KNEE

Treatments &
Procedures

Of all the areas treated by orthopedic surgeons, the knee is the most commonly injured joint. Five million Americans seek medical help every year for knee pain. Knees are complicated mechanisms that absorb shock. Their extreme flexibility allows for change in direction while moving at high speeds. Our knees are made of ligaments that provide support and muscles for strength. It is a well-lubricated, reliable mechanism unless unduly twisted, bruised or broken.

Total Knee Replacement

A total knee replacement, also known as a total knee arthroplasty, involves removing damaged portions of the knees, and capping the bony surfaces with man-made prosthetic implants. A total knee replacement repositions the knee into proper alignment and replicates the original function, allowing for a near-normal range of motion. Common reasons for undergoing a total knee replacement include severe pain, stiffness, chronic inflammation or degeneration that limits everyday activities; pain that interferes with sleep; and mild knee deformity such as bowing inward (varus) or outward (valgus). Although knee replacement s provide excellent results and patient satisfaction, they are typically reserved for patients who have exhausted other options in order to minimize the need for future revision procedures to repair or replace worn components.

What is a total knee replacement?
Also known as total knee arthroplasty, a total knee replacement is a surgical procedure performed by an orthopedic surgeon that relieves pain and restores function to the knee through the use of prosthetic implants.

What happens during a total knee replacement?
During a total knee replacement, damaged bone and cartilage is removed from the joint. Then, the surfaces that remain are smoothed down and capped with metal or plastic. This allows the knee to glide as normal, and it reduces the pain you feel as your bones grind together.

When should I get a total knee replacement?
It’s time to ask your doctor about a total knee replacement when your knee pain negatively impacts your life. For example, if your knee pain makes it difficult to gently exercise, walk, or even sleep, it may be time to explore your options for a total knee replacement.

Another time to consider total knee replacement surgery is if your knee has a visible deformity, such as bowing inward or outward. When there is a noticeable decrease in your knee’s range of motion, ask your doctor if a total knee replacement may be right for you.

Your age is an important factor in whether it’s the right time to get total knee replacement surgery. Just like a normal joint, prosthetic joint implants wear down over time. This means that it is often more beneficial to wait until you are older to get a knee replacement so you don’t have to undergo another replacement surgery in the future.

How long does it take to recover from total knee replacement surgery?
Every patient is different, but a general timeline for a complete recovery from total knee replacement surgery is within three months. Your recovery will involve physical therapy, medication, and moving around with a walker. Talk to your doctor to learn more.

Diagnostic Arthroscopy

Arthroscopy surgery allows diagnosis and treatment of joint problems through small incisions in the skin. A camera attached to a scope is used to see inside your joint.

What is diagnostic knee arthroscopy?
Diagnostic arthroscopy is a minimally invasive procedure in which your orthopedic surgeon can look inside your joint with a tiny camera.

What happens during a diagnostic knee arthroscopy procedure?
Small incisions are made in the skin around the joint. Then, your orthopedic surgeon inserts a scope with a tiny camera on the end. Saline solution is also inserted into the joint through a tube. This causes the joint to expand, which allows the surgical instruments more room to move around. This camera allows your surgeon to see inside your joint.

This procedure allows your surgeon to make a proper diagnosis as to what is going on inside your joint so he or she can prescribe the appropriate treatment.

Why might I need diagnostic knee arthroscopy?
Sometimes, a surgeon cannot get a clear picture of what is causing your joint pain or problems. Conditions such as scar tissue and severe arthritis can interfere with imaging techniques, and occasionally, more than one joint issue may be indicated on the surface. With diagnostic arthroscopy, your orthopedic surgeon can be certain of your particular issue and recommend the right course of action to relieve your knee pain and get you back to using your knee as normal.

Torn Meniscus Repair & Trimming

What is a meniscus tear?
Menisci are pieces of cartilage that cushion the knee joint. Meniscus tears most commonly occur during sports or from other activities that cause the sudden wrenching or twisting of the knee.

How is a torn meniscus repaired?
Treatment for a torn meniscus depends on several factors, including the location and severity of the tear, your age, and your activity level.

In general, a small tear on the outside of the meniscus can heal successfully on its own or with non-surgical treatments because there is a large supply of blood to the area.

The inner part of the meniscus, on the other hand, is more difficult to heal because there is less blood supply in the area. These tears usually require surgery, but the surgery needed is typically arthroscopic, or minimally invasive. In rare instances, severe tears to the inner area of the meniscus may require open surgery.

There are a few types of surgery options for meniscus tears:

  • Repair involves using dissolving sutures to repair the tear in the meniscus.
  • Trimming involves trimming away the affected area if the tear is along the edge of the meniscus.
  • Partial meniscectomy involves removing the damaged part of the meniscus and smoothing the area.
  • Total meniscectomy involves the complete removal of the irreparably damaged meniscus.

Your orthopedic surgeon will discuss your options with you based on the status of your meniscus.

How long does it take to recover from a torn meniscus?
Recovering from a meniscus tear depends on several factors, including the specifics of your tear and which procedure you received. Typically, full recovery from meniscus surgery takes four to six weeks.

Partial Knee Replacement

A partial knee replacement removes damaged cartilage from the knee and replaces it with prosthetic implants. Unlike a total knee replacement, which removed all of the cartilage, a partial knee replacement typically removes and replaces cartilage from one particular region. The procedure is also known as a unicompartmental knee replacement, a uni, or partial knee resurfacing. A variation called a bicompartmental replacement can also be done to repair two regions, but is less common.

What is a partial knee replacement?
A partial knee replacement is a surgical procedure that relieves pain and restores function to the knee through the use of prosthetic implants.

