These Are Busy Times for the Nation’s Knee Surgeons
Professional athletes and anyone who regularly engages in strenuous physical activity as part of their job tend to suffer from joint injuries and, more often than not, it will be the articulation between the femur, tibia, and patella that is likely to sustain some form of damage. In such cases, the damage may be a dislocation, or a torn ligament or meniscus, while, even in less active individuals, the joint may simply display signs of long-term wear and tear. Whatever the cause or the nature of the damage, it will be the responsibility of one of the country’s knee surgeons to do whatever may be necessary to repair it.
While attending to the results of sports injuries, falls, car accidents, and other traumatic events accounts for much of the time of these orthopaedic specialists, many must alternate between this responsibility and caring for patients that are in need of elective procedures, while some choose to just specialise in this type of case. Whichever may be the case, it is the elective surgeries that are steadily becoming more and more responsible for filling the beds in the orthopaedic wards in most countries, including South Africa.
Today, one of the most common reasons that patients are consulting knee surgeons is to seek help in treating the damage caused by a condition known as osteoarthritis. In a healthy joint, the frictionless articulation between the heads of the femur and the tibia is made possible by a surface coating of smooth cartilage on each. Additional lubrication is provided by the synovial fluid contained within a membrane which encloses the entire joint.
In osteoarthritis, the protective layer of cartilage becomes eroded to expose the bony surface beneath, thus increasing the frictional forces and eroding the bone itself to cause pain and swelling. Once mainly associated with ageing, lifestyle changes are believed to be the reason that knee surgeons are now encountering an increasing number of younger patients with the symptoms of osteoarthritis. Whether this important joint may have been damaged through accidental injury or just subjected to excessive wear and tear, and regardless of a patient’s age, it is almost inevitable that some form of surgical intervention will prove necessary, if not immediately, then at some time in the future.
As orthopaedic specialists, their patients are referred to them by general practitioners or, in some cases, by the staff of hospital emergency departments. While those from the latter source tend to be trauma cases, those referred to knee surgeons by their GP are predominately patients with persistent joint pain, swelling, and restricted movement, and will require a confirmation of the diagnosis before proceeding with any treatment.
Arthroscopy, in which a thin metal tube fitted with a light source and a camera is inserted through a tiny incision into the joint, is an important diagnostic procedure for orthopaedic specialists. It provides a real-time magnified video image that not only assists diagnosis, but which, in many cases, can also be used to provide in situ monitoring of keyhole surgery, thereby avoiding the need to schedule a separate procedure. Additional tiny incisions through which to insert the required instruments offer knee surgeons a minimally-invasive alternative to exposing the entire joint, which increases the risk of blood loss and infection, while extending post-op recovery times. Repairs to a torn anterior cruciate ligament or meniscus, both of which are common injuries among those who play contact sports, are typical of procedures that are routinely performed in this fashion.
In the wake of the growing incidence of osteoarthritis, the demand for a partial or total replacement of the diseased joint has grown proportionately. Managed, first, with prescription pain killers and, later, with steroids, at some point most will need to be referred to a knee surgeon to be fitted with a suitable prosthesis. Typically, prosthetic joints remain functional for up to 20 years of normal use.