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Knee surgery

Knee surgery can help give you back movement that’s free of pain and stiffness

Doctor-giving-patient-a-knee-exam
It will come as no surprise that the number one reason people are referred to a consultant surgeon (after first seeing their GP or going to an accident and emergency department at their local hospital) is due to either some unexplained pain, or to pain they're feeling that obviously requires a specialist surgeon's skills.

In the case of being referred to a consultant knee surgeon, that pain may be due to a tear or problem with cartilage in the knee, osteoarthritis of the knee joint, or a dislocation of some sort in the joint.

All of these conditions result in pain, a loss of movement or flexibility followed by a poor quality of life for patients suffering from any of these problems.

You may have been referred to Three Shires Hospital by your GP or local hospital A&E department, but you may also have been referred here directly by an insurance company if you have private medical insurance and asked them for help about the pain you may be having in your knee.

It may also be the case that you would like a second opinion or that you want to see a specialist as quickly as possible, and you have the means to fund your own treatment. Whatever your reasons for accessing treatment our aim is to make sure that you get back on the road to recovery quickly.

Your initial appointment will take place with a specialist who will go through a history of the problem, a thorough examination and may order relevant investigations such as X-rays or scans. Our specialists will let you know the different options you may have to help you with recovery, which may include conservative treatment options such as pain relief, physiotherapy and injections, or more complex surgical treatment.

Whatever you decide, Three Shires Hospital is here for you, so if you're concerned about your health or would like more information, please call us on 01604 620311 and we will be happy to advise. We are situated in the beautiful grounds of St Andrews Hospital close to Northampton General Hospital and within easy travelling distance from Northampton town centre. 

The first thing we'll talk about on your initial appointment is your history. That is, the history of your condition, how you've been coping with it so far, what exacerbates the condition and what relieves it (for example, what pain relief if any you've been using and how effective that's been - that might be medications such as paracetamol, gels, injections, or physiotherapy).

We'll also talk about any allergies you may have, your social activities including any exercise regime you have, and if your quality of life is suffering because of your condition (such as sleeping well at night, taking walks, running, or playing sport).

Depending on the diagnosis at that point, recommended treatments may be as simple as lifestyle changes such as changing your activities or it may be dietary or weight loss interventions.

Following on from that, the next steps may be physiotherapy specifically directed toward the source of the problem following your specialist surgeon’s advice, injections or in some cases partial or full knee joint replacement may be an option to get back a better quality of life.

Your consultation may be over the telephone or face to face depending on your condition and the normal consultation time is around 30 minutes. 

Sport can sometimes be the cause of issues with knees. For example, footballers can twist a leg awkwardly and cause a tear in any of the ligaments or damage the cartilage in some way. We do see younger people with injuries of this sort.

Then there are congenital conditions which show up as a person grows older. Knee dislocations can happen this way, but they can also occur when twisting the leg and through wear and tear. 

The knee contains various ligaments, all of which do slightly different things, but all of which have one thing in common, they are there to keep the knee stable and in one piece.

A ligament attaches one bone to another, and it's the patella ligament that attaches the bottom of the kneecap (the patella) to the top of the tibia (your shin bone or lower leg). At the top of the patella is the quadriceps tendon that attaches the patella to the quadriceps muscle.

If anything happens to the tendon or ligament such as a tear, then there's a chance the patella will slip out of its groove, making the knee difficult to bend. This is a knee dislocation. It can be painful or not depending on many factors, but swelling usually results and surgery is usually needed.

If there is a congenital condition affecting any of these elements, then it's also possible for the knee to dislocate more easily.

Another reason for dislocation to occur is where an earlier trauma has weakened ligaments or tendons in the knee or caused other conditions to happen, which then affects the stability and allows the kneecap to pop out of place. 

Problems with the anterior cruciate ligament can also result from playing sport. The anterior cruciate ligament connects the thigh bone (femur) with the shinbone (tibia) behind the kneecap.

It most often occurs if a person makes a sudden stop, turn, or other exertion on the knee, which puts extra pressure on the ligament and can cause it to tear. The leg will then feel weak and it may swell around the damage, making the patient feel unstable.

If this ligament is badly torn, surgery is usually the only solution. 

As we age, the joints in our body can suffer from wear and tear. It's this wear and tear that affects the cartilage in our joints, and when that breaks down (which we call osteoarthritis), the bones can start to rub together causing us to lose flexibility of the affected joints as well as suffer pain (which can be extreme for some people).

Over time this can escalate to the point where we can no longer walk with ease. Hips and knees are equally affected. 

Our bodies generate the hormone cortisol to help reduce inflammation, which is the purpose of corticosteroids, however corticosteroids work in a slightly different way from our natural cortisol in that they work at the molecular level on the inside of cells, hence it can take up to five days for the steroid to start doing its work properly.

They are in effect an injectable pain killer. When we take an analgesic (pain killer) orally, it's in the hope it will eventually hit the source of the pain, but in the case of a corticosteroid injection, we can place it directly where we want it, hence its effectiveness.

Luckily the knee is very exposed and so we can carry out an injection of this sort very quickly and easily without the need of an X-ray or scan. This is done in a sterile setting but is an outpatient operation that does not involve a general anaesthetic, which means you will be in and out within an hour.

A local anaesthetic is also injected into the knee, and once the corticosteroid has been given, you will be able to walk around immediately and return home when you feel ready. Most people feel instant relief. You would need to have someone to drive you home though. 

If lifestyle changes and corticosteroid injections are not effective or it's quite obvious that there is serious damage to the knee that won't be helped by any of the above, then a partial or full knee replacement (an arthroplasty) may be the only option.

Operations on the knee are quite involved since the knee is the largest joint in the body and a long scar is required in the front of the knee with the result that on average 85% of patients are very happy with the outcome (whereas it's around 95% for hip replacements).

From diagnosis to operation takes around 6 weeks with private care, with recovery after the operation also taking around 6 weeks. 

With 49 private rooms all with en-suite facilities and 24 hour medical care, you will be well looked after should there be a need to stay overnight or longer. We also have a physiotherapy department which may be advised depending on your treatment as well as follow up care with your consultant to ensure everything is healing as expected.

If you have any questions about your appointment or what you can expect at Three Shires Hospital, please don't hesitate to call us on 01604 620311

Specialists offering Knee surgery

Mr Divyang Shukla

Consultant Orthopaedic Surgeon

MBBS, MS (Orth), DNB (Orth), MCh (Orth), FRCS, FRCS (Trauma and Orth), Fellow of European Board of Trauma and Orthopaedics

BMI Three Shires Hospital

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Mr Jason Auld

Consultant Orthopaedic & Trauma Surgeon

MBBS, BSc, FRCS (Tr&Orth)

BMI Three Shires Hospital

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Mr Gary Mundy

Consultant Orthopaedic Surgeon

MBChB, FRCS (Tr+Orth) FRCS, FRCSEd, FRCSGlasg, Diploma Sports Medicine

BMI Three Shires Hospital

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Mr David Stock

Consultant Orthopaedic Surgeon

BSC, MBBS, FRCS, ATLS, FRCS, Dip SEM

BMI Three Shires Hospital

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Mr Jon Campion

Consultant Orthopaedic Surgeon

MBBS BMedSci FRCS (Trauma & Orthopaedics)

BMI Three Shires Hospital

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Mr Pierre Nasr

Consultant Orthopaedic Surgeon

MBBS BSc Dip IMC RCS(Ed) FRCS (Tr&Orth)

BMI Three Shires Hospital

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