Also known as ‘unicondylar knee arthroplasty’ or ‘unicondylar knee replacement’.

The knee joint internally has a large area covered with specialised hyaline cartilage that allows your knee to take your body weight and move smoothly to afford you mobility.

Arthritis is the term used to describe the wearing out of this cartilage surface lining, which results in pain, swelling, stiffness, and often a variable amount of joint deformity. The wear may affect the entire surface of the joint, or only an isolated section. Severe arthritic changes in the knee that affect only one part of the knee may be treated by replacing only the affected part, as long as the rest of the joint lining is well preserved and well functioning.

It is importnant to recognise that there are a number of other criteria that must exist to maximise the success of partial joint replacements, and Dr Ihsheish will be able to discuss your specific case with you accrding to clinical and radiological assessments.

The advantages of doing this 'partial' joint replacement relate to it actually being actually smaller operation, this means a shorter surgical time, a smaller scar, and a faster recovery for the patient. In general, other complications are less also, such as bleeding. The other advantages of this operation is that it preserves the rest of your native joint for longer, buying more time for the patient before they come to need a total knee replacement. From a technical side, for the surgeon this operation is less complicated, and its conversion to a total knee replacement when this is required is also less complicated. Conversion to a total knee replacemnt may be required down the line if the rest of the joint wears out or becomes affected by arthritis.

What is the anterior cruciate ligament (ACL)?

The ACL is one of the major internal ligaments in your knee. It is located in the centre of your knee joint and functions, with other structures, to provide you with a stable knee joint, rotationally, front to back, and side to side.

The ACL may be ruptured in knee trauma sustained in sports or other accidents. This often results in rapid pain and swelling, and a feeling that that knee joint is unstable, to the point that patients may lose the confidence to participate in running or pivoting activities/sports.

Can the ACL heal without surgery?

There is evidence in the literature that some cruciate ligament ruptures have healed spontaneously, but this generally took many months and it is difficult to predict which ones will heal or not. Furthermore the dysfunction and limitations  that occur while one is waiting for healing affect day to day activities, and for active individuals this often makes the faster rehabilitation that goes with reconstruction surgery preferable.

How is ACL rupture managed?

If you suspect you have an ACL injury it is important to be referred to the orthopaedic surgeon for further management.

Dr Ihsheish will examine you clinically to diagnose your injury and any associated problems. It is common to use imaging studies such as MRI scan of the knee prior to deciding on any treatment plan.

You initial management should include the following -

• pain relief and crutches to help you mobilise
• ice to minimise the amount of swelling
• physiotherapy to minimise early onset of stiffness in your injured joint.
• a temporary light knee splint or compression bandage is found to be helpful by some patients in pain relief and reducing swelling

Following the initial assessment and management Dr Ihsheish will discuss in detail with you the subsequent treatment options, including the details of reconstructive knee surgery, non surgical options, and the expected outcomes. The decision to operate is made by the surgeon and patient together.

Does everyone with a ruptured ACL require surgery?

The aim of ACL reconstruction surgery is to allow the patient to function with a stable knee joint in your day-to-day activities (at home, work, or sports) and prevent falls and injuries to other parts of your knee.

It is important to know that not all patients need surgery, and not all patients are able to have surgery safely. The details can be complex, and Dr Ihsheish can discuss your specific details with you.

In general, if you are skeletally mature (ie your bones have stopped growing), and physically active with a well preserved joint you may benefit from reconstruction of this ruptured ligament. Again, Dr Ihsheish will be able to discuss your specific case with you.

How is ACL reconstruction surgery done?

The surgery aims to reconstruct the damaged ligament in your knee, Dr Ihsheish often uses your own tissue to form an ACL graft. The graft is placed in the site of the torn ligament, and is designed to fill the stabilising role of the native ACL.

Dr Ihsheish will most commonly use some of your own tendons, namely tendons from your hamstrings, to reconstruct the ACL. In other circumstances your surgeon can use other types of graft such as your patella ligament, donor tissue, or synthetic graft material. Hamstring graft has an excellent track record and very little chance of causing you any reaction is it is your own tissue. Dr Ihsheish can discuss the merits of the different graft options, and the most suitable graft for your case.

