Thailand Medical Agency
Knee Problems and Surgery
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Medical Tourism Services >>
- First consultation about the overall of your personal conditions and the treatment programs available in Thailand.
- Recommend the professional knee and joint specialists surgoen and team with highly experienced and international standard qualified.
- Offer the health secretary service to co-operate with hospital and make your personal arrangement.
- Planing your personal program, expected the date(treatment period), estimate budgeting.
- Arrange the accommodations , living place/hotel up to the treatment expected date and your requirement.
On your coming
- Arrange the transportation to pick up you at Airport and send to the hotel we've prepared.
- Assist for any necessary needed during your long staying.
- On the hospital appointment day, take you to hospital and be your health secretary, assist you to manage your plan details from doctor.
- Visiting during the recovery period
- Recommend and guide you the attraction trips in Bangkok, Thailand or some nearby, so that you can relax and enjoy during the treatment vacation.
Anatomy and Structure of Knee
Knee Anatomy Animation
Resource >> Edewcate.com
The knee is the largest joint in the body where the bones of the upper leg meet the bones of the lower leg. Large ligaments attach to the femur and tibia to provide stability. The long thigh muscles give the knee strength to support the weight of the body. Flexibility, strength, and stability are needed for standing and for motions like walking, running, crouching, jumping, and turning.
The knee joint is the junction of three bones: the femur (thigh bone or upper leg bone), the tibia (shin bone or larger bone of the lower leg), and the patella (kneecap). The patella is 2 to 3 inches wide and 3 to 4 inches long. It sits over the other bones at the front of the knee joint and slides when the knee moves. It protects the knee and gives leverage to muscles.
The ends of the three bones in the knee joint are covered with articular cartilage, a tough, elastic material that helps absorb shock and allows the knee joint to move smoothly.
All remaining surfaces of the knee are covered by a thin, smooth tissue liner called the synovial membrane. This membrane releases a special fluid that lubricates the knee.
Normally, all of these components work in harmony. But disease or injury can disrupt this harmony, resulting in pain, muscle weakness, and reduced function.
Knee Pain
The commom causes of knee pain are arthritis, injuries and some other joint diseases
Osteoarthritis (OA) or degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis.
Rheumatoid arthritis (RA), which generally affects people at a younger age than does osteoarthritis, is an autoimmune disease. This means it occurs as a result of the immune system attacking components of the body. In rheumatoid arthritis, the primary site of the immune system's attack is the synovium, the membrane that lines the joint. This attack causes inflammation of the joint. It can destroy the cartilage, bone, muscles, tendons, and ligaments as well.
Post-traumatic Arthritis may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.
Other causes of joint pain include avascular necrosis, which can result when bone is lack of blood supply. And deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.
Arthritis Knee Pain
What Happens in Arthritis?
The knee joint is made up of 3 bones, the femur (thigh), tibia (shin) and patella (kneecap). The ends of the bones are covered by thick layers of cartilage. Cartilage is a thick, spongy material that lines the joint providing lubrication and cushioning, which allows the knee to move smoothly and painlessly. It also works as a shock absorber and ensures that the forces going through the knee during daily activities are spread evenly throughout the joint.
Arthritis pain in knees develops when the cartilage thins and wears away resulting in bone-on-bone contact which causes pain, stiffness and inflammation.
There are two main types of arthritis in the knee:
1) Osteoarthritis: where there is degeneration of the bones
>> It is commonly known as “wear and tear” arthritis. In this type, the cartilage gradually become thin, wears away or break down occur in the attach bone. As a result of these changes, there is less space between the bones. This means that as you use the knee, you can get bone rubbing on bone, causing the inflammation of joint lining and arthritis pain in knee joints. The knee bone spurs can also limit the amount of movement in the knee leading to stiffness. Osteoarthritis may be caused by joint injury or being overweight as well.
