

Knee Treatments

Knee Biomechanics
Knee Treatments
The majority of knee problems can be treated without the need for surgery (non-operatively). Knee problems requiring operative treatment generally fall into one of these categories:
  1. ​A  major, likely irreversible, structural abnormality within or close to the knee joint
  2. Significant on-going symptoms affecting level of function and/or quality of life
  3. The problem is of long duration
  4. Non-operative treatment options have been tried and failed to fully resolve the problem
Most patients will have 3 of 4 of these, if not all 4.
Non-operative treatment options:
Simple painkillers such as paracetamol
Non-steroidal anti-inflammatory drugs (NSAID’s) such as ibuprofen, Voltarol, Naproxen
Ice therapy, particularly early on
Massage and gentle heat

Activity modification including initial rest, avoidance of aggravating activities, exercise that doesn’t aggravate the knee but allows for continued muscle conditioning such as non-breaststroke swimming, X-trainer, cycling, gym exercises.
Physiotherapy to optimise the above, work of muscle conditioning generally, add additional local modality treatments such as ultrasound, short-wave diathermy, TENS
Use of a simple knee support, with gradation up to bespoke definitive bracing.
Injection treatments fall into 2 broad categories, the commonly used cortisone injections, for which I tend to use Triamcinalone, the newer Hylan type injections which I generally use Synvisc 1 or Durolane or the newer platelet rich plasma (PRP) injections.
Knee arthroscopy
Arthroscopy is done through small incisions (commonly 2 small incisions at the front of the knee). During the procedure, an arthroscope (a small camera instrument about the size of a pencil) is inserted into your knee joint. The arthroscope sends the image to a television monitor. On the monitor, thesurgeon can see the structures of the knee in great detail.
The surgeon can use arthroscopy instruments to feel, repair or remove damaged tissue. To do this, small, specialised surgical instruments, of which there re now a wide variety, are inserted through the incision. 

Osteotomy literally means "cutting of the bone." In a knee osteotomy, either the tibia (shinbone) or femur (thighbone) is cut and then reshaped to relieve pressure on the knee joint.
Knee osteotomy is used when you have early-stage osteoarthritis that has damaged just one side of the knee joint. By shifting your weight off of the damaged side of the joint, an osteotomy can relieve pain and significantly improve function in your arthritic knee.
(see also Knee Surgery and Keyhole Surgery section)

Partial knee replacement
In about 30% of patients, the arthritic wear out process is confined to one part or compratment of the knee. If this is the case and there is no evidence wear in the rest of the knee, nor fixed contactures I will tend to suggest a partial or unicompartmental knee replacement. This has the benefits of being a smaller operation, with a shorter recovery time, reduced risk of major complications and when it works well as good as or even superior results in terms of symptons and return to normal function.
In my private practice I now undertake as many partial as total knee replacements.
I have used the Biomet (now the Zimmer-Biomet) Oxford partial knee system for over 15 years.

Total knee replacement
A total knee replacement (also called knee arthroplasty) is the most commonly undertaken major knee surgery in the UK.
There are three basic steps to a knee replacement procedure.
  • Bone joint surface re-section. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
  • Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button. I resurface the patella selectively, only if the patella joint surface is more than 50% worn out. If it is severely maltracking or if it is an abnormal shape. I have used the Stryker Triathlon knee system for over 7 years.

​You can get a lot more information about major joint replacements including total and partial knee replacements by visiting the National Joint Registry website at

Knee Anatomy
Knee Conditions
Knee Treatments
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