Patchwork knee operation that cuts recovery time in half



20:59 GMT, 28 April 2012

A new knee-repair operation that cuts recovery time in half is offering NHS patients with arthritis an alternative to a total joint replacement.

The procedure involves replacing only areas of cartilage that are diseased and leaves the ligament structures alone, allowing more natural movement.

Latest figures show that about 90,000 knee-replacement operations are carried out each year in Britain – which is higher than the number of hip replacements – with the biggest increase in those aged under 65.

Injury toll: Keen rugby player Gary Derrickk had pioneering bicompartmental knee surgery

Injury toll: Keen rugby player Gary Derrickk had pioneering bicompartmental knee surgery

Surgeons suggest that a traditional total knee replacement in a patient over 65 can last between ten and 15 years. In younger, more physically active patients, standard implants wear out faster.

Now the NHS is offering a sophisticated new replacement called bicompartmental knee resurfacing.

Philip Chapman-Sheath, Consultant Orthopaedic Surgeon at Spire Southampton Hospital, says: ‘This operation is tailored to the specific needs of the patient as we are replacing only the parts affected by osteoarthritis.’

The knee joint is the largest in the body and consists of two hinges – one joins the tibia (shin bone) with the femur (thigh bone), while the other links the patella (knee cap) to the femur.

To keep each joint stable and flexible, the knee is supported by a framework of ligaments. In an arthritic joint, the cartilage that coats the end of each bone has worn away, exposing unprotected bone which then deteriorates. It is not known why this happens, but genetics and being overweight are factors.

Traditional total knee replacement involves a large incision with the surgeon replacing all areas of the joint – whether or not they are worn out – and removing ligaments.

In the new operation, the medial ligament of the knee – which runs along the inner knee – and the patella are replaced at the same time, sparing the other ligaments in the joint. Arthritic areas of cartilage are cut away and implants, made of chrome, titanium or hard-wearing plastic, are cemented or screwed into their place. The operation is carried out under spinal or general anaesthetic and takes about an hour. Patients usually go home within three days.

Experts have likened it to patching the knee of a pair of jeans. Mr Chapman-Sheath says: ‘The implants replace the worn-out sections of cartilage, creating a new smooth surface.

‘Because we leave the ligaments alone, afterwards patients are able to do much more in terms of non-impact sporting activity such as golf, swimming and cycling, which might not have been possible after a total knee-replacement operation.’

However, this bicompartmental option can be used only once, so when the lateral or outer third becomes worn out, a total knee replacement would be needed.

Mr Chapman-Sheath adds: ‘As patients are presenting to surgeons at much younger ages, we can now offer them this option of resurfacing just the damaged areas, thus buying time before a full knee replacement becomes necessary.’

How the operation works

How the operation works

One patient to benefit is Gary Derrick, 52, a building firm director from Lyndhurst, Hampshire. Once a keen rugby player, Gary says: ‘I played prop forward for various local teams but when I reached 40, the injuries were taking too long to heal and I was forced to give up. I was diagnosed with knee arthritis in July 2008.’

Despite being in a lot of pain, Gary was reluctant to have an operation on his left knee as he had already had reconstructive surgery on his right side after a cruciate ligament snapped some years previously.

‘I became used to having pain and as my work entailed being out on building sites, climbing up ladders and walking on uneven ground, the bone had worn off the inside of the knee and I constantly felt as if someone was stabbing my leg with a needle,’ he says.

Three years ago, Gary went to see Mr Chapman-Sheath, who offered him the option of being one of the first to trial the bicompartmental operation.

‘I was in hospital for three days and I suffered knee pain for only one of them. I was surprised at just how quickly it healed,’ says Gary.

He needed to use crutches for six weeks and was able to go back to work with just one crutch at five weeks.

Three months later he was virtually pain-free. He says: ‘I often forget I ever had any problems.’