. Your hospital or surgery center will contact you about the specific details for your surgery. Usually, you will be asked to arrive at the hospital an hour or two prior to your surgery. Do not eat or drink anything after midnight the night before your surgery.

After arrival, you will be evaluated by a member of the anesthesia team. Arthroscopy can be performed under local, regional, or general anesthesia. Local anesthesia numbs your knee, regional anesthesia numbs you below your waist, and general anesthesia puts you to sleep. The anesthesiologist will help you determine which would be the best for you.

If you have local or regional anesthesia, you may be able to watch the procedure on a monitor, if you wish.

The surgeon will then insert the arthroscope to properly diagnose your problem, using the image projected on a monitor to guide the arthroscope. If surgical treatment is needed, the surgeon can use a variety of small surgical instruments (e.g., scissors, clamps, motorized shavers, or lasers) through another small incision.

This part of the procedure usually lasts 45 minutes to 1 1/2 hours.

Common treatments with knee arthroscopy include:

• Removal or repair of torn meniscal cartilage.
• Reconstruction of a torn cruciate ligament.
• Trimming of torn pieces of articular cartilage.
• Removal of loose fragments of bone or cartilage.
• Removal of inflamed synovial tissue.

At the conclusion of your surgery, the surgeon may close your incisions with a suture or paper tape and cover them with a bandage.

You will be moved to the recovery room. Usually, you will be ready to go home in one or two hours. You should have someone with you to drive you home.

Your Recovery at Home

Recovery from knee arthroscopy is much faster than recovery from traditional open knee surgery. Still, it is important to follow your orthopaedic surgeon's instructions carefully after you return home. You should ask someone to check on you that evening.

Swelling

Dressing Care

You will leave the hospital with a dressing covering your knee. You may remove the dressing the day after surgery. You may shower, but should avoid directing water at the incisions. Do not soak in a tub. Keep your incisions clean and dry.

Your orthopaedic surgeon will see you in the office a few days after surgery to check your progress, review the surgical findings, and begin your postoperative treatment program.

Bearing Weight

After most arthroscopic surgeries, you can walk unassisted. Your orthopaedic surgeon may advise you to use crutches, a cane, or a walker for a period of time after surgery. You can gradually put more weight on your leg as your discomfort subsides and you regain strength in your knee. Your surgeon may allow you to drive after a week.

Exercises to Strengthen Your Knee

Medications

Your orthopaedic surgeon may prescribe antibiotics to help prevent an infection and pain medication to help relieve discomfort following your surgery.

Complications

Potential postoperative problems with knee arthroscopy include infection, blood clots, and an accumulation of blood in the knee. These occur infrequently and are minor and treatable.

Knee Problem Warning Signs

Call your orthopaedic surgeon immediately if you experience any of the following:

• Fever
• Chills
• Persistent warmth or redness around the knee
• Persistent or increased pain
• Significant swelling in your knee
• Increasing pain in your calf muscle

Reasonable Expectations After Arthroscopic Surgery

An intercollegiate or professional athlete often sustains the same injury as a weekend recreational athlete, but the potential for recovery may be improved by the over-development of knee muscles.

Physical exercise and rehabilitation will play an important role in your final outcome. A formal physical therapy program also may add something to your final result.

A return to intense physical activity should only be done under the direction of your surgeon.

It is reasonable to expect that by six to eight weeks you should be able to engage in most of your former physical activities as long as they do not involve significant weightbearing impact. Twisting maneuvers may have to be avoided for a longer time.

If your job involves heavy work, such as a construction laborer, you may require more time to return to your job than if you have a sedentary job.

Medical Terms and Glossary of Definitions Regarding the Knee

Anterior:

Closer to or at the front of the body.

Anterior Cruciate Ligament (ACL):

The ligament that connects the tibia to the femur at the center of the knee. Its function is to limit rotation and forward motion of the tibia.

Antibiotic Cement Spacer:

In the event a patient has a severe infection in the knee after a Total Knee Replacement, an antibiotic cement spacer will be placed in the knee (after the old prosthetics are removed) until the infection is healed and a new prosthetic can be inserted. The cement spacer is constructed of the same material as the cement used to hold the prosthetic components in place.

Arthroscopy:

A minimally invasive surgery to repair or remove soft tissues of the knee, such as the Anterior Cruciate Ligament or the meniscus.

Articular Cartilage:

The specific cartilage that covers the moving surfaces inside the knee such as the tibia and the femur, as well as the underside of the patella.

Bone Spurs:

Abnormal projections of bone, also known as osteophytes. Usually caused by increased stress on the ends of the bones.

Cartilage:

A smooth material that covers bone ends at a joint to cushion the bone and allow the joint to move easily without pain.

Collateral Ligaments:

Ligaments that run along the sides of the knee and limit sideways motion.