Factors that may increase your chance of developing osteoarthritis include:
>> Increasing age
>> Excess body weight
>> Family history of osteoarthritis
>> Certain endocrine, metabolic, or neuropathic disorders, avascular necrosis
>> Having an injury or surgery to the joint surface, especially the cartilage
>> Having an occupation or doing physical activities that put stress on joints
2) Rheumatoid Arthritis: where there is inflammation in the joint
>> Rheumatoid arthritis is a chronic, systemic inflammatory disorder. It occurs as a result of the immune system attacking components of the body. In rheumatoid arthritis, the primary site of the immune system's attack is the synovium, the membrane that lines the joint. This attack causes inflammation to the joint and lead to destruction of the cartilage, bone, muscles, tendons, and ligaments. The inflammation also excess fluid in the joints. Joints become swollen, painful and warm, and movement is limited by resultant stiffness.
RA can be caused by a combination of genetic and environmental factors
>> Genes—People with rheumatoid arthritis may have a specific genetic defect that increases their risk for developing this condition.
>> Family members with RA
>> Defects in the immune system
>> Chemical or hormonal imbalances in the body.
>> Excess weight or obesity
>> Heavy or long-term smoking
Treatment
The goal of treatment is to reduce joint pain and inflammation and to improve joint function. Treatments may include;
>> Medications
>> Dietary supplements
>> Alternative therapies (eg, acupunture, relaxation therapy, yoga)
>> Mechanical aids (eg, shock-absorbing shoes, splints or braces, firm mattress, canes, crutches, walkers)
>> Losing weight
>> Exercise
>> Physical therapy
>> Heat and ice
>> Corticosteroid injections
>> Surgery
Knee Injury
Knee injuries are grouped into 4 categories;
1. Ligament Injuries: damage to the ligaments that support the joint
2. Cartilage Injuries: damage to the cartilage lining the joint
3. Muscle Injuries: damaged to the muscle fibers
4. Kneecap Injuries: damage to the patella bone
>> Knee Ligament Injuries <<
There are 4 ligaments in the knee, which work in the pairs. The anterior cruciate ligament and posterior cruciate ligament control the forwards and backwards movement of the knee and are really important for providing stability. The medial and lateral collateral ligaments provide sideways stability for the knee. Ligaments are usually injured either by sudden twisting movements, or when a great deal of force goes through part of the knee eg from a sporting tackle. The common problems in this type of injuries include;
1) ACL Injuries >> Anterior Cruciate Ligament gets overstretched and tears/ruptures
2) MCL tear >> Damage to some or all of the fibres of the Medial Collateral Ligament
3) Knee Sprain >> Overstretching any of the knee ligaments which tears some of the fibres. This is one of the most common knee injuries
>> Cartilage Injuries <<
The knee joint is lined with 2 types of cartilage, articular cartilage which lines the bones, and then a second special layer of cartilage known as the meniscus. The meniscus works like special cushioning to reduce the force going through the knee bones. The common problems in this type of injuries include;
1) Meniscus Tear >> Tear in the cartilage lining the knee joint. This is one of the most common knee injuries
>> Muscle Injuries <<
If the muscles around the knee are suddenly overstretched, some or all of the muscle fibres can tear. These are commonly referred to as muscle strains. The common problems in this type of injuries include;
1) Calf Strain >> Tear to some or all of the muscles fibres in one or both of the calf muscle
>> Knee Cap Injuries <<
The common problems in this type of injuries include;
1) Dislocated Patella >> Knee cap get pushed out of place. This is one of the least common knee injuries
2) Patella Fracture >> When the kneecap bone breaks into two or more pieces.
Chondromalacia Patella
The patellar is a small bone that sits inside the muscles at the front of the thigh. It rests in a special groove (the patella groove) on the front of the thigh bone (femur) where it moves up and down as you move your leg.
Chondromalacia patella occurs when there is softening of the articular cartilage of the kneecap and when the kneecap rubs against the bones rather than gliding over them. This causes damage and small tears in the cartilage which get inflamed and leads to front knee pain, swelling and clicking/grinding noises when moving the knee.
Causes and Risk factors
>> Muscle imbalance or muscle weakness on the inside of the knee can affect the position of the kneecap in the patella groove. Instead of gliding easily up and down the centre of the groove, it is pulled out to the side which causes damaging to the cartilage.
