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23 OCTOBER 2021 • HEALTHCARE INNOVATIONS DISTRIBUTED WITH THE SATURDAY DAILY MAIL


New choices and more options in knee surgery


Recent developments and new techniques from specialist surgeons improve function and speed recovery in knee patients


“THIS MORE MINIMAL APPROACH HAS MANY ADVANTAGES FOR THE PATIENT, WHERE ONLY ONE PART OF THE KNEE IS RESURFACED AND ABOUT 70% OF THE KNEE REMAINS NATURAL TISSUE”


is carefully removed and the resurfacing consisting of cobalt chrome metal alloy is securely fixed to the area to provide a smooth surface where previ- ously there was roughened bone. Tis process requires a specialist technique and specific instru- ments conducted by a surgeon who


has undergone expert


IMPROVEMENTS IN TECHNOLOGY CAN BE UTILISED TO OFFER PATIENTS MORE CHOICE OF MINIMAL INTERVENTION


training. Between the two resur- faced areas of the knee, a poly- ethylene ‘cartilage’ acts as shock absorber and spacer. Te oper- ation is perhaps more techni- cally complex than that of knee replacement, and research shows the best results are achieved by surgeons who have a significant experience of this procedure. Tis more minimal approach


has many advantages for the patient, where only one part of the knee is resurfaced and about 70% of the knee remains natural tissue. All the ligaments of the knee remain intact,


including


the vital cruciate ligaments, which are sacrificed in total knee replacement.


Tere’s never been a more exciting time to be involved with knee surgery — as a surgeon and engineer, but also as a patient. Rapid advances in the devel- opment of new, more minimal implants and improved patient care helps to maximise what can be achieved in both symptom relief and function. Te establishment of specialist


knee services, such as that offered by Professor David Barrett at London’s prestigious King Edward VII’s Hospital, Marylebone, is an example of how improvements in tech- nology can be utilised to offer patients more choice of minimal intervention with reliable outcomes, which can for the first time include return to sporting activities such as tennis, golf and skiing.


More active patients now


enquire about surgery at a younger age than was previously the case when the classic knee replacement was designed some 50 years ago. Knee replacement in an elderly population remains a success story, but the younger, more active patient requires a higher level of activity, a return to some sporting or recrea- tional pursuits and an accel- erated rehabilitation in order to minimise the downtime of a prolonged recovery. Professor Barrett has been involved for more than 20 years as a professor of orthopaedic engineering and consultant knee surgeon in the development of smaller, more minimal or partial resur- facing techniques of the knee. Tese


developments, with advances coupled in anaesthesia


and rehabilitation techniques, have considerably improved the speed, outcome and ease of the patient journey as they proceed through knee surgery.


KNEE PRESERVATION — PARTIAL RESURFACING While in advanced cases, the entire joint may have to be replaced, there’s increasing evidence that arthritis, or the bone-on-bone


contact that


causes the pain as the knee begins to wear, occurs initially in specific areas of the knee. For 80% of cases, this will be on the inner, or medial, side of the knee. Of


the remaining 20%, some


patients initially develop pain on the outer side of the knee; others, under the knee cap. At this stage, the rest of the joint is generally in good


condition and the underlying bone is strong. Te technique of partial resurfacing is focused on intervening at this stage, rather than delaying until the whole joint is involved and a complete replacement is required as all the surfaces and the bone below has become involved. Long-term studies show that if the inter- vention is correctly performed, arthritis won’t progress in the joint and a partial resurfacing is all the patient will require to resume their activity, pain-free, for the significant long-term of 15 to 20 years. Partial resurfacing of the common inner


most area of


the knee (right, top images). Different areas may be resur- faced (right, bottom images). Te damaged surface of the bone on the affected part of the knee


FUNCTION AND RECOVERY Te most significant advantage to the patient of partial resurfacing is the degree of function and the speed of recovery following surgery, coupled with the mini- misation of pain and the ease of mobilisation. Professor Barrett’s patients usually walk, fully weight-bearing, on the day of the operation. Te surgical incision using minimal access techniques is considerably smaller than that of total knee replacement (TKR) and the speed of recovery can be three times more rapid than TKR. When the incision is stable and the patient has ascended and descended stairs, they return home either the same day, or the day after surgery. Within a few weeks, patients can expect to resume driving and all the other


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