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Knee Surgery on the Gold Coast

Dr Hartley performs the following knee operations:

Osteoarthritis of the Knee

Osteoarthritis is loss, thinning or damage to the articular (joint) cartilage of the knee. Osteoarthritis causes the formation of bony spurs (osteophytes), hardening of the bone (sclerosis) and formation of bony cysts. Other signs and symptoms of osteoarthritis are a collection of fluid within the joint, knee pain and joint stiffness. You may become “bow-legged” or less commonly “knock-kneed”.

Symptoms

  • Pain at night (nocturnal pain)
  • Pain doing the shopping causing you to lean on a trolley
  • Pain using stairs requiring you to use a hand rail or place two feet on every step
  • Difficulty getting into or out of a car
  • Difficulty picking something up off the ground

Other symptoms may include clicking noises, grating sensations, or a loss of joint flexibility. You may be at more risk of developing osteoarthritis in the knees if you are overweight or had a previous knee injury.

Diagnosis

An x-ray may show joint space narrowing, osteophytes (bony spurs), sclerosis (hardening of the bone) and bone cysts. It is important to remember X-rays do not diagnose how much pain you have.

Surgery

Surgery for knee osteoarthritis can include an arthroscopy if there is also a meniscal tear, a partial or a total knee replacement. Surgery is only contemplated after all non-operative measures have been considered.

knee replacement

Knee replacement can be either partial or total. If your arthritis involves only one part of your knee your knee may be suitable for a partial knee replacement. For more information about robot assisted partial knee replacement please click here.

A total knee replacement involves removing up to 1cm of cartilage and bone from both the femur (thigh bone) and tibia (shin bone). This is replaced with metal and a piece of plastic (polyethylene) is inserted in between, to form a new knee.

Before Surgery

Five days before surgery stop taking aspirin and anti-inflammatories. If you smoke please stop as early as possible before surgery. You will be admitted on the day of surgery and need to remain fasted for at least six hours before the procedure.

Surgery

Your leg will be cleaned and prepared for surgery. You will be given either a general anaesthetic to make you unconscious or a spinal anaesthetic to numb the area. Mechanical devices to reduce the risk of clots, such as stockings or foot pumps, will be used during the operation. An incision will be made up to 30cm long, extending from above your kneecap to below. Soft tissue is then moved to expose the knee joint. The tibia and femur will be cut, and the diseased knee joint will be removed. More bone from the tibia and femur may also be removed to make sure the prosthetic knee joint is sitting correctly.

Usually, a special type of glue called bone cement will be used to adhere the prosthetic knee to the femur and tibia. The kneecap (patella) may be replaced with a prosthetic button. Ligaments and muscles will be rearranged. A drainage tube will be inserted into the wound. The incision will be closed with stitches or clips.

Immediately after the operation your knee will be covered with a dressing and a drainage tube removing excess fluids from the wound. You will be closely monitored by Dr Hartley’s team, who will regularly check your vital signs e.g. blood pressure. To minimise the risk of infection you will be given antibiotics, and other medications to thin your blood and reduce the risk of clots both during and after the operation. If you experience reoccurring of persistent pain, strong pain relief can also be given via an epidural or drip.

Recovery

Immediately after surgery your spinal anaesthetic will ensure that you have no pain but you will not be able to mobilise for a few hours. After this time the blocks in your back and around your knee will begin to wear off and the physiotherapist will see you. Early mobilisation is key to help reduce the risk of complications such as blood clots, knee stiffness and bed sores. Your stay in hospital will usually be between 3-5 nights. If the physiotherapists suggest it you might be transferred to Southport Private Hospital for extra physiotherapy prior to going home.

ACL reconstruction

The anterior cruciate ligament (ACL) is one of four ligaments that help stabilise the knee by acting like strong ropes to hold your femur (thigh bone) and tibia (shin bone) together. Your anterior cruciate ligament (ACL) can be over-stretched, but still intact or it can be torn and ruptured. An ACL rupture of the main ligament in the middle of your knee - the anterior cruciate ligament (ACL) is a common occurrence, and both ACL ruptures and partial injuries are caused by contact sports, jumping sports and unexpected twisting movements.

ACL reconstruction is performed after a complete rupture of the ACL ligament. This is a very common injury and this orthopaedic surgery involves repairing the torn or ruptured ACL ligament by harvesting an unused tendon from behind the knee and threading it back through the knee joint. This procedure restores stability and support to your knee, allowing you to return to normal walking activities in about a month.

Preparation For Surgery

Five days before surgery stop taking aspirin and anti-inflammatories. If pain medication is required, use Panadol / Panadene or Panadene Forte. Dr Hartley will have reviewed your other routine medication. If you smoke try to abstain from having cigarettes a few days before your surgery. You will be admitted on the day of surgery and need to remain fasted for six hours before the procedure. The operation is usually done under general anaesthesia.

Surgery

The anaesthetist will discuss the anaesthetic with you and your options for post-operative pain relief. Most patients have a general anaesthetic.

The surgery aims to reconstruct the damaged ligament in your knee, so Dr Hartley often uses your own tissue to form an ACL graft. The graft is placed in the site of the torn ligament, and is designed to fill the stabilising role of the native ACL. Antibiotics will be administered through a drip to decrease the risk of infection. After the anaesthetic has been given, a tight band, a tourniquet, will be tied to your upper thigh and everything except your knee will be covered by sterile drapes.