Condyle:

A rounded projection at the end of a bone that anchors muscle ligaments and articulates with adjacent bones.

Femur:

The thigh bone or upper leg bone.

Fibula:

The outer and thinner of the two bones of the human leg between the knee and the ankle.

Glucosamine/Chondroitin:

Glocosamine is a dietary supplement that helps to grow and repair cartilage. Chondroitin helps cartilage maintain elasticity.

Hamstring Muscles:

The muscle group located on the back of the thighs; they allow the knee to flex, the thigh to extend and the leg to be drawn inward.

Hyaluronic Acid Injections:

Hyaluronic acid is found in the fluid in your joints and helps to protect them from wear. Osteoarthritis can cause the hyaluronic acid to get thinner, which means it doesn’t protect the joint as well. Injections can put more hyaluronic acid into your knee joint and help protect it more.

Intramedullary Canal:

The canal that runs up the center of the femur.

Lateral:

Farther from the midline of the body (near the side).

Lateral Compartment:

The joint on the outer, or lateral side, of the knee.

Long Bone X-ray:

A combination of three separate x-rays to produce one image of the legs.

Ligaments:

Elastic bands of tissue that connect bone to bone.

Malleoli:

Either of the two rounded protuberances on each side of the ankle, the inner formed by a projection of the tibia and the outer by a projection of the fibula.

Medial:

Closer to the midline of the body (near the middle).

Medial Compartment:

The joint on the inner, or medial, side of the knee.

Medial Parapatellar Retinaculum:

The sleeve of tissue medial (midline) to the patella (kneecap). This is a continuation of the extensor mechanism (quadriceps and patellar tendon).

Meniscus:

Pads of cartilage that further cushion a joint, acting as shock absorbers between two bones. Meniscus can be found on both the lateral (on the side) and medial (near the middle) side of the knee joint.

Menisectomy:

Surgery that results in the removal of part of the meniscus, or cartilage, of the knee. This is typically performed arthroscopically, or through small holes instead of a large surgical incision.

steoarthritis:

The most common type of arthritis affecting the knee. It is a chronic disease and is characterized by destruction of cartilage, overgrowth of bone, bone spur formation and impaired function. This type of arthritis occurs when bone rubs against bone and occurs in most people as they age.

steophytes:

Abnormal projections of bone, also known as bone spurs. Usually caused by increased stress on the ends of the bones.

Patella:

The kneecap; a flat triangular bone located at the front of the knee joint.

Patella Femoral Arthritis:

Arthritis that is primarily focused around the kneecap (patella) and femur (thigh bone).

Patellar Ligament:

This ligament helps secure the patella over the front of the knee joint.

Patello Femoral Joint:

The joint under the kneecap, or patella.

Primary Total Knee Replacement:

A "Primary" Total Knee Replacement refers to the first time a patient receives a knee replacement. The surgeon alters the femur, tibia and patella and fits those bones with prosthetic components.

Post Traumatic Arthritis:

A sub-classification of osteoarthritis.

Posterior:

Closer to or at the back of the body.

Posterior Cruciate Ligament (PCL):

The ligament located just behind the anterior cruciate ligament. It limits the backward motion of the tibia.

Prosthesis (plural is prostheses):

An artificial body part designed to supplement or replace natural parts. In total knee replacement, the prosthetic components replace the ends of the tibia and femur, the underside of the patella and compensate for cartilage and some ligaments.

Pulse Oximeter:

A probe placed on a patient's finger that measures the oxygen saturation level in his/her blood.

Quadricep Muscles:

The muscle group located on the front of the thighs; they extend the legs.

Resident, Orthopedic Resident:

After completing four years of medical school, doctors-in-training have a period of residency, or learning on the job. The residency can last from 4 to 7 years, and individuals at this stage of training are known as residents.

Revision Surgery:

A surgery that replaces knee components or corrects problems from previous total knee replacement surgeries.

Rheumatoid Arthritis:

An inflammatory disease that involves the lining of the joint (synovium). The inflammation generally affects the joints in the hands and feet and tends to occur equally on both sides. Over time, cartilage and bone becomes eroded and the joints become very deformed.

Steroid Injections:

Injections of corticosteroid directly into the knee can often produce pain relief for those suffering from osteoarthritis. Corticosteriods reduce inflammation at the area of injection for days or weeks at a time.

Synovial Membrane:

This membrane produces lubricating fluid (synovial fluid), which contributes to the smooth movement of the knee.

Tendons:

Tough cords of tissue that connect muscles to bone.

Tibia:

The shin bone or the larger bone of the lower leg.

Valgus:

An abnormal position in which part of a limb is twisted outward away from the midline, opposite of varus. Also known as knock-knee.

Varus:

An abnormal position in which part of a limb is twisted inward toward the midline, opposite of valgus. Also known as bowleg.