The Intricate Work of Modern Knee Specialists

May 24, 2019 | Articles

The Intricate Work of Modern Knee Specialists

Jointed appendages are among the greatest accomplishments of evolution. They first enabled the transformation of aquatic animals into land-dwelling creatures and later empowered some of those creatures to stand upright on two legs and, next, to fashion the primitive tools that marked the first step in the development of human civilisation.

One of the most intricate and hard-working of those joints is the one that permits the articulation between the thigh bone or femur and those in the lower part of the leg – the tibia and fibula. In constant use during a lifetime, the joint frequently becomes damaged. Fortunately, evolution has also produced knee specialists with the knowledge and skills to make the necessary repairs.

This type of joint is termed a hinge joint. That is to say, the bones of the upper and lower leg remain aligned during flexion with no significant lateral movement, much like the hinges on a lid. To achieve this, a number of anatomical structures are involved. Firstly, the muscles that control the movement are secured to the bone by tendons, and the entire joint is stabilised by specialised connective tissue structures termed ligaments. To enable frictionless movement between the heads of the femur and tibia, the ends of each have a coating of cartilage and the entire structure is contained within a membrane filled with viscous synovial fluid, which acts as a lubricant. Knee specialists are required to navigate their way through this complex structure when undertaking their various restorative, surgical procedures.

Joint problems can be divided into two types. Firstly, there are those that arise as the result of a traumatic injury. These are especially common among professional and amateur athletes who are striving to excel at their particular sport. Such injuries tend to involve the softer tissues of the joint, such as ligaments and cartilage, rather than bone, and although they can often be treated by a physiotherapist, knee specialists are frequently called upon to provide a surgical solution.

There are also a number of diseases that can affect our joints. The most common of these is osteoarthritis. Associated with pain and swelling in the affected joints, it is the result of the gradual erosion of the layer of cartilage that normally protects the articulating surfaces. The exposed bone is then subject to frictional forces that create surface irregularities. The bones can then become chipped, causing pain, swelling, and stiffness. Patients suffering from osteoarthritis could lose all mobility in the affected joints without timely interventions by knee specialists.

Today, these specialised orthopaedic surgeons routinely replace the damaged portions of bones in these and other joints, including those of the hips and shoulders, with prosthetic structures. The procedure is known as arthroplasty and may involve either a total or partial joint replacement, depending upon the extent of the damage. Whereas once, the assessment of that damage would have been determined by manual examination of the joint and X-rays, the development of the arthroscope has greatly improved the evaluation process. Today’s knee specialists employ the arthroscope to obtain a close-up, live view of the interior of a joint, rather than having to rely on a fuzzy negative image for guidance.

Although a relatively new medical specialism, orthopaedics has developed rapidly and its development has been characterised by innovation. Early attempts at joint replacements were hampered by limited materials available for the manufacture of prosthetics and certainly not by any lack of surgical skills. That innovative spirit persists and has led to an exciting new application for the arthroscope. Rather than subjecting their patients to the more radical process of exposing the entire joint, knee specialists are now performing many of their interventions arthroscopically. With the device positioned in the joint and a couple of extra tiny incisions through which to insert the instruments, a surgeon is then able to conduct a procedure while guiding his or her actions by means of the video image displayed on the arthroscope’s monitor.

Tough new, biocompatible materials with which to construct prosthetic joints have since become available, while many of the more progressive orthopaedic surgeons have developed the knowledge and skills to take arthroscopic surgery to the next level. Rather than limiting its use to irrigation of the joint and repairs to a damaged meniscus or ligament, a growing number of knee specialists are now employing this form of keyhole surgery to perform partial and even total knee replacements. Hailed as a breakthrough, the future seems certain to hold many more.