By Mr. Mark Bloomfield
The knee is, if anything, mechanically a more complex joint than the hip. Whilst serious hip problems are relatively rare in the younger, more active patient, knee trouble of one form or other can present at any age. Sporting injuries of varying severity are very common! Many knee problems will settle spontaneously given time, anti-inflammatories and perhaps physiotherapy. It is useful to remember the mnemonic R.I.C.E.
Ice: Ice-packs (crushed ice/frozen peas in a bag covered by a towel)
Compression: by a supportive bandage wrapped around the knee.
Elevation: best is to lie flat so knee is above level of heart.
If these measures do not restore adequate knee function quickly, see your GP who will advise whether specialist referral is necessary.
Most knee problems that fail to settle after the above can be addressed by arthroscopy (‘keyhole sugery’) of the joint. Examples include meniscal (cartilage) tears, removal of loose bodies and correction of patellar (knee-cap) alignment or tracking. In older patients, the underlying problem may relate to early wear or arthritis. In this group arthroscopy may be disappointing but still worth trying as the alternative of Total Knee Replacement is more hazardous and involves a longer recovery period.
Knee arthroscopy can usually be performed as day case surgery. Functional recovery varies greatly but patients are seldom away from work for more than 10 – 14 days. Post operative physiotherapy may be required to obtain the best results. In cases where the degenerative changes are very advanced or a patient with wear changes has failed to respond to arthroscopy, Mr. Bloomfield may advise Knee Replacement. Metal on polyethylene knee replacements are giving better long term results than the same materials used for hip replacement. There seems little need therefore to experiment with unusual materials or designs.