Sam Rajaratnam FRCS (Tr. & Orth.) Consultant Orthopaedic

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Meeting the challenges of Knee Arthritis

• Sam Rajaratnam FRCS (Tr. Orth.)
• Consultant Orthopaedic Surgeon
• Eastbourne D.G.H
• Horder centre
• Esperance House

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Topics

• KNEE
• What is Arthritis of the knee
• Presenting symptoms
• Prevention
• Conservative treatment
• Operative treatment
• Latest advances

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What is Osteoarthritis ?

• Pain
• Stiffness
• Loss of Function
• Instability giving way
• Can be Primary or Secondary

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Causes

• Primary Osteoarthritis(Family History)
• Secondary
• Post Injury and instability
• Meniscal tears
• Inflammatory Arthritis
• Autoimmune Disorders (e.g. Rheumatoid)

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Desired Effects

• Control Symptoms
• Reduce progression

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Meniscal tears
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Meniscal Repair
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Meniscal Repair vs Resection
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Meniscal tears

• Diagnose Early (especially in young patient)
• Preserve as much meniscus as possible
• Prevent further delamination
• Prevent Osteoarthritis
• In young patients refer early

• RARE FOR MENISCAL TEAR TO HEAL SPONTANEOUSLY
  (RED-RED)
• MRI CAN MISS TEARS (SIGNAL ARTIFACT) SO
  CLINICAL EXAM IMPORTANT
• FORCES CAUSING INJURY GREATER IN YOUNG PATIENT
  (MENISCUS LOOSES ELASTICITY WITH INCREASING AGE)

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• Treat Ligament Instability

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Treat Ligament injuries

• Torn ACL

• POST RECONSTRUCTION

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Day Surgical Arthroscopic Hamstring ACL -
Accelerated Rehabilitation

• Key Changes
• Pre ACL Rehab
• Patient education
• Improved technique
• Ice cold saline infusion
• Advanced Local Blockade
• Physiotherapy services
• Key to good results
• Early reconstruction
• before meniscal damage
• has occured

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• Reduce Weight

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The Arthritic Knee conservative treatment

• Glucosamine
• Chondroitin sulphate
• Fish oil
• Visco-suplementation
• Simple analgesics

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The arthritic Knee (Antero-medial wear) Most
common pattern. Very Painful
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Partial Knee replacement

• Minimially invasive
• Quick recovery (discharge after 24 hours)
• Mobile bearing
• Good 25 year results

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Isolated patello-femoral wear

• Pain on walking up down stairs
• No problem walking on flat ground
• Patella can lock or catch
• Patient can complain of knee giving way

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Patellofemoral replacement
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Lateral Osteoarthritis

• Knee Gives way
• Knock Knee
• Deformity can progress rapidly
• Often required total knee replacement
• (lateral unis have variable results)

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Combined patterns

• Most patents have combined patterns of wear
• May have fixed contractures
• May have ongoing ligament instability
• Severe bone defects

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Newer TKR designs

• Better bearing surfaces
• Higher Flexion
• Better fixation methods
• Hopefully will prove to improve function and
  longevity
• (time would tell !! We are embarking on a Biomet
  National trial)

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Numerous alignment techniques

• Computer navigation
• Intramedullary jigs
• MRI assisted Signature
• Fundamentally implants need to be aligned well
  for long term implant survival

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Signature Vanguard TKR
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Young osteoarthritic knee

• Difficult problem
• Options
• osteotomy
• Treat instability
• Unicompartmental knee replacement

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Osteotomy
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Young medial osteoarthritis
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Young Valgus Osteoarthritis
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Cartilage Repair

• Suitable for 15 55 year old
• Discrete area of chondral damage
• Stable knee (no ligament instability)
• Medial femoral condylar defects , Trochlea
  groove, Patella
• Various techniques available

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MACI ACI
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Osteochondral grafting
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Microfracture
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Chondro-tissue
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New Cartilage Repair services

• We are developing Cartilage repair services in
  Eastbourne Horder, so patients normally sent to
  London can be treated locally
• National trial / Ethics Committee/ Human tissue
  authority - Pending

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Horder centre

• Able to accept acute-on-chronic problems
• Direct choose and book referrals
• Very short MRI waiting times
• Consultant run service