Sunny Deo - Knee Surgeon Swindon, Keyhole Knee Surgery & Sports Clinic

Knee Surgery & Keyhole Surgery

Knee Surgery & Keyhole Surgery
There is a wide array of knee surgery procedures, which have evolved over many years, particularly the last 20. They are being refined all the time. There are two broad groupings of surgery, open and arthroscopic (keyhole).

Surgery is undertaken for a large number of specific problems affecting the main structures within the knee most commonly the menisci (cartilages), anterior cruciate ligament, joint surfaces and other ligaments. In addition operations close to the joint can offload forces through the joint to relieve symptoms such as osteotomies.
Keyhole surgery is largely used for sports injuries to the knee involving the menisci (cartilages), joint surfaces and joint lining (synovium), and can also assist major reconstruction operations such as ACL reconstruction and osteotomies. It has limited, yet potentially, highly useful roles in the management of degenerative and arthritis conditions.

Knee Biomechanics
Knee Anatomy
Knee Conditions
Knee Treatments
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Common arthroscopic operations:
  • Arthroscopic debridement
  • Partial meniscectomy
  • Meniscal repair
  • Microfracture
  • Patellar/Quads tendon procedures

Open End Arthroscopic Assisted Operations
Common non-keyhole procedures are:
  • Anterior cruciate ligament (ACL) reconstruction
  • Medial patella-femoral ligament (MPFL) reconstruction
  • Patellar realignment
  • Realignment osteotomy
  • Other ligament reconstructions
  • Chondral replacement surgery (AMIC, MACI)
  • Tendon procedures
Many of these surgeries are undertaken in conjunction and are assisted by arthroscopic surgery.

When do we consider Knee Surgery?
Key reasons (indications) for surgery are:
  • Symptoms affecting quality of life and level of function
  • Symptoms are commonly pain, stiffness, instability, deformity, which often are initially activity related but may eventually become constant.
  • Symptoms that have failed to settle with non-operative treatment 
  • Deformity, instability or bone loss that can't settle with non-operative methods.

Knee replacement surgery
Also known as knee arthroplasty — can help relieve pain and restore function in severely diseased knee joints. During the knee replacement operation damaged bone, cartilage (joint surfaces) and thickened joint lining from your thighbone, shinbone and kneecap are removed and replaced with an artificial joint made of metal alloys and high-grade plastics (polyethylene).  Most knee replacements attempt to replicate your knee's natural ability to roll and glide as it bends.

Total or partial replacement?
Knee replacements are no longer just total replacements, as partial replacements are available with evidence that in the right patients, they work better, last as long and cause less complications than traditional total joint replacements. At the other end of the spectrum, patients with more complex deformities and problems such as multiple ligament loss are more constrained replacements. Partial replacements are sometimes called unicompartmental knee replacements.
The most common types I use is the Oxford Partial Knee System  and the Triathlon Total Knee replacement system

We’re planning a gallery of the different types of replacement for you to view.
When is Knee Replacement Surgery Done?
The most common reason for knee replacement surgery is to repair joint damage caused by osteoarthritis and rheumatoid arthritis.
You may be a candidate for knee replacement if:
  • Your pain is disabling. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. They also may experience moderate or severe knee pain at rest.
  • Your pain affects normal function/sports activities. Your activities and daily life may be ok but you can't comfortably do what you relaly what you really want or need to. This is a potential area of contention in terms of healthcare rationing
  • You have severe end stage arthritic changes on x-ray or scan.
  • Other treatments haven't helped. Other treatments include weight loss, physical therapy, activity modification a stick or other walking aids, medications, braces, injections (not only cortisone, but hylan) and keyhole surgery
  • You have a knee deformity. Knee replacement can be especially helpful for people who have a knee that bows in or out
  • You're 55 or older. Knee replacement is typically performed in older adults, but it may be considered for adults of all ages. Young, physically active people are more likely to wear out their new knees prematurely
  • Your general health is good. Conditions such as restricted blood flow, diabetes or infections can complicate surgery and recovery