>> Poor alignment of the kneecap where the patella doesn’t sit in the right position or tends to be either too high or too low. Some people are born this way, but it doesn’t become apparent until adolescence
>> Overuse of the leg which make lots of force goes through the knee (eg running, jumping, twisting)
>> Flat feet, this can change the way the forces are distributed through the knee and makes the cartilage more prone to damage
Symptoms of Chondromalacia Patella
>> Front knee pain: tends to be achy rather than sharp
>> Pain when you first get up after prolonged sitting
>> A grating/grinding sensation when moving the leg
>> Minor swelling around the patella
>> Tenderness with any pressure through the kneecap
Treatment
>> Exercises: Kneecap exercises and stretches can help to combat any muscle imbalance and improve how the kneecap moves.
>> Knee Brace Straps: Wearing a strap directly under the kneecap helps take pressure off the joint, dramatically reducing pain.
>> Medication: Non-steroidal anti-inflammatories (NSAID’s) such as ibuprofen will help to relieve inflammation and pain.
>> Ice: Using ice regularly, and before and after activity can help reduce swelling and pain.
>> Modifying your Activity.
>> Shoe Insoles: Insoles known as orthotics can help to correct flat feet.
>> Knee Pads: Gel Pads are an excellent way to reduce pain and irritation.
>> Surgery: This is only considered if nothing else works and the pain is really affecting you. It is done arthroscopically, where they make 2-3 small holes around the knee and insert a camera. They will then cut any tight ligaments to allow the patella to sit in the right place in the groove and/or shave off any damaged bits of cartilage.
Osteochondritis dissecans
Osteochondritis dissecans results from a loss of the blood supply to an area of bone underneath a joint surface. It usually involves the knee. The affected bone and its covering of cartilage gradually loosen and cause pain. It may be caused by a slight blockage of a small artery or to an unrecognized injury or tiny fracture that damages the overlying cartilage.
Causes and Risk factors
>> Osteochondritis Dissecans is caused by a reduction in blood flow to the end of the bone. This most commonly occurs by repeated unrecognizable injury causing damage the end of the bone. This usually happens due to overuse eg. in sport with lots of jumping or rapid changes in direction.
>> There is also a genetic link in about 10% of cases of Osteochondritis Dissecans.
Symptoms of Osteochondritis Dissecans
>> Pain: this is the most common symptom and tends to be triggered by activities such as stairs, sports and any twisting movements.
>> Joint Locking: the joint may get stuck in a position if the loose fragment gets stuck.
>> Weakness
>> Decreased movement: the joint may not fully bend and/or straighten, especially if there is a loose fragment
>> Swelling: may develop around the joint
>> Clunking: There may be a painful “clunk” when bending or straightening the knee. This usually happens when the outer side (lateral) of the knee is affected.
Treatment
Treatment varies according to the severity of Osteochondritis Dissecans but aims to:
1) Reduce Pain and swelling
2) Repair the joint surface
3) Decrease the chance of future problems eg Osteoarthritis
>> Non-Surgical Treatment
Stage 1-2 lesions can usually be treated conservatively with:
1) Rest: avoid activities that stress the joint, allows the bone to heal. Crutches may be required.
2) Physical Therapy: to strengthen and stretch the joint without aggravating the condition.
3) Knee Braces: can support the knee and reduce the pressure going through the joint.
**Children and young adults tend to respond best to these treatments as their bones and cartilage are much better at regenerating. Most adults with Osteochondritis Dissecans will require surgery.
>> Surgery: If conservative treatment has failed, or if the disease has progressed to stage 3 or 4, surgery is usually required.
Knee Treatment and Surgery
Alternative Treatments
Treatment should begin with the most basic options and progress to the more involved, which may include surgery. Not all treatments are appropriate for every patient. Knee replacement is generally reserved for patients who have tried all of the other treatments and are still left with significant pain during normal activities. Non-operative treatment options include:
>> Weight Loss
>> Activity Modifications
>> Exercise, strengthening exercise , mobility exercise
>> Knee braces or knee support
>> Heat / Ice
>> Anti-Inflammatory Medications / Pain relief medication
>> Natural Remedies / Supplements
>> Cortisone Injections
Preparing before knee surgery
Once you and your Doctor have decided that joint replacement surgery is right for you, you will need to prepare both physically and emotionally. The appointment will be set for general health check up and the hospital stay before surgery date including extended stay after surgery.