What happens during a partial knee replacement?
During a partial knee replacement, damaged bone and cartilage is removed from the damaged area of the joint. Then, prosthetics are used to take the place of the damaged cartilage. The specific prosthetics used in your knee will depend on your diagnosis and anatomy.

When should I get a partial knee replacement?
Partial knee replacements are often recommended when arthritis has damaged only one part of the knee joint. It is not recommended for patients who are obese, have misaligned knees, or who have widespread arthritis.

How long does it take to recover from partial knee replacement surgery?
Every patient is different, but a general timeline for a complete recovery from partial knee replacement is around four weeks. Your recovery will involve physical therapy, medication, and moving around with a cane. Your doctor will give you specific guidelines to follow.

Patella (Knee Cap) Procedures

The patella is a flat triangular shaped bone that protects the knee joint and helps muscles move your leg more efficiently. A healthy patella glides up and down a groove at the end of your femur, pain free.

Depending on your diagnosis, there are several different procedures available for pain in the patella, or knee cap.

Removal of Damaged Cartilage
Damaged cartilage can cause pain in your patella. After small incisions are made around your knee cap, the surgeon will insert a scope with a tiny camera and surgical instruments. The camera allows your surgeon to see inside your joint. Saline solution will also be injected into the joint to help give your surgeon more visibility. Then, using a specialized tool, your surgeon will remove the damaged cartilage that is causing your knee pain.

Drilling/Microfracture
Drilling small holes in the bone of the patella helps encourage the growth of healthy tissue. This process is also known as microfracture.

Patella Realignment
Sometimes, the ligaments to the side of the patella become too tight, which can cause misalignment of the knee cap. In a patella realignment procedure, your surgeon cuts the too-tight ligament, allowing your patella to move back into its correct place.

Removal of Painful Plica
A plica is a fold in the tissue that lines the joint of the knee. If your knee cap begins to pinch one of these plica, it can cause pain. Your orthopedic surgeon can remove the painful plica through arthroscopic surgery.

Revision Knee Replacement

With wear, the original components of a total knee replacement break down and loosen from the bone surface they were once firmly attached to. Revision knee replacement involves the exchange of some or all worn components of the primary total knee replacement. The breakdown of the original components and loosening from the bone surfaces causes pain in the joint. Your doctor will determine the degree of complexity for this procedure based on the amount of loosening and associated damage to the underlying bone surfaces that may have occurred over time.

What is a revision knee replacement surgery?
Over time, the prosthetics of total knee replacements wear down or become loose. Revision knee replacement is recommended when the components of an older knee replacement begin to cause pain in the knee.

What happens during a revision knee replacement surgery?
In a revision knee replacement, the damaged parts of the previous knee replacement are carefully removed. Then, revision implants are inserted.

Torn ACL

The anterior cruciate ligament, or ACL, is a ligament in your knee joint that connects your femur (thigh bone) to your tibia (shin bone). When it becomes injured or torn, the severity of the tear determines whether you will need ACL repair or ACL reconstruction.

What is ACL repair surgery?
ACL repair is for tears in the ACL that have disconnected from the bone, but are still intact. In an ACL repair surgery, your orthopedic surgeon will reattach the ligament to the bone. If the ligament has a slight tear, your surgeon can also sew it back together arthroscopically.

What is ACL reconstruction surgery?
ACL reconstruction is for injuries that have torn the ACL in two. In an ACL reconstruction surgery, the torn ligament is removed completely and replaced with graft tissue. This graft tissue typically comes from your knee, your thigh, or from a donor. The graft is secured to the ends of your femur and tibia. As your body heals, the graft tissue will attach fully to the bone.

There are several different types of grafts that can be used to reconstruct a torn ACL.

Allograft
Allograft tissue is tissue from a donor. Using a wire as a guide, the graft tissue is inserted through tunnels drilled into the tibia and femur.

Bone-Patellar Tendon-Bone Graft
An ACL reconstruction using a bone-patellar tendon-bone graft involves the harvesting of both tendon and bone. Bone plugs at each end of the harvested tendon are used to affix the graft—which will become your new ACL—in place.

The procedure involves the following steps:

  • Tissue is harvested from the tendon that secures your patella (knee cap)
  • The torn ACL is removed; any remaining debris is cleaned out
  • A special drill is used to create a tunnel in your tibia (shin bone) and femur (thigh bone)
  • The graft is inserted into the tunnel
  • The harvested bone plugs are anchored into the tunnel with screws or other hardware

This procedure is often used in younger, more active patients.

Hamstring Graft
This procedure involves the following steps:

  • The torn ACL is removed
  • A portion of your hamstring muscle is removed to serve as a graft
  • Using a wire as a guide, the graft tissue is inserted through tunnels drilled into the tibia and femur

Quadriceps Tendon Graft
This procedure involves the following steps:

  • The torn ACL is removed
  • A portion of your quadriceps muscle is removed to serve as a graft
  • A plug of bone from your knee cap is attached to one end of the graft
  • A special drill is used to create a tunnel in your tibia (shin bone) and femur (thigh bone)
  • The graft is inserted into the tunnel
  • The harvested bone plug is anchored into the tunnel with a screw or other hardware

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ORTHOPEDIC SURGEONS

Experience in treating a broad
range of joint disorders.

Scott Bowen M.D.

ASH-Edwards

Paul K. Edwards M.D.

ASH-Hefley

William Hefley Jr., M.D.

ASH-Lorio

Jerry Lorio M.D.

ASH-Martin

Kenneth Martin M.D.

ASH-Moore

Samuel A. Moore D.O.

ASH-Riley

Clay Riley M.D.

ASH-Smith

Joel Smith M.D.

ASH-Stewart

Jason Stewart M.D.

Dr-Wilson-BioHeadShot2

Nicholas B. Wilson M.D.

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