Do you have Knee Pain?

Knee painYour knee can get damaged due to accidental fall, twisting, injury while walking, running, playing sports.

Arthritis – Damage and wear of the cartilage can occur due to Osteoarthritis, Rheumatoid Arthritis, Previous Injury, Fracture or Dislocation.

Knee pain can be commonly caused due to:

  1. Cartilage damage: Early arthritis, osteonecrosis and injuries may lead to cartilage damage of a limited area leading to pain, stiffness, swelling and difficulty in performing daily activities such as walking, standing, sitting for long, climbing stairs and sitting cross legged.
  2. Meniscal Tear: Results from injury, when one excessively bends the knee as in squatting, or due to twisting. Apart from pain, swelling, stiffness and difficulty in walking, there may be ‘locking’.
  3. Ligament Tears: Sports injuries or accidents may cause ligaments to tear causing instability and ‘giving way’. The cruciate and collateral ligaments are commonly damaged.

Have you been advised Knee Surgery?

Treatment for knee pain depends on the cause of knee pain.

Knee Preservation

It includes different methods of treatment for knees with mild cartilage damage, meniscal or ligament tears. The key is early diagnosis of the problem and prompt treatment so that it does not worsen and require major surgery in the future!

Knee Preservation includes the following treatment options –

  • Lifestyle changes
  • Exercises
  • Arthroscopy
  • ACI Autologous Chondrocyte Implantation or Cartigrow (Cultered Cells)

How can changing my lifestyle help preserve my knee joint?

Lifestyle plays an important role in joint health. This is especially true in someone who has been diagnosed with early arthritis, ligament or meniscal injury.

  • Keeping your knee muscles strong will help in improving the weight distribution on your knee joint.
  • Maintaining your ideal body weight also reduces the load on your knee and reduces the risk of further deterioration and damage.
  • A well-balanced diet, adequate in calcium and vitamin D will help keep your bones and cartilage healthy.
  • Regular exercises (like cycling, walking) help keep your bones and cartilage healthy.
  • Avoidance of certain activities based on your specific problem may be advisable to prevent further damage.
  • Certain protein supplements (glucosamine and chondroitin) may help in protecting the cartilage.

What is the role of exercise in joint preservation?

Early knee arthritis, ligament or meniscal injury can lead to functional limitations due to muscular weakness or instability that prevents one from performing daily activities and even participating in physical activities. Specific exercises can help in reducing pain, improving function by strengthening muscles and improving gait.

  • Static quadriceps exercises
  • Knee extension excercises
  • Straight leg raising
  • Recline cycling

What is arthroscopy?

Arthroscopic surgery or “key-hole” surgery allows the surgeon to look inside the joint and perform procedures using special tiny instruments. This usually requires a stay of 24 hours or less in hospital. Meniscal and ligament tears are treated using arthroscopy as also certain cartilage regeneration procedures. Arthroscopy and washout of the joint is not helpful in knees with complete loss of cartilage.

What is ACI (Autotogous Chondrocyte Implantation-Biological Treatment)?

This is a minimally invasive procedure which involves transplanting your own cartilage cells to an area of limited cartilage damage. This is done as an open surgical procedure only when a small area of cartilage is involved. It requires overnight stay in the hospital. The transplanted cartilage cells may help to re-grow and form new normal cartilage at the site of damage, and is useful for loss of small areas of cartilage.

What is Knee Resurfacing?

The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment). The bones in each compartment are covered by a thin layer of cartilage which prevents the bones from touching each other.

Arthritis usually starts in only one compartment, while the other two remain healthy. In Knee Resurfacing, only the diseased cartilage in one or two compartments is removed and resurfaced with metal and polyethylene leaving normal ligaments, meniscus, and cartilage intact. By Resurfacing one or two compartments at the right time, the knee joint can be preserved and total knee replacement can be avoided or delayed for over 15 years.

Osteoarthritis starts in one compartment (either medial or patellofemoral) and then affects the other compartments. By Resurfacing one or two compartments at the right time, the knee joint can be preserved and knee replacement can be avoided or delayed for many years. Only that compartment with worn out cartilage is resurfaced with metal and polyethylene; the remaining joint with its ligaments, meniscus, and cartilage is preserved. The key is to diagnose the problem early and treat it promptly so that it does not worsen and require a knee replacement in the future! Unfortunately, Rheumatoid Arthritis affects all 3 compartments at once and so resurfacing of one or two compartments alone cannot help.

