Welcome to hipandkneesurgery.es

 

Thank you for logging into our website. We intend to give you some basic information on hip and knee pathology, that may eventually require surgery. Orthopaedics is a very extensive surgical specialty and deals with a great variety of soft tissue and skeletal pathology. Hip and knee pathologies are amongst the most frequent conditions requiring evaluation by an Orthopaedic Surgeon.

 

There is a high incidence of acute knee injuries in the young, both in the practice of sports and in labour-related trauma, as well as in RTAs. In the older population group brittle bone fractures around the knee are seen more often as the population ages.

 

Trauma around the hip (proximal femur) is infrequent in the younger group, however, it has become a true epidemic in those over 70. Hip fractures (both intra- and extra-capsular) are amongst the most prevalent fragility fractures, second to porotic fractures in the spine. 

 

If we exclude traumatic hip and knee events, that in most cases will require hospital treatment via the A&E Department, the most common conditions that merits an orthopaedic consultation are degenerative disorders in both joints. 'Wear and tear', or Osteoarthritis of the hip and knee poses a significant workload in any orthopaedic practice with an interest in this matter.

Osteoarthritis

 

Osteoarthritis (OA) is a disease of synovial joints in which the articular cartilage degenerates and gradually resorbs down to underlying bone. The subchondral bone becomes eburnated and there is new bone formation around the edges of the articular surface (osteophytes), degeneration also occurs in the capsule and ligaments thus making the joint stiff and painful. 

 

OA is classified as either primary (unknown underlying cause) or secondary (following trauma, joint infections, rheumatic diseases, congenital hip abnormalities, joint instability...). OA increases in frequency with age.

 

Most common clinical features include pain (the most frequent reason for consultation), joint stiffness, swelling, progressive deformity and/or instability.

 

Diagnosis is based on history taking, clinical examination and diagnostic imaging:

  • X-Rays remain the primary, and in many cases, sole investigation for an accurate diagnosis, with the cardinal signs that include: narrowing of the joint space, subchondral sclerosis, marginal osteophytes, subchondral cysts and bone remodelling.
  • MRI Scan, CT-Scan and Bone Scan are sometimes required to further assess the state of the affected joint.

 

The management of OA depends on the joint (or joints) involved, the stage of the disorder, the severity of the symptoms, the age of the patient, and the functional needs.

 

Non-operative (conservative) treatment is tried first in most of the patients, includes different measures such as the use of analgesia and non-steroidal anti-inflammatory drugs, changes of lifestyle (weight loss, restriction of activities, use of a cane/stick), use of orthotics (knee or hip braces), intra-articular injection of steroids or hyaluronic acid, physiotherapy...

 

When conservative treatment has failed or the condition is deteriorated causing severe pain and disability, instability or gross deformity, surgery is required to improve the patient's quality of life. 

 

There are various surgical possibilities for operative treatment in osteoarthritic conditions:

  • Arthroscopic Lavage ('key-hole' surgery) of the affected joint - widely used when there are early OA changes in the knee, shoulder and ankle - that can give temporary relief and therefore delay a major procedure
  • Osteotomy (realignment osteotomy) was widely used in the 70s and 80s. Nowadays it remains a viable alternative to partial joint replacement for unicompartimental OA of the knee, in young and active patients, and in the presence of good-quality bone
  • Arthrodesis to stiffen the joint permanently thus giving a stable and painless joint, at the expense of movement. This operation is now rarely used, but should be considered for any destructive condition when there are serious contraindications to osteotomy or arthroplasty.

  • ARTHROPLASTY (JOINT REPLACEMENT SURGERY) seems the ideal way of treating any disorder causing joint destruction in the absence of a major contraindication, such as active infection in the joint. The aim of joint replacement surgery is to obtain a painless, stable and mobile joint. However, several problems should be overcome: implants must be durable, permit low-friction movement at the articulation, they must be firmly fixed to the skeleton and they must be inert to avoid unwanted reaction in the surrounding tissues. 

 

Many joints can be replaced nowadays (shoulder, elbow, wrist, ankle...), however, hip and knee arthroplasties account for over 90% of these surgeries, due to the higher prevalence of osteoarthritic conditions in the lower limbs.

 

 

For further information on Osteoarthritis visit OrthoInfo.org from the American Academy of Orthopaedic Surgeons (AAOS) by clicking here.

X-ray shows advanced OA changes in the right hip joint and normal left side

Hip Surgery

Total Hip Replacement (THR) remains one of the most successful operations for advanced disease in the joint. Osteoarthritis (OA) is the predominant diagnosis in over 90% of the cases.

Weight-bearing X-rays showing bilateral OA changes, worse on the medial side

Knee Surgery

Over 75.000 Total Knee Replacements (TKR) are performed in the UK every year according to the latest data from the National Joint Registry (2015). Osteoarthritis was present in more than 95% of the patients.