Total Knee Replacement with computer navigation

Total knee replacement, or knee arthroplasty, is an orthopedic procedure wherein an orthopedic surgeon replaces the damaged or worn surfaces of the knee with prosthesis. Replacing these surfaces with an implant relieves pain and increases mobility, allowing patients to return to their everyday activities faster than they would had they undergone traditional knee surgery.

 

Dr. Innes uses computer navigation to guide him when placing the joint implant - an exciting innovation that improves the precision of total knee replacement surgery and thus improves the short and long-­term performance of the knee replacement.

ACL Reconstruction

The ACL is one of the major ligaments in the knee and connects the femur to the tibia. Because the knee is a hinged joint that experiences constant movement and supports substantial weight, damage to the ACL is common, particularly in athletes, and may require reconstructive surgery.

 

ACL reconstruction is undertaken using arthroscopic surgery and aims to restore function to the knee. Because most ACL tears cannot be repaired, the torn ligament needs to be reconstructed. The torn ligament is removed and a graft is used in its place. New ligament will grow on the graft. Dr. Innes generally uses grafts obtained from the patient’s body- though each patient's condition is unique.

Meniscus repair

Meniscus tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscus tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.

 

How your orthopedic surgeon treats your tear will depend on the type of tear you have, its size, and location. If Dr. Innes determines that surgery is necessary to repair the meniscus, he will perform knee arthroscopy to address your knee pain. You may undergo a partial meniscectomy, which involves trimming away the damaged meniscal tissue, or total meniscus repair. Some meniscus tears can be repaired by suturing the torn pieces together. Whether a tear can be successfully treated with repair depends upon the type of tear, as well as the overall condition of the injured meniscus. Because the meniscus must heal back together, recovery time for a repair is much longer than from a meniscectomy.

Meniscectomy

A meniscectomy is an arthroscopic, outpatient surgical procedure used to treat torn meniscus cartilage in the knee. In a meniscectomy, the torn segment of the meniscus is removed. Dr. Innes will recommend a meniscectomy based on the ability of meniscus to heal, patient’s age, health status, and activity level.

 

Depending on the extent of the tear, Dr. Innes will determine whether to perform a total meniscectomy, which is  a complete removal of the torn meniscus, or a partial meniscectomy, where only the unstable meniscal fragments are removed.

Knee ligament reconstruction

Knee ligaments that are badly damaged or ruptured need to be repaired through reconstructive surgery. Aside from the ACL, there are three other major knee ligaments that are commonly injured:

 

• Posterior cruciate ligament (PCL) - The ligament, located in the center of the knee, that controls backward movement of the tibia.
• Medial collateral ligament (MCL) - The ligament that gives stability to the inner knee.
• Lateral collateral ligament (LCL) - The ligament that gives stability to the outer knee.

 

Dr. Innes uses the most advanced form of knee ligament repair surgery, which is a minimally invasive procedure known as arthroscopic surgery. In this type of procedure, Dr. Innes uses a very small incision and fiber optic technology to see inside the knee and repair the problem areas. An arthroscope is inserted into one incision, and very thin surgical instruments are inserted into one or more of the other incisions.

 

With these state-of-the-art tools, Dr. Innes will replace the torn ligament with a tissue graft. The graft acts as scaffolding on which a new ligament can grow. Grafts can be taken from several sources including:

 

• the patellar tendon, which runs between the kneecap and the shinbone
• the hamstring tendon at the back of the thigh
• the quadriceps tendon, which runs from the kneecap into the thigh

Autologous chondrocyte implantation (ACI)

Autologous chondrocyte implantation (ACI) is an innovative procedure to treat cartilage and joint problems, particularly in the knee. ACI takes place in phases. The first phase sees the surgeon taking a small section of articular cartilage from the affected knee. The articular cartilage sample is then sent to a lab in order to separate the chondrocytes (the cells that produce cartilage in the body). Once the cells from the articular cartilage sample have multiplied, which generally happens after three to five weeks, they are returned to the surgeon for the second phase of the procedure.

 

During the second stage, the surgeon smooths the damaged area of the knee and covers it with a small patch of membrane. The chondrocytes that were cultured in the laboratory are then injected under the membrane. Over time, the cells will grow and settle into the joint, replacing the damaged area with new, healthier cartilage.

Microfracture

Microfracture is a surgical technique used to repair damaged articular cartilage. During this procedure, the surgeon uses a sharp tool to make multiple holes in the joint surface. Bone marrow cells and blood from the holes combine to form a "super clot" that completely covers the damaged area. This marrow-rich clot is the basis for the new tissue formation. The microfracture technique produces a rough bone surface that the clot adheres to more easily. This clot eventually matures into firm repair tissue that becomes smooth and durable. Since this maturing process is gradual, it usually takes two to six months after the procedure for the patient to experience improvement in the pain and function of the knee.