From the start I was able to walk normally
Former patient K.K
FAQ's
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FAQ's
ACL (Anterior Cruciate Reconstruction)
If the ACL (anterior cruciate ligament) is torn, this may occur after sport or after knee trauma. The patient experiences giving way and normal activities are not possible due to instability of the joint. Patients who are involved in pivoting or twisting sports such as basketball, tennis, soccer, rugby or other racquet sports and ski-ing, will be unable to partake without the knee giving way. Patients who have active manual activities such as outdoor jobs in building or construction or are involved in the services or police and fire services will not be able to resume their employment without stability of the joint. Under these considerations surgery is necessary to restore stability and function as well as safety to the knee.
The immediate problem with anterior cruciate ligament rupture is the giving way or instability of the joint. However long term studies indicate that patients with an absent ACL or ACL damage will suffer abnormal movements of the knee during every day life. It is known that these patients because of the abnormal movements, will suffer significant damages to the two cartilages or washer like structures within the knee. Damage to the washer like structures will increase the rate of wear in the joint and therefore athletes who suffer an anterior cruciate ligament injury are well known to develop osteo-arthritis or wear and tear arthritis in the knee much earlier than the normal population. Anterior cruciate ligament reconstruction is often perceived as a method of stabilising the joint not just for the short term function of the knee but in order to try and prevent long term damage in early osteo-arthritic change in the joint.
It is very rare to remove the screws after anterior cruciate ligament reconstruction or indeed any of the fixation devices which are made of titanium as they are designed to last in the bone for a life time. Occasionally if screws or fixation devices are troublesome they may be removed at a short surgical procedure as a day case surgery.
The anterior cruciate ligament reconstruction should last the rest of your life. There is an early period of twelve weeks in which the graft recovers its blood supply and becomes stronger, thereafter increasing its strength from twelve weeks until eight months post surgery when it will be strong enough to undertake contact sports with the appropriate training. The graft will not be rejected as it is your own tissue, but care and attention should be taken to the appropriate rehabilitation protocols for ACL reconstruction (see ACL reconstruction on the website).
With all surgical incisions there is numbness and some discomfort around the surgical incision site in the first few months. Small fibres of nerves which are cut within the skin incision will make the area around the scar numb for a few months until those structures grow back and sensation is restored to the joint.
There are several different methods by which different donor material may be used to reconstitute the anterior cruciate ligament. Three common methods are – 1. Use of the hamstring tendons 2. Use of the patellar tendon 3. Use of human donated tissue (allograft) Depending on the patient’s wishes regarding activity post surgery, the patient’s build and sex and nature of the injury each graft is assessed on its suitability as an individual choice for that patient. There are pros and cons to each type of anterior cruciate ligament reconstruction and Professor Barrett will be able to advise you and perform each of these surgeries depending on your choice and the indications for operation.
It is advisable not to go beyond the physiotherapist’s advice and do extra activities in the rehabilitation. If the knee joint is over stressed it becomes painful and swollen. This should be an indication to reduce all activities immediately other than that of simple day-to-day movements. Anti-inflammatories may be taken and the joint should be rested and iced to restore the swelling to normal. Once the joint is reduced to a normal size and pain and discomfort has stopped, normal activities at a much lower level may be resumed.
Total Knee Replacement
Normally with normal rates of activity a knee replacement may be expected to last between twelve and fifteen years. However activity levels between patients along with weight, activity status, age and type of activity vary considerably and these will all influence the longevity of the implant. Commonly the knee joint may fail through loosening between the bone and the metal insert or more commonly, wear of the plastic bearing that separates the two metal parts of the knee (see illustrations in total knee resurfacing part of the website). Several of the knee resurfacings employed by Professor Barrett have the advanced facility to have the plastic bearing exchanged to increase the longevity of the implant.
Professor Barrett uses implants that are modelled to accept the highest form of activities for patients undergoing knee surgery. The knee resurfacings used by Professor Barrett will enable kneeling, dancing, swimming, doubles tennis, ski-ing and other racquet sports. Many patients find kneeling a little uncomfortable related to the scar over the front of the knee but no significant damage will be done by the kneeling process.
Patients may resume sexual activities when they feel the discomfort of the knee settling down and feel able to indulge in such an activity. Clearly care should be taken over the wound related to the knee and patients may choose to modify their positions to reduce the load on the joint in the healing phase. In the long term however no special precautions for the knee need to be taken.
Knee joints will eventually wear out as any mechanical structure. Knee joint replacement is performed on those patients suffering wear and is commonly performed as an expert procedure by Professor Barrett. The bearing between the two metal inserts may be replaced or indeed the whole joint may be re-operated upon. It is accepted that sometimes the results from second time surgery are not as effective as first time surgery and that following multiple replacements the artificial joint may be less effective, however there is no limit to the number of times you may have joint revision surgery.
On return from hospital following a four to five day stay, the patient will be able to walk and ascend and descend stairs. Over the following subsequent six weeks the knee joint function will improve until the patient is walking normally perhaps with a stick for support and able to ascend and descend stairs normally using a rail. Increasingly the patient will be able to bend following six weeks and indulge in more normal activities and by twelve weeks the patient will effectively have a normal range of movement. Muscle strengthening however continues up to a year following surgery and many surgeons will indicate that full recovery has not taken place until twelve months has elapsed since the knee joint surgery.
Most implants are made of a medical grade of stainless steel. This metal will set off metal detectors such as those used at airports. Patients may wish for a covering letter provided by Professor Barrett in order to show security personnel.
Knee resurfacing surgery is major surgery although it is routine amongst surgeons who have expertise in this procedure. Approximately 600,000 people worldwide undergo some form of knee resurfacing procedure each year. Over 90% of those patients will achieve a very significant improvement of quality of life and pain relief.
As part of the knee resurfacing surgery, Professor Barrett would wish to restore the normal alignment to the joint to reduce the normal function of the limb and restore the ligaments and muscles to normal function. He will endeavour to straighten your legs back to their normal alignment.
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