The graft is fixed firmly inside your knee joint in a position that mimics the native ACL.

The surgery is ‘arthroscopic’, meaning it is done through small incisions in the skin. The knee is swollen and tense after the operation, and although crutches are used for a few days after the operation for support, Dr Ihsheish generally does not place a splint on your knee after the operation.

Patients may go home the same day of surgery or stay for one night in order to be assessed by the physiotherapist the next day.

There is a rehabilitation protocol available through our clinic which you will be encouraged to follow over the following weeks.

What follow-up will I have?

Dr Ihsheish, nurses, and physiotherapists will see you during your hospital stay.

As outlined in our protocol, a vital part of your post-operative follow-up is guided physiotherapy, which will begin in the first week after surgery and continue for 3-6 months.

Your surgeon will see you at two weeks after the surgery to review your wounds and early progress, and thereafter appropriate arrangements will be made accordingly. There will be restrictions on your physical activities which Dr Ihsheish will discuss with you specifically, and these are outlined on our protocol in general also.The restrictions are aimed at protecting the new graft while is re-establishing blood supply and gaining strength.

What should I look out for following the surgery?

It is normal to experience swelling and warmth in the area of the operation.

Some of the dressings may have some dry blood on them.

Your knee will be a little stiff in the first 1-2 weeks after the surgery, this should improve gradually, as should the swelling and pain in your knee and leg.

Look out for anything different to the above, or temperatures/fevers or feeling generally unwell and bring it our attention please.

It is not unusual for your knee to feel weak or unstable early after the surgery, this should improve with ongoing physiotherapy.

Please note that physiotherapy is the most important aspect of your recovery after the surgery, and make sure your have the protocol when you visit your physiotherapist.

What is knee replacement?

Knee replacement (also called knee arthroplasty) is a major surgical procedure where the worn out articulating surface of the knee joint is replaced by a prosthetic surface.

Who requires a knee replacement?

Knee joints may wear out and begin to cause pain and other symptoms, leading to dysfunction in day-to-day life. If the symptoms are not adequately controlled by simpler measures such as

• pain medications
• activity modification
• physiotherapy/splints etc

then replacing your native joint with a prosthetic one is indicated.

Joints may wear out from so called ‘wear-and-tear’ (also called primary arthritis), or from other causes such as trauma, infections, inflammation (so called secondary arthritis). Your surgeon will be able to discuss in relevant detail with you the specific disease affecting your joint.

What is a knee replacement prosthesis made of?

The prosthesis has several components, generally with metallic and polyethylene components. The metal is generally an alloy – a combination of different metals that produce a highly smooth surface that has good wear characteristics. The Polyethylene is likewise designed to have similar characteristics. Dr Ihsheish will measure the dimensions of your joint before and during the operation and implant prosthetic components that fit your bones, with the aim of reconstituting your normal knee dimensions, range of movement, and stability.

Dr Ihsheish uses only prosthetic devices that have excellent theoretical and clinically proven characteristics and outcomes, he is quite happy to discuss with you the relevant prosthetic device for your knee joint.

How to prepare for your surgery?

Firstly, it is important that you are clear in your mind about the reasons for your painful symptomatic knee joint, and the indications for such operation in your case specifically. You should talk to Dr Ihsheish about any concerns or questions you have before the surgery, it may also be helpful to read about the condition or operation, and talk to anyone you know who may have had the procedure.

Dr Ihsheish will discuss with you relevant detail at the time of booking your surgery.

You must have radiographs (x-rays) of the joint affected which your surgeon can organise, and you will be required to have blood and other tests before the day of your surgery.

Please look after your skin, make sure there are not scratches or breaks in your skin and look after your health in general. Try to keep your joint mobile and strong as that will help you have a smoother recovery.

The hospital will contact you before your surgery and provide you with information about fasting and medication, when and where to come, and what to bring with you.