With the aid of a specialised telescope called an arthroscope, Dr Hartley will inspect the inside of your knee. If any other damage is found e.g. a meniscal tear, it will be addressed during surgery.

 A tunnel will be drilled in the top of your leg bone (tibia) and the bottom of your thigh bone (femur). The tendons will be passed through these tunnels and anchored in place with special devices (screws and buttons) to provide knee stability. Your knee will be injected with local anaesthetic to help with post-operative pain. All wounds will be closed using normal and dissolving sutures.

Recovery

Once you are fully awake in recovery you will be transferred to the ward, usually 4E. The following morning you will be seen by a physiotherapist who will provide instructions for leg exercises and instruct you on the correct use of crutches. Once you are mobilising safely, have regained some motion in your knee and your pain is controlled by oral medication you will be able to go home. Most patients are discharged the morning after surgery at about 10am.

Knee arthroscopy

Knee arthroscopy is used for the treatment of meniscal (cartilage) tears of the knee. Meniscal injuries of the knee are one of the most common orthopaedic injuries we see in our surgical practice today. The meniscus is a piece of cartilage in the knee that cushions the joint, like a shock absorber.

When you cause an injury to the meniscus, you lose the cushion that protects your knee joint, resulting in pain and stiffness on movement and your knee might even ‘lock up’ when you are walking. Common causes of meniscal injuries include activities that involve twisting or pivoting at the knee. Meniscal injuries are very common in professional athletes or anyone who plays a lot of football, basketball, tennis and golf. They are also frequently experienced by anyone who participates in contact sports, and in members of the armed forces, due to the nature of their training and combative profession.

This type of orthopaedic surgery is also called keyhole surgery and involves two 1cm cuts in the front of the knee. A fibre optic camera is inserted through one of the 1cm cuts and our working instruments are inserted through the other. This is generally a low risk operation and most patients are discharged the same day as the orthopaedic surgery on the Gold Coast.

Knee arthroscopy is keyhole, day surgery of the knee.

Preparation for surgery

Five days before surgery stop taking aspirin and anti-inflammatories. If pain medication is required, use Panadol / Panadene or Panadene Forte. Dr Hartley will have reviewed your other routine medication. If you smoke please stop a few days before your surgery. You will be admitted on the day of surgery and need to remain fasted for six hours before the procedure. The operation is usually done under general anaesthesia.

Surgery

The limb undergoing the procedure will be marked and identified before the anaesthetic. Once you are under anaesthetic, the knee will be prepared in a sterile fashion. A Tourniquet will be placed around the thigh to allow a blood free procedure.

The arthroscope is introduced through a small incision on the outer side of the knee. A second incision on the inner side of the knee is made to introduce the instruments that allow examination of the joint and treatment of the problem.

Recovery

Dr Hartley will close your incisions and cover them with a soft bandage. You will be moved to the recovery room and should be able to go home within one or two hours. Be sure to have someone with you to drive you home. Recovery from knee arthroscopy may be faster than recovery from traditional open knee surgery. Follow Dr Hartley’s instructions carefully after you return home.


Revision knee replacement surgery

Two of the most frequent groups of people who require knee replacements are over those who are over 50 years of age or who suffer from arthritis of the knee. So these are the two groups of people who are also more likely to suffer from a failed knee replacement.

A third group of people who can also suffer from a failed knee replacement are those in much younger age groups, but who perform high impact sports activities that cause irreparable damage to their knee joints and require knee replacement surgery. Failure of a total knee replacement is very rare, but rates of up to 13% per year have been noted9. However, when they occur, they require a revision knee replacement surgery to replace the failed prosthetic components.

Dr Hartley is well-known for his expertise as a leading knee surgeon on the Gold Coast and has performed thousands of knee replacement surgeries over the years.

No two revision knee replacements are the same. Fractures around the knee are common causes for revision knee surgery.

Preparation for Surgery

Five days before surgery stop taking aspirin and anti-inflammatories. If pain medication is required, use Panadol / Panadene or Panadene Forte. Dr Hartley will have reviewed your other routine medication. If you smoke please stop a few days before your surgery. You will be admitted on the day of surgery and need to remain fasted for six hours before the procedure. The operation is usually done under general anaesthesia. You will meet the nurses and answer some questions for the hospital records. Your anaesthetist will also ask you a few questions.

Surgery

You will be given hospital clothes to change into and have a shower. The operation site will be shaved and cleaned and you will go to the operating room.
As each knee is individual, there are different sized knee replacements to suit. If there is more than the usual amount of bone loss sometimes extra pieces of metal or bone are added.

Dr Hartley will perform the two hour surgery under sterile conditions in the operating room under spinal or general anaesthesia. You will be on your back and a tourniquet applied to your upper thigh to reduce blood loss. An incision around 7cm is made to expose the knee joint. The bone ends of the femur and tibia are prepared using a saw or a burr. Trial components are then inserted to make sure they fit properly. The real components (femoral and tibial) are then put into place with or without cement. The knee is then carefully closed and drains usually inserted, and the knee dressed and bandaged.

Recovery

You will wake up with our knee in a bandage and drainage tube removing excess fluid and given antibiotics to reduce the risk of infection. You will be closely monitored by Dr Hartley’s team with strong pain relief will be given via an epidural or drip. You will be encouraged to move your feet and bend your leg as soon as you can. Physiotherapists will encouraged you to try walking on the day after your surgery.

If you are after more information or would like to book an appointment please call our receptionist Annie Thomas on 1300 447 563 or complete our online enquiry form.