Orthopedic Surgeries

Given the anatomical complexity of the knee, pain can take many forms and have many possible causes. At our orthopaedic clinic, our specialists will carry out a thorough examination and recommend the appropriate therapy. If conservative treatment methods (e.g. medication, physiotherapy, physiotherapy) do not solve the problem, surgery may be recommended.

The most common knee problems are injuries or tears of the knee cartilage (meniscus), varying degrees of cartilage wear (arthrosis), cartilage detachment, rupture of the knee ligament (anterior cruciate ligament), and displacement of the kneecap (patella).

Arthroscopy

The most commonly used diagnostic and treatment method for knee injuries is arthroscopy. Arthroscopy - also known as joint reflection - is a surgical procedure used to diagnose problems in the wrist, elbow, shoulder, knee, and ankle joints, in which the interior of the joint is examined with a small camera. The surgeon makes an incision in the skin, through which the endoscope is inserted, and a camera provides a view of the inside of the joint and its condition. This allows for the detection, diagnosis, and immediate treatment of various abnormalities.

The surgical intervention is minimally invasive: making small incisions at the appropriate points on the knee, the orthopedic surgeon introduces the arthroscope into the knee joint, locating, repairing, or removing damaged parts using it.

Joint reflection can be used to examine and treat cartilage damage, tears, impingements, and painful inflammation. During the surgery, the specialist can achieve results with several solutions:

• Removal of the damaged parts of the cartilage;
• Repairing the well-vascularized outer parts of the cartilage with stitches;
• Replacing the cartilage deficiency with bony-cartilaginous grafts, also known as mosaic plastic, taken from the non-weight-bearing surface of the knee joint;
• Smoothing the worn, fragmented cartilage surface using a cartilage shaver (shaver), thus reducing friction and irritation, swelling and pain symptoms;
• In the case of a complete tear of the anterior cruciate ligament, replacing the torn ligament with a graft - usually a so-called autograft taken from the patient's own knee,
• In the case of chronic kneecap pain - typically caused by tilting of the kneecap to the outside - performing a cut on the outer sheath.

Knee Prosthesis Surgery

Knee prosthesis implantation is the second most common major joint prosthesis surgery after hip prosthesis implantation. It is most commonly needed in cases of age-related degenerative knee disease, joint inflammatory disease, joint dislocations causing damage, or accident-related deformities.

We recommend the procedure in cases where the cartilage surface covering the knee joint wears off, disappears, and as a result, bone touches bone during movement. This causes severe pain and makes movement, walking difficult.

During the knee prosthesis implantation surgery, the orthopedic surgeon makes a longitudinal incision in the skin above the knee joint. Then the joint capsule is opened, and based on the previous sizing, the femur and tibia are cut to shape, thereby removing the diseased cartilage and a small portion of the bone. The metal prosthesis implants are fixed onto the tibia and then onto the femur, and a hardened plastic insert is placed into the metal component on the tibia, thus ensuring the proper motion function.

The prosthesis implant is shaped just like the ends of the original bones on both the femur and tibia and functions just like the previous knee joint, but the inflammation and pain caused by cartilage wear disappear. Today's modern total knee arthroplasty surgeries can provide a permanent solution for patients suffering from advanced knee joint wear.

The fixation of the prosthesis can be cemented, i.e., with adhesive, and cementless, i.e., without adhesive. We distinguish two types:

• Total knee prosthesis: when it replaces the entire damaged joint surface of both the femur and tibia,
• Knee prosthesis sled: when the prosthesis replaces the joint surface of the femur and tibia only on one side of the knee. It gets its name from the shape of the prosthesis.

The type of prosthesis is determined by the orthopedic surgeon based on preoperative examinations to be the most suitable for the bone and ligament system of the knee. It is important to know that rehabilitation following implantation plays a key role in successful recovery.

The price of the knee prosthesis implantation includes the cost of 3 days of hospital care and rehabilitation following the operation, but it does not include the cost of the implant to be implanted. If a special implant needs to be implanted, its price may differ from that listed in the price list.

In the case of a knee prosthesis replacement, we provide an individual price offer.

Knee Ligament Surgeries

There are two cruciate ligaments in the knee: the anterior and posterior cruciate ligament. These ligaments connect the femur to the tibia in an X shape, ensuring the stability and mobility of the knee. The anterior ligament (ligamentum cruciatum anterior, LCA) has the task of vertically holding together the knee joint and preventing the knee from moving laterally. The posterior cruciate ligament is primarily responsible for preventing the knee from being overstretched or bent forward.

The internal and external collateral ligaments help to ensure that the kneecap does not shift during movements of the knee.

In case of ligament injuries, strains or ruptures, the stability and mobility of the knee are compromised. The anterior cruciate ligament is more vulnerable, and if this ligament ruptures, the fundamental stability of the knee disappears. During sports injuries, partial ruptures of the anterior cruciate ligament and the internal collateral ligament most commonly occur. The posterior ligament is less frequently injured, but the treatment of this should be given equal emphasis. In more severe cases of ligament rupture, knee ligament surgery is performed, which is decided by the orthopedic surgeon specialist.

Cruciate ligament injuries most commonly occur in sports that involve sudden stops and changes of direction, such as basketball, soccer, handball, or skiing.

In case of a cruciate ligament injury - partial rupture - for those patients who moderately strain their knees during everyday activities, physiotherapy treatment and wearing a knee brace may be sufficient. However, in the case of ligament injuries exposed to active strain, intense sports (e.g., athletes), surgical intervention is recommended, since the ruptured ligament does not regenerate itself but scars, and thus it cannot function as it did before the injury.

During the anterior cruciate ligament reconstruction, we replace the ruptured ligament with a graft, a tissue strand with appropriate properties taken from another part of the body - usually next to the knee. The surgery is performed with an arthroscope, making small incisions around the knee to reach the surgical area. The surgeon secures the graft into the holes drilled into the knee joint - the femur and tibia - with screws or other fixation devices. Over time, the graft is surrounded by new ligament tissue. Whether the surgery is performed under general anesthesia or spinal anesthesia is suggested by the anesthesiologist during the consultation.

In case of a collateral ligament rupture, we use a different procedure: during the surgery, we unite the injured ligament stumps with sutures (we perform a ligament suture), and then fix the joint.

It is important to know that after the surgery, a long period of rehabilitation - at least 6-8 months - is to be expected.