How is the surgery done ?

The anaesthestist will discuss with you the details of your anaesthetic before the operation, various options are available.

Your surgical team will prepare your knee in the operating room. You will be given antibiotics to reduce the chance of infections. Your skin will be cleaned and sterile surgical drapes used to cover the skin.

The operation is performed through an incision over the knee joint. Dr Ihsheish will remove the damaged surface of the joint and replace it with a suitably sized and shaped prosthesis. He will aim to achieve a range of movement and stability to gain you maximum function from this new joint. At the end of the operation the skin is closed and a dressing applied.

What happens after the operation?

From the operating room you will be moved to the recovery room where you will slowly wake up under the supervision of specialised nursing staff. From there you will be moved to the ward where you may spend 3-5 days (average). During your stay on the ward you will be continually monitored and physiotherapy will begin. You will have various blood tests and xrays as part of this early recovery phase.

When you wake you may notice that you have a small urinary catheter or a wound drain. It is your surgeon’s preference not to use these tubes routinely, as he believes they have no proven advantage in the current literature, however in certain cases exceptions may be made. If these tubes are present they will generally be removed in the first 1-2 day after the operation.

You may also notice intravenous lines – tubes/needles that provide you with fluid in the early phase after your operation, these are also utilised to give you antibiotics and pain relieving medications as required.

When do I go home from hospital?

In general, you will be allowed to go home when you have fulfilled these three requirements

• you must be medically stable
• you must be comfortable, such that your pain is controlled with tablets (ie not requiring injections)

And,

• you must satisfy the physiotherapy and nursing staff that you are safely mobile in and out of bed.

After leaving the hospital you will have physiotherapy arranged on an outpatient basis. This is a vital part of your recovery aimed at achieving a mobile, strong, and stable joint.

Will I require a stay in the rehabilitation ward?

The hospital stay for most patients undergoing joint replacement through our clinic is 3-5 days. Please note that there is no pre-determined length of stay for any of these patients, and that every patient’s recovery is different. Dr Ihsheish firmly believes that physiotherapy is a major factor in producing a good outcome, when your pain has improved and you are medically stable the team may determine that a short stint in the rehabilitation ward may be of benefit – rehabilitation aims to give you more intensive physiotherapy and functional recovery than you would receive on the standard hospital ward.

What follow-up will I have with my surgeon?

Dr Ihsheish will see you while you are in the hospital, and you will need to make an appointment to see him at approximately 2 weeks after the surgery to have your wound reviewed. Your surgeon does not routinely use visible sutures and so there will be no sutures to remove. Follow-up down the line, including any relevant tests, will be arranged for you in due course through the clinic.

How long is the recovery following knee replacement?

In hospital stay is generally 3-5 days.

At two weeks most patients have discarded the crutches, but this is variable for each individual patient.

Physiotherapy will continue for 6 weeks.

Hydrotherapy may commence after 2-3 weeks if your surgeon is happy with the wound.

You are allowed to drive 3-4 weeks after the surgery if you are walking without a walking aid at that time.

You are allowed to kneel on the operated side after six weeks if you so choose.

It is not unusual to experience some discomfort related to the surgery for several weeks, this should be different to your arthritis pain, and will gradually subside.

The operation site may be warm and swollen (compared to the normal side) for several weeks at least, this is quite normal and represents the increased blood flow to the area to heal the area after the surgery.

What if I have any concerns or questions?

Please contact our clinic on 6109 0002 if you have any questions or concerns at any point. If you are unable to contact us please contact your family doctor or your local hospital.

What is knee arthroscopy?

Knee arthroscopy is a surgical procedure (sometimes referred to as “keyhole surgery”) where the surgeon can access the interior of the knee joint through small incisions (less than 1cm) in the skin, avoiding the need for large incisions and scars. A small camera (the arthroscope) and other specialised surgical (arthroscopic) instruments can be inserted through these incisions, and the surgeon can perform debridement (clean-out), repair, or reconstruction of internal joint structures, the arthroscopy can also be used to simply look inside a joint to diagnose a problem.

