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Articular cartilage damage in the knee is commonly seen in the elderly as part of the degenerative process of arthritis, and can relatively easily be managed with joint replacement surgery when symptoms are sufficiently severe. Articular cartilage damage in the younger population is a far more challenging dilemma with no currently accepted and effective treatment. This can lead to pain, loss of function and an inability to participate in everyday activities. This damage can also lead to further breakdown of the joint resulting in early osteoarthritis. Joint replacement in active, younger patients often gives inferior outcomes and will result in premature implant failure due to the higher demands being placed upon the implant.

Read more: Cartilage transplantation

A knee arthroscopy is a procedure that involves making two or three small incisions, or portals, usually in front of the knee. A small arthroscope (three to five millimetres in diameter) is inserted into the knee allowing the surgeon to see and operate inside the joint. Knee arthroscopy is usually carried out under a general anaesthesia, either as a day case or in some instances as an overnight stay in hospital.

Read more: Knee Arthroscopy

Indications for UKR Surgery

  • Unicompartmental pain / Osteoarthritis (OA)

Indications for PFJ Surgery

  • Patellofemoral joint pain / OA

Indications for TKR Surgery

  • Pain on mobilising
  • Restricted range of movement
  • Tibial and/or femoral OA
  • Functional Restrictions
  • Progression from a UKR

Possible complications of Surgery:

  • Infection
  • Bleeding
  • Nerve damage
  • Deep Vein Thrombosis
  • Pulmonary embolism
  • Persistent/ Recurrent Pain
  • Failure of prosthesis
  • Patello-femoral instability and other complications
  • Peri-prosthetic fractures, especially of the femur (supracondylar)
  • Neurological complications: peroneal nerve palsy / altered sensation post-op
Read more: Rehabilitation Guidelines for patients undergoing Total Knee Replacement (TKR), Patellofemoral...

Reasons for revision

  • Aseptic loosening Wear and tear of the joint surface, partial loosening of a joint replacement, resorption (gradual breakdown) of the bone around the replacement causing the bone to become thin or cracking of the cement that holds the implants in place. Revision surgery for this type of loosening usually requires one operation. The loose implant is removed and a new one is put in./li>
  • Septic loosening The hip is loose due to infection. It is difficult to treat infections in the hip as the blood supply is reduced and the implants can make it difficult for antibiotics to get to the specific area. Therefore, the implant is removed with an antibiotic spacer inserted temporarily. The patient is treated with a minimum of six weeks antibiotics and when the infection is clear, another operation is needed to put a new implant back in the hip.
Read more: Revision Hip Replacement Surgery
stem cell harvest and transplant for cartilage defects in the knee

Articular cartilage is a thin layer of highly specialised tissue that provides a smooth, lubricated surface for joint movement and transmits forces to the underlying bone. Articular cartilage, however, has a limited capacity for healing and repair, which means that once the joint surface is damaged, the subsequent repair is limited. The resultant repair is often with a different type of cartilage – fibrocartilage, which lacks the same biochemical structure as normal articular cartilage and has been shown to break down more rapidly. The injured joint is therefore unlikely to return to its original structure and function, predisposing the patient to premature osteoarthritis.

Read more: Stem cell harvest and transplant for knee cartilage defects
Total Hip Replacement (THR)

There are many conditions which require a hip replacement. The most common is osteoarthritis. Osteoarthritis simply means that the cartilage of the hip joint has worn out, resulting in the head of the thigh bone/femur (ball) and the acetabulum of the pelvic bone (socket) rubbing together. This is very painful and stops you being able to move your hip as you once did.

Read more: Total Hip Replacement (THR)
Total Knee Replacement (TKR)

There are many conditions which require a knee replacement. The most common is osteoarthritis. This means that the cartilage of the knee has worn out, resulting in the top of the shinbone (tibia) and the bottom of the thigh bone (femur) rubbing together. This is very painful and stops you from being able to move your knee as you once did.

Read more: Total Knee Replacement (TKR)