>> Medical Evaluation will take 2-3 weeks before admission date. The doctor will need to perform the physical examination and laboratory test to determine whether your body is ready for knee surgery or not. If you also have the last health check up report, you can bring and send to doctor. Its might be useful.
>> Preparing the skin on your leg. It is patient responsibility to take care of their skin on leg and knee, espectually on side that will be operated. If you have even a tiny scratch, it may be infected which may complicate the knee surgery. If you are not sure about anything on skin, you should talk to doctor before get surgery plan
>> Medications or supplements you are taking. You should bring a list of all you take and the dosage, the doctor will be seriously concern about it. Then, doctor will explain which medicine is restrict before surgery and let you stop it.
>> Social Planning...Patient should well prepare for daily activities after knee surgery. Even though patient will be able to walk with the crutches or walker, the assistant person who can help you with your meal or taking activities daily living will be also necessary.
>> Home Planning...For safety reason during patient staying at home, the secured safety bars or handrails in your shower or bath should be installed. Climbing stair will not recommend in first 3 weeks after knee surgery.
>> Hospital Admission...Normally, you will need to stay in hospital 1-2 days in advance before surgery date. Your doctor and nurse will inform you all details about using of anasthesia. The surgery may take time about 1-2 hours. After knee surgery is done, patient will need to stay in recovery room for 1-2 hours
>> Recovering and hospital stay...Usually, patient will have to stay in hospital after knee surgery around 5-7 days. During the recovery time, you be given a pain relief medication. Your leg will look big because the surgical cotton with bandage that covered on your leg to protect the inflamed and there is a small tube that drains out the residual blood in knee. The second day after surgery, doctor will take the surgical cotton and bandage out. You will be recommended to start moving slowly on your bed and push your feet toward your body and straight backward frequently to protect a blood clot in leg. After nurse remove all the bandage out, you can start to move your knee with the assisted machine to improve your knee bending. The walker machine can help you to get up and walk after knee surgery. You can put your body weight on the replacement knee although you might feel pain when move. You should frequently walk during the day to faster reduce the pain and recovery. Importantly, you must avoid water to touch your wound for the first 2-3 weeks or until doctor allow. Doctor will give some rehabilitation instruction to help you recovery quickly.
Partial Knee Replacement or Unicompartmental Knee Arthroplasty
A partial knee replacement is where half of the knee joint either the inside (medial) or outside (lateral) parts of the knee is removed and replaced with a metal and plastic prosthesis. It is called a partial replacement because only one part of the damage knee is replaced.
They are performed when there is damage to one side of the knee joint, usually from arthritis. They are sometimes known as a Uni Knee Replacement (UKR) or Unicompartmental Knee Arthroplasty.
Before surgery, you will be given anesthesia, which is medicine that blocks pain. You will have one of two types:
>> General anesthesia makes you unalert and unable to feel pain.
>> Regional ( spinal or epidural) anesthesia numbs you below your waist. You will also receive medicines to make you relax or feel sleepy.
The surgeon will make a cut over your knee.This cut is about 3 to 5 inches long.
>> Next, the doctor examines the entire knee joint. If there is damage to more than one part of your knee, you may need a total knee replacement.
>> The damaged bone and tissue is removed.
>> A man-made part made of plastic and metal is placed into the knee.
>> Once it is in the proper place, it is secured with bone cement.
>> The wound is closed with stitches.
Total Knee Replacement or Knee Arthroplasty
Knee replacement surgery is a procedure that is performed when the knee joint has reached a point when painful symptoms can no longer be controlled with non-operative treatments.
In total knee replacement procedure, your surgeon removes the damaged entire joint lining, bone and cartilage, then replace the joint surfaces with a metal and plastic implant that functions similar to a normal knee. Knee replacement implants have been modified in order to provide the best possible functioning with long-lasting results.
These pieces may be placed in up to three surfaces in the knee joint:
>> Lower end of the thigh bone. This bone is called the femur. The replacement part is usually made of metal.
>> Upper end of the shin bone, the large bone in your lower leg. This bone is called the tibia. The replacement part is usually made from metal and a strong plastic.
>> Back side of your kneecap. Your kneecap is called the patella. The replacement part is usually made from a strong plastic.
You will not feel any pain during the surgery because you will have one of these two types of anesthesia:
>> General anesthesia. This means you will be asleep and unable to feel pain.
