COVID-19 Update | Full Return of Elective Surgery in South Australia
Dr Crowley specialises in arthroscopic (minimally invasive) surgery of the knee to treat mechanical causes of knee pain. He performs over 300 surgeries of this type per year.
He also performs total and partial (unicondylar or unicompartmental) knee replacements in appropriate patients (approximately 150 per year). Dr Crowley is experienced in anterior cruciate ligament reconstruction. He routinely uses hamstring tendons but also has significant experience in using the middle third patellar tendon and artificial tendons (LARS).
A knee arthroscopy is a surgical procedure used to examine, diagnose and treat several knee related conditions such as osteoarthritis, patella problems, knee synovitis and meniscus and cartilage injury.
An arthroscope requires admission to hospital and anaesthesia. The surgeon makes 2 very small incisions (portals) through which an arthroscope (camera) and instruments are inserted into the separate portals, in order to examine and treat the meniscal and articular cartilages, the cruciate ligaments and the synovial lining/inflammation – depending on what is the patient’s treatable condition.
The procedure is performed as day surgery or a single overnight stay. Due to the minimally invasive nature of the surgery, recovery time is relatively short; for the majority of patients, it takes between one and six weeks to recover. Recovery is largely dependant on the patient’s past medical history and response to rehabilitation.
The Anterior Cruciate Ligament (ACL) is one of four main ligaments of the knee and the major anteroposterior stabilising ligament, whilst also providing rotational stability to your knee. ACL Reconstruction surgery is aimed at restoring knee stability.
ACL Reconstruction surgery requires admission to hospital and is performed arthroscopically (several small incisions) and requires anaesthesia, with or without a nerve block. The ligament is replaced by a tissue graft, routinely taken from the hamstring tendons of the same leg, or occasionally an artificial (LARS) ligament.
The procedure is performed as day surgery or a single overnight stay and immediate post surgery mobilisation is encouraged. Complete recovery from an ACL reconstruction requires long-term rehabilitation and therefore the recovery time for ACL reconstruction will vary depending on the patient’s dedication to rehabilitation. It can take six months to a year to return to active sporting activity.
When the knee joint is severely worn out, whether by arthritis or an injury, a Total Knee Replacement (TKR) / Knee Arthroplasty may be required for the patient. As the name of the procedure suggests, it replaces the surface of the knee joint with artificial materials (metal and plastic components).
The procedure involves anaesthesia with or without a nerve block and an incision. It involves removal of the worn out articular cartilage surfaces and bone of the femur (thighbone) and tibia (shin bone), the synovial lining (synovectomy) and the patella (knee cap). The metal and plastic implants are then inserted and then fixed in place using either bone cement or press fit technique. The exact steps will vary depending on the patient’s knee joint condition and age.
Recovery time from surgery may vary from three to six months to a full year and rehabilitation will be an important part of recovery. Rehabilitation will include physiotherapy, hydrotherapy and a gym strengthening program. After full recovery, patients should be pain free and functional. However, it is very common that following knee replacement surgery patients are unable to run or kneel on the replaced joint.
Total Knee Replacement Revision surgery is not commonly needed. Primary Total Knee Replacement surgery, although very demanding, tends to be very successful, with a 96% twenty year survival rate. However, on some occasions, for a variety of reasons, there is a chance that a TKR may fail. In these rare cases, the patient could experience symptoms such as knee stiffness, instability, pain and/or swelling – and this is why a Revision TKR may be required.
Revision TKR is a different surgery than primary TKR; specific parts of the original artificial knee join, or its entirety, will be removed and replaced with new ones. The procedure lasts longer, is more complex and requires careful planning, specialised implants and equipment. In most cases it also requires bone graft.
Recovery time largely depends on the patient – however, most peopled are able to walk with a cane within one to six weeks. Rehabilitation will be important during recovery with a patient undergoing physiotherapy, hydrotherapy and a gym strengthening program.
Also known as Unicompartmental Knee Replacement, this surgery is much less invasive than Total Knee Replacement. If affects a smaller part of the knee join and it is recommended for people who have a serious arthritis knee problem confined to only one of the three compartments within the knee; if this is not the case, a Total Knee Replacement is the next step.
Partial Knee Replacement involves a shorter incision and it is specifically targeted at removing only the damaged cartilage areas, while leaving any healthy areas of the knee joint intact. It requires the use of smaller implants.
The recovery period can be six weeks after surgery but always depends on the patient, their medical history and their body’s recovery rate and response to rehabilitation, including physiotherapy, hydrotherapy and a gym strengthening program.
Dr Richard Crowley has recently launched the new mymobility Apple Watch App program for knee replacement patients. The program utilises wearable technology to transform patient care after surgery. Patients receive a free Apple Watch® and app to guide their recovery pre and post surgery. Find out more about the mymobility experience.