What procedures can be performed arthroscopically?

Your surgeon can do a large number of procedures in this way. These can be termed diagnostic or therapeutic.

Diagnostic procedures are those that are aimed at finding out the cause of a problem. For example if your knee is painful or swollen, the surgeon is able to access the joint and inspect its internal components, as well as take samples or fluid or tissues which can be sent to the lab to help diagnose the cause of your symptoms.

Therapeutic procedures are planned once the problem has already been diagnosed. Examples of these can be removal of loose pieces of bone or cartilage, debridement (“cleaning out”) of abnormal or diseased tissues or cartilage, repair or reconstruction of damaged structures – such as ligament or fracture repair or reconstruction.

Dr Ihsheish will discuss with you before the operation what the intended purpose is.

How do I prepare for a knee arthroscopy?

In general your surgeon will discuss before-hand with you the need for any specific preparation.

It is important to keep the skin clean and free of scratches or injuries if possible.

On the day of surgery you should fast (refrain from food or drink) for at least six hours before the surgery. If you are taking any regular medications please ask your surgeon if it is permitted to take these with a small sip of water.

What to bring with you on the day ?

It is important to make sure you have your imaging with you (xrays, scans such as MRI or CT scans).

You will need crutches to help you mobilise after knee surgery. If you do not have these please ask out practice where you may be able to get them, sometimes you may be able to get these at the hospital.

What will happen after the surgery?

Most of these procedures are termed “day procedures” – meaning that you will be able to leave the hospital on the same day, once you have overcome the effects of the anaesthetic. You will not be able to drive or operate machinery as the effects of the anaesthetic medications impair your ability to do this for 24 hours, therefor it is important to make arrangement for someone to take you home.

Your knee will be bandaged and depending on the procedure undertaken you may wake with a splint on your leg. The staff at the hospital will let you know if you can walk on this leg or not.

The knee will feel swollen and difficult to move. The swelling results from the fluid used to inflate your joint during the operation. This fluid will be absorbed by your body over the following days.

The bandage may be removed after 1-2 days. Under the bandage you will see small dressings stuck to the skin at the site of the incisions, these are generally water-proof and you can shower with them in place. Please leave these on your skin until your surgeon removes them to inspect the wounds at your follow-up appointment. Your follow-up is usually approximately 2 weeks after the surgery.

What should I look out for at home?

It is normal to experience pain and swelling after these procedures. Both will subside but this happens gradually over several days. If the pain or swelling increase in your leg, or you develop abnormal sensation or skin/temperature changes please bring it to the attention of your surgeon or other medical staff.

If you have any other concerns please also do not hesitate to get in touch with our practice and let us know.

Arthroscopy is a surgical procedure that allows the operating surgeon to visually inspect the joint internally by the use of a small camera.

The surgeon makes small incisions in the skin near the joint (usually less that 1 cm) and inserts a small camera (the arthroscope) to view the joint. In the past the surgeon used to view the joint directly through a small eyepiece, but these days the arthroscope is a fibreoptic instrument that transmits the picture to a large screen in the operating theatre which can be viewed clearly and safely. Pictures or videos can be taken through this instrument and saved for later viewing or record keeping, and to allow the patient to also view the interior of their joint.

Dr Ihsheish can insert similarly small instruments through other incisions and perform many procedures without the need for large incisions.

Examples of what the surgeon can do include taking samples of fluid or tissues for examination, and removal of abnormal tissues and repair or reconstruction of ligaments or cartilage inside the joint.

The advantage of arthroscopy is that it can be performed through very small incisions in the skin, thus avoiding the need for a formal large incision. This should mean less pain and general discomfort, and cosmetically it means less scarring. Many arthroscopic procedures thus allow a more comfortable and faster recovery phase following surgical procedures.
Many joints can be approached arthroscopically these days, commonly these procedures can be done in such joints as the knee, ankle, shoulder, elbow etc.