>> Regional (spinal or epidural) anesthesia. Medicine is put into your back to make you numb below your waist. You will also get medicine to make you sleepy.
After you receive anesthesia, your surgeon will make a cut over your knee to open it up. This cut is often 8 to 10 inches long. Then your surgeon will:
>> Move your kneecap (patella) out of the way, then cut the ends of your thigh bone and shin (lower leg) bone to fit the replacement part.
>> Cut the underside of your kneecap to prepare it for the new pieces that will be attached there.
>> Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone and the other part will be attached to your shin bone.
>> Attach both parts to the underside of your kneecap. A special bone cement is used to attach these parts.
>> Repair your muscles and tendons around the new joint and close the surgical cut.
The surgery usually takes around 2 hours.
Knee Arthroplasty
Knee arthroscopy is surgery that uses a tiny camera to look inside your knee. Small cuts are made to insert the camera and small surgical tools into your knee for the procedure. Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an endoscope and the surgical instruments insert into the knee cavity through a small incision.
Arthroscopy may be recommended for these knee problems:
>> Torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
>> Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
>> Swollen (inflamed) or damaged lining of the joint. This lining is called the synovium.
>> Kneecap (patella) that is out of position (misalignment).
>> Small pieces of broken cartilage in the knee joint
>> Removal of Baker's cyst. This is a swelling behind the knee that is filled with fluid. Sometimes the problem occurs when there is swelling and pain (inflammation) from other causes, like arthritis.
>> Some fractures of the bones of the knee.
Three different types of pain relief (anesthesia) may be used for knee arthroscopy surgery:
>> Local anesthesia. You will stay awake and your knee would be numbed with pain medicine. You may also be given medicines that relax you. .
>> Spinal anesthesia. This is also called regional anesthesia. The pain medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.
>> General anesthesia. You will be asleep and pain-free.
>> Femoral nerve block. This is another type of regional anesthesia. The pain medicine is injected around the nerve in your groin. You will be asleep during the operation. This type of anesthesia will block out pain so that you need less general anesthesia.
The surgeon will make two or three small cuts around your knee.
>>A narrow tube with a tiny camera on will be inserted through one of the cuts. The camera is attached to a video monitor that lets the surgeon see inside the knee.
>>The surgeon may put other small surgery tools inside your knee through the other cuts. The surgeon will then fix or remove the problem in your knee.
>>At the end of your surgery, the saline will be drained from your knee. The surgeon will close your cuts with sutures (stitches) and cover them with a dressing.
>>Many surgeons take pictures of the procedure from the video monitor,You may be able to view these pictures after the operation so that you can see what was done.
Knee Osteotomy
Osteotomy of the knee is surgery that involves making a cut in one of the bones in your lower leg. This can be done to relieve symptoms of arthritis.
>> The surgery is called a tibial osteotomy if the cut is made on the shin bone.
>> The surgery is called a femoral osteotomy if the cut is made on the thigh bone.
Osteotomy of the knee is done to treat symptoms of knee arthritis that no longer respond to other treatments. Arthritis most often affects the inside part of the knee. The outside part of the knee usually isn't affected. This often occurs because the inside of the knee holds more of your weight than the outside of the knee when you walk and stand. Knee replacement surgery may not be the best option for some people. By having an osteotomy, you and your doctor may be able to delay a knee replacement for up to 10 years, while still allowing you to stay active.
During surgery:
>> You will be pain-free during surgery. You may get spinal or epidural anesthesia, along with medicine to help you relax. You may also receive general anesthesia, in which you will be asleep.
>> Your surgeon will make a 4 - 5 inch surgical cut on the area where the osteotomy is being done.
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If you are having a tibial osteotomy, the cut is made below the kneecap.
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If you are having a femoral osteotomy, the cut is made above the kneecap.
>> For a closing wedge osteotomy, the surgeon may remove a wedge of your shinbone from underneath the healthy side of your knee. >> For an opening wedge osteotomy, the surgeon may also open a wedge on the painful side of the knee.
>> Staples, screws, or plates may be used, depending on the type of osteotomy. >> You may need a bone graft to fill out the wedge.
The procedure usually takes 1 to 1 1/2 hours to perform.