What it is Arthritis? The bones that form your hip and knee joints are covered in cartilage providing a smooth and frictionless surface. This allows easy movement of the joint and acts to protect and cushion the ends of the bones where they meet to form a joint. If the cartilage wears away, the underlying bones become exposed. This will lead to painful motion between the exposed bone surfaces (bone on bone arthritis). It may also lead to abnormal outgrowth of bone causing painful spurs (osteophytes).

When non-surgical treatment for your knee arthritis is no longer effective, I will discuss with you the role of a total knee replacement. The decision to proceed with surgery will be made collaboratively, between you, your family, primary care doctor, and myself. Total knee replacement is surgery to replace the damaged part of your knee joint with an artificial implant. It is an effective procedure to relieve pain, and restore mobility/function so you can resume normal activities.

In a partial knee replacement, only a portion of the knee is replaced. This surgery is typically performed for osteoarthritis (wear and tear type) and post-traumatic arthritis (arthritis that develops after an accident such as a fracture or meniscal injury). The prerequisite for a partial knee replacement is that the arthritis only affects a single compartment of the knee (medial, lateral, patellofemoral). During the procedure, the damaged compartment is removed and replaced with metal components and medical grade plastic bearing. Healthy cartilage in the other compartments, along with all knee ligaments are all preserved. Different types of partial knee replacements: Each of the three compartments – medial, lateral, patellofemoral (knee cap) can be replaced, depending on the location of arthritis.

When non-surgical treatment for your hip arthritis is no longer effective, I will discuss with you the role of a total hip replacement. The decision to proceed with surgery will be made collaboratively, between you, your family/whānau, primary care doctor, and myself. Total hip replacement surgery involves removing the damaged bone and cartilage and replacing it with prosthetic components. The damaged socket (acetabulum) will be prepared to receive a metal socket. The damaged ball (femoral head) will be removed, and a metal stem will be placed into the thigh bone (femur). A ceramic ball and liner will be inserted on to the stem and socket, forming the artificial joint. In some instances, I may use bone cement to help fix the prosthesis on to your bone, depending on your age, bone quality, and indication for surgery.

What is an Anterior Cruciate Ligament? The anterior cruciate ligament (ACL) is one of the four major ligaments in the knee joint. It is located in the center of the knee and helps to stabilize the knee joint by preventing the shinbone (tibia) from sliding forward on the thighbone (femur). It helps to prevent the knee from wobbling or collapsing. It also helps to control the rotation of the knee joint. How do you injure your anterior cruciate ligament? ACL injuries are common in sports that involve sudden stops and changes in direction, such as rugby, soccer and netball. They can also occur in non- athletic activities, such as a fall or a motor vehicle accident. If ACL surgery is required, I will use key-hole (arthroscopic) surgery to reconstruct your torn ACL using a graft from another part of your body. This graft can be taken from your quadriceps tendon, patella tendon, or hamstrings tendon.

What is a high tibial osteotomy? High tibial osteotomy (HTO) is a surgical procedure that is used to realign the bones that form the knee joint, to prevent development or progression of arthritis in one compartment of the knee. Its primary goal is to reduce pain, improve function, and delay the need for joint replacement surgery. How does a high tibial osteotomy work? Angular deformity, such as bowing of the knee, can lead to increased distribution of weight through one part of the knee. This can lead to accelerated wear and tear of the cartilage in the knee and lead to degeneration. Injuries such as previous knee fracture/dislocation and meniscus injury, can also cause accelerated cartilage degeneration and cause post-traumatic arthritis. During an HTO, I will cut the shin bone (tibia) and realign it so that the weight-bearing forces are directed away from the damaged part of the knee to a healthier area. This will offload the damaged part of the knee.

What is a meniscus? In your knee, there is an inner and outer meniscus (medial and lateral meniscus). The menisci (plural of meniscus) are specialized soft tissue composed primarily of collagen and water. The menisci sit between the cartilage of the thigh bone (femur) and shin bone (tibia), protecting the knee joint cartilage. It acts as shock absorbers and help to make knee movements smooth and contribute to the overall stability of the knee. How do you injure your meniscus? Meniscal tears occur due to shear forces between the thigh bone and shin bone. Typically, an acute tear occurs during a forceful, twisting knee movement whilst the foot is still on the ground. Meniscal tears can also occur without an acute severe injury. In some cases, a tear develops due to gradual wear and tear (degeneration), especially in older population as the worn meniscus tissue is more prone to tears. A seemingly minor incident may cause a meniscus tear in the older population. Treatment depends on the type and location of the tear, your activity levels, and your symptoms. It is important to know that even if you have been diagnosed with a meniscus tear, it does not necessarily mean you will need to have surgery.

What is a patella dislocation? A dislocated patella (kneecap) is a common injury. When the kneecap dislocates, it will come out of the normal groove it lies in. It is frequently associated with tearing of the muscles and ligaments. Often, the kneecap will go. back into the groove spontaneously, but sometimes it needs to be put back into place at the hospital under sedation (this process is called a reduction). For a first-time dislocation, the treatment is usually non-surgical, with a short period of bracing and referral to physiotherapy. If you have injured any other structures at the time of your first patella dislocation, such as cartilage injury, fracture, or loose bodies in the knee, I may recommend surgery to manage these problems acutely. If you have recurrent dislocations despite thorough rehabilitation, especially if you have normal variations in the shape of your knee which predispose you to further dislocations, then surgery may be recommended.