Wilhelmsburger Krankenhaus - Insel der Menschlichkeit

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Main focus trauma surgery / orthopaedics - knee joint surgery

Knee joint
The knee joint carries our entire body weight and sometimes a lot more. On average, a human being takes about 1.5 million steps a year and carries out numerous other movements. To make all this possible for us, the knee joint composed of an open joint which is made up of the long femur, the shinbone (fibia) and the kneecap and stabilised by ligaments and muscles. A layer of cartilage and the so-called synovial fluid keeps the bones apart from each other and so ensures almost perfect movement free of pain.

Knee joint surgery - the whole spectrum of modern knee joint surgery.
Our concept - findings-dependent individual method selection and operation procedures.

Axis correction knee joint
Where there are pronounced malpositions of the legs, i.e. knock knees or bandy legs, the inside and the outside of the knee is falsely pathologically stressed. In time, this often leads to a premature knee arthrosis. Particularly for cartilage damage, or after relevant operative care, the straightening of such axis malpositions are of key importance for the long-term healing success. Depending on the situation, the malpositions are remedied by removing or replacing a shelf wedge on the thigh or in the tibial plateau area.

Cartilage surgery
Human cartilage is particularly exposed to extreme stress during the course of a lifetime in the hip joint and knee joint and is therefore of an extremely abrasion-resistant consistency. Deterioration, injuries and inflammations to the joint as well as diseases of the joint such as rheumatism can result in a cartilage defect. As our body is hardly in a position to repair the cartilage on its own, often the only treatment for extremely widespread cartilage damage is an artificial joint. Where the cartilage damage is small to medium, modern joint surgery, however, does have various special treatment methods such as the culture of own cartilage tissue, arthroplastic abrasion and mosaic cartilage bone ransplantation.

The culture of own cartilage tissue
So far, the most experience with the culture and transplantation of own cartilage tissue has been made on the knee joint. In autologous cartilage transplantations, initially a small piece of healthy cartilage is removed from the healthy fringe area of the joint during the course of a joint arthroscopy. In the laboratory, the cartilage cells of the removed tissue are caused to multiply. The result is the creation of a so-called cartilage culture which can be implanted into the defective cartilage through a small opening in the joint. After the cartilage cell transplantation, patients should consistently only put partial pressure on the knee. A passive exercise treatment of the knee joint using motor-operated motion device (CPM - Continuous Passive Motion therapy) is permitted.

Arthroplastic abrasion
Arthroplastic abrasion is particularly used during knee joint arthrosis. With the framework of a knee arthroscopy the uppermost layer of bone, where the cartilage is completely destroyed, is drilled, milled or opened with the smallest hammers. This results in minimal bleeding from the undamaged bone. With the blood, connective tissue cells enter into the defective area; at a later stage these cells then convert to replacement cartilage. In this way, the defect is covered by a fibro-cartilage layer. Although fibro-cartilage is not nearly as resilient as the innate hyaline cartilage, it is nevertheless better than not having any cartilage at all. It usually takes about four to six weeks to form the new joint coating. Unfortunately, an arthroplastic abrasion does not always lead to sufficient replacement cartilage formation. Arthroplastic abrasion can always be combined with a joint conversion operation to relieve the primarily damaged main knee joint. The strain on the fibro-cartilage is thus reduced and the changes of a long-term improvement to the complaint is increased.

Mosaic cartilage bone transplantation
Cartilage damage of dimensions up to six square centimetres can be treated by way of a mosaic cartilage bone transplantation. In this technique, bone cartilage cylinders with undamaged cartilage are removed from joint areas not subject to stress and transplanted in mosaic form into the defect cartilage. This process allows for an up to 80 percent reconstruction of a defective cartilage area with hyaline cartilage, that is to say healthy innate cartilage. The remaining gaps are filled with fibro-cartilage. In this way, a new intact and resilient joint area is created.

Meniscus injuries
With very few exceptions, an operative arthroscopic treatment is required for meniscus injuries. Torn off meniscus parts have the effect of sand in a motor and destroy the joint's cartilage which leads to premature deterioration of the joint. The aim of the arthroscopic operation is to retain as much healthy meniscus tissue in the knee joint as possible. Completely torn off meniscus parts are removed.

Particularly with younger patients with an accidentally caused meniscus tear close to the joint capsule, an arthroscopic meniscus suture or arthroscopic meniscus fixing with special surgical staplers are indicated. The injured meniscus can quite often be saved with this method. A meniscus suture, however, requires a long-term relief and care of the knee joint so as to allow for a stable healing process for the menisci which are exposed to extreme stress in daily life.

Cruciate ligament injuries
For young and sporty people, cruciate ligament injuries count among the injuries most operated on of
the knee joint. Both the anterior as well as the posterior cruciate ligament provide the central supporting pillars of the knee joint An instability in the knee joint takes place after a tear of the anterior cruciate ligament which is often not clearly noticeable when walking normally and performing everyday movements. Knee experts agree that knee joint instability in active patients cannot sufficiently be compensated for by mere non-operative treatment involving muscle treatment.

It is important to restore the lost support in the knee's interior after a cruciate ligament rupture. During the operation, we carry out an anterior and exterior cruciate ligament plastic surgery arthroscopic, that is to say with small skin incisions. We prefer to use the thigh tendons semitendinsus and the gracilis tendon from the inside of the thigh; these are removed via an approximately 3cm skin incision below the knee joint. As that area has several strong tendons, there is no loss of strength or functionality through the removal of the tendons. In rare cases where the tendons are not suitable, we fall back on a graft from the middle third of the patella tendon with bone. This requires an incision of between three to six centimetres below the knee joint to extract the tendon. The whole operation is performed arthroscopically. The new replacement cruciate ligament is set firmly in place with resorbable screws on the drilling channel; the screws fully dissolve within a year following the operation.

Rehabilitation takes place immediately after the operation. Usually, one can put pressure on the knee and move it immediately. Each patient receives a personally adapted post-op physiotherapy treatment plan which is based on the operation so as to build up muscles, and train walking and movement processes. The patient can usually leave the clinic after three days and, apart from possible recovery pain, is fully deployable. First sports activities can already start three months following surgery.

Post-op treatment after joint surgery
After any surgical procedure to the joints, each patient receives a personally adapted post-op physiotherapy treatment plan which is based on the operation. The programme is geared at building up muscles, and training walking and movement processes. Your cooperation is extremely important in this process. Our goal is to see that you get well as quickly as possible and can regain your usual quality of life.

Geriatric endoprosthesis consulting hours
These consulting hours are intended for older patients with numerous and serious accompanying illnesses who require an artificial knee joint or hip joint. Here you will not only be examined and advised by a specialist surgeon but also by an anaesthetist, an internist and specialists for geriatric medicine.

Any necessary preliminary examinations can be planned together with your general practitioner. Together we shall ensure that the accompanying illnesses are adjusted and the operation can be performed applying the highest level of safety. Rehabilitation already starts on the day prior to the operation: Under the supervision of a physiotherapist, the patients learn how to walk using forearm crutches, so that they are mobile as quickly as possible after the operation.