We offer a complete range of specialist knee surgeries at London Bridge Orthopaedics. Our surgeons and physiotherapists are experts in providing high quality care, both before, during and after surgery.
If necessary, your knee surgery can be arranged with a minimum of delay. Most arthroscopic (keyhole surgery) and minimally invasive surgery can often be carried out on a day-case basis. Our services include but are not limited to the following surgical procedures:
Knee arthroscopy (Keyhole surgery)
Knee arthroscopy is used to diagnose and treat certain types of knee conditions. Arthroscopic surgery (keyhole surgery) involves inserting a small camera inside a joint. Through other small incisions, surgeons then insert instruments to examine, repair or remove damaged structures.
Knee arthroscopy is the most common arthroscopic procedure performed in orthopaedics. This can be carried out under general, regional, or local anaesthesia. Compared with traditional open surgery, knee arthroscopy tends to minimise scarring, blood loss and pain, and reduce recovery time.
Determining if your knee can be treated with arthroscopy will depend on the underlying condition and your specific symptoms.
Ligament reconstruction and repair
Anterior cruciate ligament injury (ACL) is a common sports injury to one of the major ligaments (fibrous tissues) of the knee joint. If an ACL is completely torn, it will not heal back together (repair), even if the torn ends are sewn together. However, it can be surgically reconstructed.
ACL reconstruction surgery may be considered if you need to return to sports that involve changing direction and jumping. Once swelling subsides, the torn ACL may be reconstructed surgically using either a piece of your own tissue (autograft) or a piece of donor tissue (allograft).
When an autograft is carried, the surgeon usually replaces your torn ACL with a section of tendon taken from the large leg muscles at the back of your thigh (hamstrings) or using a portion of your own patellar tendon (tendon below the kneecap). Currently, almost all knee reconstructions are done utilising arthroscopic surgery, which uses smaller incisions and causes less scarring than traditional open surgery.
Surgical treatment for meniscal tears includes meniscus removal, meniscal repair or meniscal replacement. For most patients meniscal repair is successful and there are very low rates of complications.
Arthroscopic surgery (keyhole surgery) is generally recommended for meniscal tears. This surgery involves removing the torn tissue and saving the healthy tissue. The surgeon repairs the meniscus using dissolvable sutures (stitches) or anchors to attach the torn edges of tissue together.
Surgical repair may result in less pain than meniscal replacement or removal, and will usually provide a return to normal knee function. Successful surgical repair of a meniscal tear may also prevent long-term complications, such as osteoarthritis.
Autologous chondrocyte Implantation (ACI)
Autologous chondrocyte implantation (ACI or cartilage implants) is a surgical procedure used to treat small damaged areas of cartilage that lie on the surface of the bones between each joint. This is a two-stage procedure. In the first stage, the surgeon uses arthroscopic surgery (keyhole surgery) to collect cartilage cells from the patient. These cells are sent to a cell expansion laboratory where they are multiplied by growing in a culture.
Growing enough cells takes about 4–6 weeks, after which a second surgery is then scheduled. During this surgery (not an arthroscopy), a larger incision is used to directly view the area of cartilage damage and implant the new cells into this area.
Autologous chondrocyte implantation is a significant procedure. You will need to follow an intensive, prescribed physiotherapy routine after the surgery, which is essential for effective recovery. ACI is only appropriate for patients with small areas of cartilage damage, not widespread wear of the cartilage as seen in knee arthritis. This type of surgery is most commonly performed in the knee but it has been rarely used in other joints, such as the ankle.
Osteotomy (surgical removal of a bone)
An osteotomy is a surgical procedure to remove or realign a segment of bone. Most often, an osteotomy is performed to realign a deformed bone. In patients with degenerative arthritis (osteoarthritis) of the knee joint, deformities of the knee are common. The ideal patient for a knee osteotomy is a young, active person, who has arthritis limited to one side of the knee joint.
A knee osteotomy can be used to surgically alter the patient’s weight-bearing forces from the worn-out side of the knee joint to the healthier side of the joint. Once the bone is surgically realigned, a metal plate and screws may be used to hold the bones in the new position. Rehabilitation from this surgery may take some months.
Some patients may find lasting relief with an osteotomy, but the majority of patients undergo knee osteotomy surgery as a means to delay eventual knee replacement surgery. Osteotomy can often delay the time until joint replacement is required by 15 years, or longer.
Knee Replacement and Knee Resurfacing
Knee replacement surgery is the most common joint replacement procedure. At London Bridge Orthopaedics we offer three types of specialist knee replacement surgery.
Total knee replacement
Total knee replacement surgery is typically used to treat severe osteoarthritis. In this procedure, the surgeon removes the damaged joint surface and cartilage and replaces it with an implant made of metal and high-grade plastics or polymers. Your specific implant will depend on factors including your age, activity level, surgeon’s preference, and the anatomical shape of your knee.
The results of modern knee replacements are generally very good, with many lasting over 20 years, and allowing an active lifestyle. In younger, more active patients, they will tend to wear out quicker.
Partial knee replacement (knee resurfacing)
Partial knee replacement (unicompartmental knee replacement) is performed using minimally invasive surgery. Also called “knee resurfacing”, this procedure uses a smaller surgical incision and produces a faster recovery time than traditional total joint replacement surgery. Instead of removing the entire joint, partial knee replacement only removes the most damaged areas of cartilage, and just replaces these surfaces.
Partial knee surgery may be possible if the arthritis in the knee is confined to a limited area. However, where the arthritis is more widespread, a total knee replacement will be needed. Long-term results of partial knee surgery are excellent with the vast majority of patients regaining a very high level of mobility.
Revision knee replacement surgery
Revision knee replacement surgery (revision arthroplasty) is carried out when an initial knee replacement is worn out or no longer functions. Such second time knee replacement cases are more complicated than first knee replacements, with slightly less predictable results.
As such, revision knee replacements require significant surgical expertise and careful post-operative rehabilitation. However, a recent report found that only about 2% of knee replacement surgeries required a second surgery, within five years of the initial knee replacement. Our knee surgical team have a large experience in revision knee replacement procedures, as a consequence of their working in large second opinion centres, which receive complex cases on a daily basis.
A structured physiotherapy programme is essential to improve your stability, mobility and rehabilitation following knee surgery. Physiotherapy training can also be an important part of a non-surgical treatment programme following knee injuries.
At London Bridge Orthopaedics, we offer you the convenience of on-site inpatient and outpatient physiotherapy services, as part of our high quality care.
Our Chartered Physiotherapists are experts in the non-surgical treatment of musculo-skeletal injuries. They use a variety of techniques to help you strengthen your knee, improve tissue healing and reduce pain.
Depending on your injury, these may include:
- Biomechanical assessment and correction
- Joint mobilisation and manipulation
- Soft tissue massage and stretching
- Prescribed exercises
To maintain knee stability, you’ll also need to follow your prescribed exercise programme. If you have your own physiotherapist, we can refer and liaise with him/her and to send them details of your diagnosis, clinical assessment, operation details and post-operative care.