Knee Resurfacing includes the following treatment options

Unicompartmental Knee ResurfacingUnicompartmental Knee Resurfacing
Unicompartmental knee resurfacing (UKR) is a minimally invasive procedure where only the inner (medial) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out.

Patellofemoral Knee ResurfacingPatellofemoral Knee Resurfacing
Patellofemoral Resurfacing (PFR) is a minimally invasive procedure where only the front (patellofemoral or behind the knee cap) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out.

BKRBicompartmental Knee Resurfacing
Bicompartmental knee resurfacing (BKR) is a minimally invasive procedure where both the inner (medial) and front (patellofemoral) compartments of the knee joint are resurfaced when the cartilage there gets completely worn out.

Total knee Replacement or Resurfacing. What is the right surgery?

Arthritis usually starts in only one compartment, while the other two remain healthy. Most surgeons use implants to replace all 3 compartments (Total Knee Replacement) as it is a technically easier operation. Patients who have osteoarthritis in only one compartment may not need a total knee replacement.
In Resurfacing, only the diseased cartilage in one compartment is removed and resurfaced with metal and polyethylene leaving normal ligaments, meniscus, and cartilage intact. By Resurfacing one compartment at the right time, the knee joint can be preserved and knee replacement can be avoided or delayed for over 15 years.

The benefits of resurfacing include a smaller incision, less pain, little swelling and faster recovery. Your knee will be as similar to your normal knee as possible, will feel normal, and will be as flexible so that you can lead a normal life. The operation removes less bone than a total knee replacement because only damaged cartilage is removed. The wear rate of unicompartmental resurfacing is exceptionally low, allowing them to last long. Results from around the world show that those who have had resurfacing are more satisfied than those with a knee replacement. It is also very likely that there will be no need for any further operations on your knee. However, should you require knee replacement after many years, it will be an easier operation as the remaining knee had been preserved, and the results will be equally satisfactory and long-lasting.

However, knee resurfacing is a more difficult operation and few surgeons are trained to perform.

Common questions about knee resurfacing

  • What is resurfacing?
  • What are the types of Knee Resurfacing?
  • When is resurfacing required?
  • Is resurfacing painful?
  • Can resurfacing be done in both my knees at the same time?
  • Will I need physiotherapy after surgery?
  • How successful is resurfacing of the knee?
  • Why is resurfacing preferred over replacement?
  • How long will it last?
  • Are there any complications of resurfacing?
  • How often will I need to come for a check-up after surgery?
  • What is High Tibial Osteotomy?

What is Total Knee Replacement TKR?

The end of your thigh bone (femur) can be compared to a rocking chair. It has two distinct surfaces called condyles, which rest on the shin bone (tibia), forming two ‘compartments’, the inner (or medial) and the outer (or lateral compartment). A third compartment is in the front of the knee behind the knee cap (patello-femoral compartment). The bones in each compartment are covered by a thin layer of cartilage which prevents the bones from touching each other.

Arthritis means damage and wear of the cartilage covering the bone ends. It can be of different types – Osteoarthritis, Rheumatoid Arthritis, and Post-traumatic Arthritis (after previous injury, fracture or dislocation) being the common ones. It causes pain, stiffness, swelling and difficulty in performing your daily activities such as walking, standing for long, getting up from a chair, climbing stairs and sitting cross-legged.

When the cartilage in all 3 compartments of your knee is severely damaged, results in pain, swelling, stiffness and deformity, and affects your daily activity, you should start thinking about knee replacement. It should be considered only after all other standard treatment (lifestyle modifications, medicines, exercises and physiotherapy) has failed to improve your quality of life. Through examination, x-rays and possibly scans, we will help you decide which is the best option for you – replacement or resurfacing (in which only the diseased cartilage in one compartment is resurfaced leaving normal tissues, ligaments, and cartilage intact).

‘Knee Replacement’ is actually misleading as your whole knee is not replaced! It only involves resurfacing the entire cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

When the cartilage in all 3 compartments of your knee is severely damaged, results in pain, swelling, stiffness and deformity, and affects your daily activity, you should start thinking about knee replacement. It should be considered only after all other standard treatment (lifestyle modifications, medicines, exercises and physiotherapy) has failed to improve your quality of life. ‘Knee Replacement’ is actually misleading as your whole knee is not replaced! It only involves resurfacing the cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

What are the different types of Total knee replacement?

