The knee

The knee is one of the most complex joints in human body and is often exposed to injuries.

The knee consists of three bones: femur, tibia and patella. The knee joins the femur to the tibia. The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee.

In case of knee injure patients feel pain, weakness and limitation.

There are various causes of pain in the knee.The most common ones are: inflammatory processes, degenerative processes, injuries and static deformities. In establishing diagnosis, it is important to take patient’s history and carry out orthopaedic examination to assess the general condition of the joint,intensity of pain and extent of movements. This is followed by ultrasound, X-ray, arthroscopy and magnetic resonance which  is most useful.

The most common knee injuries are meniscus and ligament injuries which affect knee joint stability.

Treatment of meniscus and ligament injuries is mostly non -operative in cases where physical therapy can be used or surgical-by using arthroscopy.

The team of experts in Atlas hospital perform the most modern knee operations.

Knee prosthesis (arthroplasty)

In the initial stage of the arthrosis conservative treatment is used. It consists of physical therapy, body weight reduction and anti-inflammatory local joint injections and use of analgetics.

In advanced knee arthrosis with a total damage of cartilage in all parts of the knee, knee replacement is necessary (arthroplasty).

If however, only the inner or outer part of the knee is damaged, partial knee replacement is possible. Partial knee replacement is possible  when cartilage in other parts of the knee is well preserved.

Thus, the pain disappears and the full function of the knee is regained.

Patella stabilisation

Patella may be unstable for many different reasons. Some of them include congenital looseness of soft tissue, bone displasia and ligament injuries.

The treatment of unstable patella depends on the cause of instability.

Patella can be stabilised by arthroscopic cutting of the connective tissue from the external part of the patella and by stitching the connective tissue on the internal part of the patella. In this way patella  regains the correct position. In traumatic luxation of the patella when medial ligament is ruptured, reconstruction of that ligament is performed.

Bone operations are also possible to stabilise the patella. Rehabilitation depends on the type of the operation.

Corrective osteotomy

In younger patients with initial signs of arthrosis it is possible to delay degenerative changes in the joint by correcting the axis of “O”or “X” knee. These intervention are called corrective osteotomy.

In “O”knee, tibia osteotomy is performed while in “X” knee femur osteotomy is performed.

Rehabilitation – Patients stay in hospital about two or three days and immediately start with knee exercises and walk with the help of two crutches until the first check-up and RTG 6 weeks later. After that,patients usually walk with the help of one crutch only and gradually start to bear weight on the operated leg. Further check-ups are 3 or 6 months after the operation.

Regenerative therapy are used to treat degenerative diseases and injuries of the knee.

How is this procedure carried out?

Total knee replacement replaces all three damaged parts of the knee. Today the most frequently used prostheses are: biocondilar endoprostheses, cement and non-cement prostheses. Femur component is of medical steel while the tibial component is of titanium.

Polyethylene which reduces rubbing and serves as joint cartilage is implanted on the tibial component.

Today it is a special “cross link” which is a resistant to wear and tear.

Often, there is no need for patella component replacement.

Rehabilitation

Patients stay in hospital 3-4 days. With the help of physiotherapist they start physiotherapy the same day.

 The day after the operation patients can walk with the help of physiotherapist and two crutches.After two or three weeks,patients can walk with the help of one crutch only and continue like this for the next couple of weeks until they feel they can walk without crutches.The first check-up is after six weeks ,then after 3 months and then after 6 months.After that,yearly check-ups are recommended.

Knee arthroscopy

Arthroscopy is a surgical procedure that allows doctors to view the knee joint without making a larger incision through the skin and other soft tissues.

It is used to diagnose and treat a wide range of knee problems. During knee arthroscopy, a surgeon inserts a small camera, called an arthroscope, into your knee joint. The camera displays pictures on a video monitor and a surgeon uses these images to guide miniature surgical instruments.

The advantage of arthroscopic surgery compared to classical approach (arthrotomy) is that it is less invasive and causes less damage to the skin, provides better view of the inner joint and the recovery period is shorter, which is especially important for sportsmen.

Arthroscopy enables a surgeon to assess clearly the condition of joint cartilage,ligaments, capsule and other joint structures and to decide about further treatment.

Knee arthroscopy can establish and treat the following disorders:

-ligament,meniscus and tendon injuries

-synovitis

-joint fractures

-free joint bodies composed of cartilage and bone

-joint cartilage damage

Experts: Orthopaedic

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  Dr Dr. Gavrilović Gordan

  Orthopaedic and traumatology surgeon
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  Ass. dr sci med Doc. dr. Stevanović Vladan

  Orthopaedic and traumatology surgeon
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  Prof. dr Prof. dr. Blagojević Zoran

  Orthopaedic and traumatology surgeon
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  Dr Dr. Stefanović Zoran

  Orthopaedic and traumatology surgeon
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  Dr Dr. Aleksandrić Dejan

  Orthopaedic and traumatology surgeon Doctor of the Serbian national football and volleyball team
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  Dr Dr. Vukadin Ognjen

  Orthopaedic and traumatology surgeon
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  Dr Dr. Trbović Nenad

  Orthopaedic and traumatology surgeon
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  Dr Dr Zorić Miodrag

  Orthopaedic and traumatology surgeon
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  Dr Dr Raspopović Danijel

  Orthopaedic and traumatology surgeon
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  Dr Dr Lazović Andrija

  Orthopaedic and traumatology surgeon