Treatments of Knee Conditions

The surgical treatment options vary according to the different conditions. Common knee surgeries include:

Diagnostic and therapeutic arthroscopies
This is usually done as a day surgery procedure through a small telescope that is inserted into the knee. Patients with meniscal and cruciate ligament injuries usually go through arthroscopy. Patients can either go home on the same day or a day later. In younger patients with isolated cartilage injuries/ defects, two-stage articular cartilage transplantation is offered.

Open surgeries
This includes proximal and distal realignment procedures for isolated patellofemoral problems and involves doing a lateral retinacular release of the patella and tibial tubercle elevation and medialisation to improve the patellar tracking.

High tibial osteotomies (cutting bone) are commonly performed, which involve either a medial opening wedge or lateral closing wedge osteotomy of the proximal tibia to redirect the weight bearing forces from the medial compartment of the knee to the lateral side and reduce the intraosseous pressure thereby relieving patients of their pain and varus deformities. These surgeries can be performed bilaterally in one sitting or in a staged manner.

Total knee replacement
This is done commonly nowadays for severe tricompartmental arthritis. This surgery involves resurfacing of the damaged articular lining of the knee mainly the distal femur and proximal tibia with metal prosthesis and inserting a tibial articular liner/ insert made of high density polyethylene. The patellar articular surface may also be replaced, but to a lesser extent depending on the findings of the surgeon during the surgery with a patellar button that is also made from material similar to tibial insert.

The prosthesis is usually fixed with bone cement. If only one compartment is involved, unicompartmental knee replacements are offered. The risks of this elective surgery is weighed against the benefits of this procedure as it improves the quality of life of most patients and gives them significant relief from pain.

The commonly cited risks are of that related to anaesthesia, bleeding, infection, and deep venous thrombosis in veins of the lower limbs, fracture, loosening of the prosthesis- aseptic or septic.

Patients are usually assessed preoperatively by the anesthetists and if fit, they can usually come in on the day of surgery. Post operatively there would usually be a drain placed in the knee which would be removed on post operative day 1 or 2 followed by making the patient sit up in bed, out of bed, and allowed to walk bearing full weight on the operated limb with the help of a walking frame. Usually patients would go home by the 4th or 5th postoperative days.