KNEE SURGERY

Conditions treated and types of surgical interventions

There are various conditions involving the knee joint that necessitate surgery. The most common concerns older patients suffering from osteoarthritis, a degenerative chronic disease involving the capsule, ligaments and cartilage and which leads to a gradual wear and tear of the joint.
But knee related conditions, such as meniscal lesions or tears of the anterior and/or posterior cruciate ligament can also commonly be diagnosed in young patients, caused by trauma or by repeated efforts relating to sports. Knee pain can also be caused by overload pathologies or post-traumatic disorders like bursitis or tendinitis.
The Casa di Cura San Giovanni clinic employs highly qualified orthopaedic doctors specialised in treating these conditions using advanced orthopaedic techniques. These include:

Knee bursitis treatment

Prepatellar bursitis is inflammation of the synovial bursa of the knee that causes an increased production of synovial fluid with a consequential increase in the volume of the same, leading to the formation of a bubble measuring a few centimetres in diameter. In more severe cases, especially if dealing with a recurring condition or one that was difficult to resolve, the surgical excision of the inflamed bag may be recommended.

Unicompartmental knee prosthesis - Minimally invasive knee prosthesis

A unicompartmental knee prosthesis is a therapeutic option for a small proportion of patients diagnosed with knee osteoarthritis. A minimally invasive partial knee prosthesis is taken into consideration if the patient’s osteoarthritis is limited to only one part of the knee. The knee is divided into three main compartments: the medial compartment (the inside of the knee), the lateral compartment (the outer part of the knee), and the patellofemoral compartment (the front of the knee between the patella and the femur). In unicompartmental knee prosthesis surgery, only the damaged compartment is replaced with metal and plastic parts. Remaining healthy cartilage and bone of the knee remain untouched. Typically, osteoarthritis, which is a chronic degenerative disease (in other words a disease whose natural evolution dictates that the condition worsens and spreads over time) starts off in the knee affecting a single compartment, and then slowly involves the others.

Knee arthroscopy

Arthroscopy is a minimally invasive surgical technique:
a small surgical instrument called an arthroscope (a fiber optic cable fitted to a camera) is introduced through a small skin incision measuring approximately 1 cm (portal) within the joint distended using a sterile aqueous solution. This makes it possible to “look inside” the joint, obtaining a 360 degree view of the internal workings; images are viewed by the surgeon and the patient, if awake, on a TV monitor.
Through other small incisions (portals) special surgical instruments can be introduced that facilitate the repair of lesions identified. Arthroscopy is useful for diagnosing and treating various knee pathologies including:

Meniscus lesions:

the menisci can be damaged at any age in different ways and for various reasons. Young people who practice sports may undergo sudden torsions of the knee, often followed by lesions of the internal (less mobile) and or external meniscus.
With age, the meniscus begins to degenerate becoming less elastic and the lesion can present itself even after a simple movement (such as kneeling).
Depending on the type, on the extent of the lesion and on the age of the patient, the recommended meniscus surgery using arthroscopy may consist of a MENISCECTOMY (removal of the damaged part of the meniscus while leaving the healthy part) or of a MENISCAL REPAIR of the lesion using special suture techniques.

Ligament lesions – Ligament ruptures:

Anterior cruciate ligament (ACL) lesions occur as a result of sudden injuries of the knee in rotation or following a sudden stress to the knee, beyond its normal range of motion. Generally ACL ruptures are associated with pain, swelling and instability.
ARTHROSCOPIC ACL RECONSTRUCTION surgery is recommended when the knee “gives out”. This can occur not only in sports, but also in as part of normal everyday movements (climbing stairs, walking, getting out of a car).
The damaged ligament is reconstructed using tendons taken from same knee. It is possible to use a part of the patellar tendon, a part of the quadriceps tendon, or grafts from the gracilis and semitendinosus tendons, all with similar results. It is also possible to replace the anterior cruciate ligament with a ligament taken from a cadaveric donor.

Cartilage lesions:

The cartilage surface that covers the articular part of the femur, tibia and patella can be injured as a result of trauma or tissue degeneration (osteoarthritis); arthroscopy makes it possible to accurately assess the severity of cartilage damage.
Using arthroscopy, it is possible to “smooth out” cartilage lesions (DEBRIDMENT) or perform techniques to “stimulate the repair of the lesion” (CONDROABRASION, PERFORATIONS, MICROFRATTURES).

Patella surgery for treating patella instability or malalignment:

The patella is kept centred on the femur by the equilibrium of two opposing ligaments (the alar ligament and the internal ligament).
In many cases anterior knee pain and collapse of the knee are due to a problem of the patella; the latter may not be in line with the femur (the external alar ligament is stretched and shortened).
In well selected cases in which physiotherapy was not effective, the surgical intervention for the RELEASE OF THE EXTERNAL ALAR LIGAMENT using arthroscopy makes it possible to loosen the ligament that pulls the patella off track, misaligning it in the knee.

Varus and valgus knee

When an outward angle is formed by the femur and the tibia, the condition is known as valgus knee (X-legs); conversely, in the presence of an inward angle, the condition is referred to as varus knee (O-legs). These bone deformities require surgical treatment only in the presence of pain (an osteotomy procedure is performed which corrects the angle, rebalancing the load on the knees).

Total knee prosthesis

Total knee prosthesis surgery is performed on patients with severely damaged knees due to osteoarthritis or from a previous trauma, or in the event that the patient is no longer able to perform simple activities such as walking or climbing stairs. Most patients who undergo total knee prosthesis are between 50 to 80 years of age, although orthopaedic surgeons evaluate patients individually. Total knee prosthesis surgeries have been performed successfully on patients of all ages, from young teenagers suffering from juvenile osteoarthritis, to elderly patients with degenerative juvenile osteoarthritis. The materials used for knee replacement implants consist of a femoral component in metal alloy (chrome and cobalt, containing nickel) attached to the end of the femur and a tibial component in titanium on the upper part of the tibia. The white surface between the two components consists of a technologically sophisticated polyethylene plastic element that takes the place of the previous cartilage and meniscus. This is the portion that is typically subject to wear and tear. This problem is now largely solved with new polyethylene treatments that make it much more resistant to wear than before. This has made it possible to extend the recommended application of this treatment to younger patients than in the past. Due to the presence of nickel in the prosthesis, patients who are severely allergic to this material must report the problem before surgery. In such cases caution is typically taken to use prosthesis that do not contain nickel (even if allergic reactions to nickel is very rare).

Knee arthroplasty revision surgery

Arthroplasty revision is a surgical procedure that aims to replace one or more knee arthroplasties. The reasons that may lead to this type of intervention can range from wear of the implants to more specific causes. (Whatever the cause, the goal is to provide the patient with a fully functional prosthesis).

Computer assisted knee prosthesis

Thanks to computer assisted surgical procedures, knee reconstruction and knee prosthesis interventions are possible, which allow for the reconstruction of the knee with maximum precision.
Our surgeons use standard or computer assisted implant techniques, relying on a special navigator used in orthopaedics treatments that transmits real time information to the surgeon on how to operate, in order to achieve a high precision geometric reconstruction.
This allows the placement of the prosthesis to be absolutely precise.
In conclusion, knee surgery is an extremely complicated procedure regardless of the type of lesion. However, the right techniques together with the most modern technologies are able to help address the problem as accurately as possible.

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