Yes, there are hundreds of different designs and models. In fact, we have helped design implants (such as the Attune Knee System, made by DePuy Johnson & Johnson) that are used worldwide by other surgeons. We decide what is best for each person based on a thorough assessment of several patient factors (age, weight, activity level, bone quality, deformity, ligament integrity, etc.). Do let us know if you have any specific design in mind. Also let us know if you are allergic to nickel, chromium or cobalt.

Common questions about knee resurfacing

  • How is your knee joint special?
  • What is arthritis?
  • What is knee replacement?
  • When do I require knee replacement?
  • What is CAS (Computer-Assisted Surgery) and how is it helpful?
  • How will your bespoke technique benefit me?
  • How successful is knee replacement?
  • Can both my knee replacements be done at the same time?
  • Do you still have pain and unable to walk after Knee Surgery?

Both Knee Replacement as well as Knee resurfacing can effectively relieve pain and restore function and provide long term benefit to the patient. However, in a small number of cases, these surgical procedures may fail and require a second surgery called “Revision” surgery.

Some of the common indications for revision surgery include:

  • Infection
  • Wear and loosening
  • Instability
  • Stiffness
  • Fractures around the knee implant

A failed knee surgery can cause continuous pain and swelling around the knee area; pain and difficulty in bending or straightening the knee; limping while walking; inability to walk well; inability to climb stairs. Patients who have these complaints may require revision joint surgery.

  • How is your knee joint special?
  • What is arthritis?
  • What is knee replacement?
  • When do I require knee replacement?
  • What is CAS (Computer-Assisted Surgery) and how is it helpful?
  • How will your bespoke technique benefit me?
  • How successful is knee replacement?
  • Can both my knee replacements be done at the same time?

You may not need a knee replacement?

About 50% of patients who were suggested knee replacement, maynot actually need a knee replacement. In last 20 years of clinical practice, we have seen increasing number of knee replacement and more significant increase in UNHAPPY PATIENTS OR FAILED KNEE REPLACEMENT.
Other treatment options are avaible and are equally good and in majority of cases help in preventing a knee replacement.

Treatments available:

  • Physical rehabilitation
  • Biological treatment (stem cell therapy)
  • Arthroscopy (Keyhole Surgery)
  • Unicompartmental knee resurfacing
  • Patello femoral resurfacing

Physical Rehabilitation

Early knee arthritis, ligament or meniscal injury can lead to functional limitations due to muscular weakness that prevents one from participating in physical activity. Certain exercises can help in reducing pain, improving function by strengthening muscles and improving gait.

  • Static quadriceps exercises
  • Knee extension excercises
  • Straight leg raising
  • Recline cycling

Biological Treatment
This is a minimally invasive procedure which involves transplanting your own cartilage cells to an area of limited cartilage damage. This is done as an open surgical procedure and requires overnight stay in the hospital. The transplanted cartilage cells may help to re-grow and form new normal cartilage at the site of damage, and is useful for loss of small areas of cartilage.

Arthroscopic knee surgery
Arthroscopic surgery or “key-hole” surgery allows the surgeon to look inside the joint and perform procedures using special tiny instruments. This usually requires a stay of 24 hours in hospital. Meniscal and ligament tears are treated using arthroscopy as also certain cartilage regeneration procedures.

Patellofemoral Resurfacing
Patellofemoral resurfacing (PFR) is a minimally invasive procedure where only the front (patellofemoral or behind the knee cap) compartment of the knee joint is resurfaced when the cartilage there gets completely worn out

Bicompartmental Knee Resurfacing
Bicompartmental knee resurfacing (BKR) is a minimally invasive procedure where both the inner (medial) and front (patellofemoral) compartments of the knee joint are resurfaced when the cartilage there gets completely worn out.

Total Knee Replacement
Total ‘Knee Replacement’ (TKR) is actually misleading as your whole knee is not replaced! It only involves resurfacing the cartilage on the 3 bones where they move against each other. The new surfaces are made of metal and polyethylene and are fixed to your bones with special bone cement. The implants we use are imported, have been well tested, and have been used successfully for many years.

Total Hip Replacement
Total hip replacement (THR) is a procedure where the diseased cartilage and bone of the hip joint is replaced by an artificial socket (to replace acetabular cup) and ball (to replace the femoral head). We use a “cementless” prosthesis which allow natural bony ingrowth around the implants and naturally fixes the THR implant to the native bone.

Revision knee and hip replacement
Revision Total Knee or Hip Replacement is a procedure where previous failed knee or hip prosthesis (implant) is replaced with a new prosthesis. Failures of previous prosthesis may be commonly due infection, loosening, instability or fractures.