Total knee replacement surgery is a procedure that involves removing a damaged knee joint and replacing it with a synthetic joint, also known as knee arthroplasty. This procedure is primarily used to treat severe knee osteoarthritis, which is characterized by the wearing out of cartilage layers inside the knee. As the cartilage wears away, bone-on-bone movement can occur with every step, leading to persistent pain, stiffness, swelling, and deformity.

In Australia, knee replacement surgery is becoming increasingly common, with almost 50,000 procedures performed last year. Thanks to improved surgical techniques and prostheses, knee replacement surgery has a high success rate in relieving pain and restoring mobility. In fact, approximately 80% of patients who undergo knee replacement surgery are satisfied with the results.

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Do I need a Total Knee Replacement?

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If you have severe osteoarthritis, rheumatoid arthritis, avascular necrosis of the knee, or bone growth disorders, a total knee replacement may be recommended. Ultimately, the decision to undergo knee replacement surgery is yours to make after discussing the options with Dr Kilian, who will only offer the surgery if it is appropriate for your situation.

Typically, the decision is based on several factors, such as pain that has not been relieved by medication, physiotherapy, or walking aids, pain that interferes with work, daily activities, and recreation, disturbed sleep due to pain, and a stiff and swollen knee, confirmed by X-rays to have arthritis.

Knee replacement surgery is typically performed in a hospital under general or spinal anaesthesia. The procedure begins with the cleaning and preparation of the knee. Your surgeon will then make an incision over your knee, typically up to 30 cm long, from above the kneecap to below it. The soft tissues are moved aside to expose the knee joint. Your surgeon will then cut through the bottom of your femur and the top of your tibia to remove the damaged knee joint. The new prosthetic joint is precisely fitted into place and anchored using bone cement. Finally, the soft tissues are put back in place, and the incision is closed.

 

Robotic Assisted Surgery

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Dr. Kilian is a highly skilled orthopaedic surgeon who specializes in performing total knee replacements using the latest technologies available. He is a firm believer in the benefits that these advancements can bring to his patients, and has dedicated himself to staying up-to-date with the latest techniques and technologies in order to provide the best possible outcomes.

One of the key technologies that Dr Kilian uses in his knee replacement procedures is robotics. Robotic-assisted surgery allows for greater precision and accuracy in the placements of implants. This technology also allows for real-time feedback during the procedure, which can help to ensure that everything is going according to plan.

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Patient-specific Instruments

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Patient-specific instruments are another technology that Dr Kilian uses in the knee replacement procedures. These instruments are created using advanced imaging technology, such as CT scans or MRI, to create a 3D model of the patient's knee. This model is then used to create custom instruments that are specifically designed for the patient's anatomy. This can help to improve the accuracy of the surgery and reduce the risk of complications.

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Dr Kilian's approach to knee replacement surgery is highly personaliszed and tailored to the individual needs of each patient. By using the latest technologies available, he is bale to provide his patietns with the best possible outcomes, including faster recovery times, less pain, and improved range of motion.

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If you are considering knee replacements surgery, Dr Kilian is an expert in the field and can help you determine the best course of action for you individual needs.

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What is ACL Reconstruction?

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To understand whether you require ACL reconstruction, it is important to know what it entails. The anterior cruciate ligament (ACL) is one of the four major ligaments of the knee that runs diagonally across the middle of the knee joint. It prevents the tibia, or shinbone, from sliding forward in front of the femur, or thighbone, thereby providing rotational stability to the knee.

While the knee's ligaments are tough, they are often injured in activities like abruptly stopping, incorrect landings, or rapid changes of direction. Direct contact can also cause injury. ACL injuries are prevalent in individuals who play pivoting sports such as basketball, football, netball, and tennis. Women are two to ten times more likely to sustain ACL injuries than men. Additionally, ACL injury is more common in younger individuals, with 50% of such injuries occurring in individuals aged 15-25.

When the ACL is injured, the ligament stretches, leading to fibre tearing. Sprains are categorized according to severity:

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• Grade 1 sprain: The ligament is slightly damaged and is only mildly stretched, but it can still help stabilize the knee joint.

• Grade 2 sprain: The ligament is stretched to the point of becoming loose, which is known as a partial tear.

• Grade 3 sprain: The ligament has been torn completely into two parts, resulting in an unstable knee joint.

 

When the ACL is completely torn, healing potential is limited, resulting in long-term instability, necessitating ACL reconstruction surgery.

Indicators that you may have an ACL tear include:

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• A popping sound or a sensation of the knee giving way during the injury

• Swelling, with the degree of injury determining its severity

• Pain, with the degree of injury determining its severity

• Limited range of motion

• Tenderness when the knee is touched

• Feeling of instability when standing or walking on the knee

 

Once you have been diagnosed and have had a conversation with Dr Kilian, the choice to have ACL reconstruction surgery is entirely yours. Dr Kilian will always offer you the available options and suggest surgery only if appropriate.

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How ACL Reconstruction is Performed

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The goal of ACL reconstruction surgery is to restore stability to the knee. Unfortunately, a torn ACL does not heal on its own, and in most cases, it cannot be directly repaired. Since most ACL tears cannot be stitched back together, the ligament must be reconstructed. This involves using a tissue graft on which a new ligament can grow. The patellar (tendon and bone), hamstring, and Achilles tendon are among the sources of grafts for ACL reconstruction.

Physiotherapy is an essential part of ACL injury treatment. It is beneficial not only after surgery but also in restoring knee strength and motion before surgery, also known as pre-habilitation.

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What is Knee Arthroscopy?

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Knee arthroscopy is a surgical procedure that utilizes an arthroscope to diagnose and treat a variety of knee conditions. An arthroscope is a small camera that is inserted into the joint through a small incision. This camera transmits images onto a large screen, allowing the surgeon to see the inside of the joint and utilize small instruments (inserted through other small incisions) to perform necessary repairs.

Arthroscopy is often referred to as keyhole or minimally invasive surgery since it only requires small incisions. Compared to open surgery, arthroscopic procedures generally cause less pain, have shorter recovery periods, and offer greater clarity regarding the feasibility of preservation methods.

Knee arthroscopy may be recommended if you have a painful knee condition that has not or is unlikely to respond to conservative treatments, such as non-drug therapies like physiotherapy or medications like anti-inflammatories. Knee conditions that can be treated arthroscopically include meniscus and other cartilage tears, multi-ligament injuries, ACL tears, and Chondral injuries.

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How does Knee Arthroscopy work?

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Knee arthroscopy is a minimally invasive surgical procedure that is typically performed on an outpatient basis, meaning that you may be able to go home on the same day as the surgery. In some cases, an overnight hospital stay may be required, and we will inform you of the expected duration of your hospital stay prior to your admission.

The procedure is carried out under either general anesthesia or spinal anesthesia (epidural). Once your knee is properly cleaned and prepped for surgery, Dr Kilian will make a small incision (about 1 cm) through your skin into the knee joint, through which the arthroscope is inserted.

The arthroscope is equipped with a tiny camera that transmits images of the inside of your knee joint onto a large screen, allowing Dr Kilian to identify any problems. A continuous flow of fluid is used to keep the arthroscope's view clear during the procedure.

Using additional small incisions, Dr Kilian will insert tiny instruments to remove any badly damaged tissue that cannot heal, and/or make repairs to other tissue as necessary.

Once the instruments and arthroscope are removed, the small incisions are closed with tape or sutures, and a dressing is applied to the skin to protect the wound. A bandage is then placed around your knee to support the joint during your recovery period.

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