Undergoing knee surgery can be a daunting process, especially when you’re faced with multiple options. A total knee replacement is usually recommended for treating widespread tissue damage in the knee. But sometimes a partial knee replacement is more suitable.

Designed to treat specific areas of arthritis damage in the knee, a partial knee replacement is a less invasive approach than a total replacement. So, what does this procedure involve, and could it be a better option for you? Read on to discover more.

What is a partial knee replacement?

A partial knee replacement focuses on replacing only one damaged compartment of the knee. It is often referred to as a unicondylar replacement or unicompartmental knee replacement surgery.

There are two main types of replacement you can undergo, including fixed-bearing and mobile-bearing procedures.

In a fixed-bearing partial knee replacement, there’s a rounded component on the femur that sits on top of a flat component on the tibia.

The mobile-bearing procedure features a movable plastic spacer nestled between these components, allowing for slight rotation in the medial compartment. This rotation capability gives it the ‘mobile’ descriptor.

Research has proved that both types of partial knee replacement give favourable outcomes. However, Mr Punwar uses the fixed-bearing partial knee replacement because it has excellent results on the National Joint Registry.

When might it be recommended?

A partial knee replacement may be suggested when only one compartment of your knee is affected by arthritis or damage, and the other parts remain healthy. This could be due to specific injuries, isolated arthritis, or wear and tear localised to one area.

Patients experiencing consistent pain, swelling, or stiffness in one part of the knee, which isn’t relieved by non-surgical treatments could be ideal candidates for the procedure.

Your orthopaedic surgeon will evaluate the extent of the damage through physical exams and imaging tests. This will help to determine if it is the right solution for you.

The benefits of a partial knee replacement

Choosing a partial knee replacement offers several advantages. Firstly, because it’s a less invasive procedure, the surgery typically involves a smaller incision. This can mean less pain postoperatively and a quicker healing process. Also, with the ‘mid-vastus’ technique, the quadriceps tendon is not split, so the recovery is quicker with a faster ability to do a straight leg-raise.

The procedure is usually carried out under a regional anaesthesia, which avoids potential complications of general anaesthesia. Also, it often leads to a shorter hospital stay and a faster return to daily activities. Since only the damaged part of the knee is replaced, preserving more natural bone and tissue, patients also tend to feel that their knee moves more naturally compared to a total knee replacement.

Of course, knee arthritis can continue to spread into other areas of the knee, but a partial knee replacement can help with knee stability, giving additional protection against wear and tear.

Certainly, all these benefits make partial knee replacements an attractive option for those who qualify.

To determine your eligibility for a partial knee replacement, or to find out more, schedule a consultation with Mr Shah Punwar.

Knee injuries, specifically those affecting the anterior cruciate ligament (ACL), are increasingly prevalent among young athletes. Furthermore, recent stories following the ‘ACL injury epidemic’ in Women’s Football demonstrates how important it is to ‘tackle’ the issue.

These injuries are notoriously challenging to treat, with a high risk of re-injury, making early prevention paramount. Enter ‘Power Up to Play’, a targeted, evidence-based warm-up program designed to safeguard the athletes of tomorrow from such injuries.

Here, we’ll explore the invaluable role of a proper warm-up, and the importance of the ‘Power Up to Play’ routine.

Why Warming Up Properly is Key to Preventing Knee Injuries

There is a way to lower the risks of developing a knee injury, and it lies in our warm-up routine. Warming up the body before strenuous physical activity significantly reduces the risk of injury. It prepares and loosens the muscles, making them less likely to strain or pull.

For adolescents and young adults, playing sports isn’t just beneficial for their physical health, but also their mental well-being, friendships, and team-building skills. However, these benefits can be marred by injuries such as ACL tears. Sports involving abrupt direction changes, jumping, and knee twisting can spike ACL injury rates, leaving athletes at risk.

A tear in the anterior cruciate ligament poses significant concerns, especially in adolescents. Their bodies are still growing, making the recovery process longer and more complicated. Surgical intervention carries its own risks, including a higher likelihood of re-injury and future joint arthritis, compared to adults.

What is Power Up to Play?

‘Power Up to Play’ is a brief yet powerful warm-up routine that’s been proven to substantially cut down on serious knee injuries when integrated into a player’s regular training or pre-match routine.

Ideally, athletes should follow the program at least 2-3 times a week to ensure safer, more effective performance.

The program involves a dynamic mix of running, plyometrics, stretching, sport agility exercises, and strengthening. It’s vital to maintain correct form throughout all the exercises to get maximum benefits and injury prevention.

‘Power Up to Play’ helps to strengthen key muscles, reinforce robust body positions, and improve stability and control. With a focus on safer landing techniques, the program takes significant strides in knee injury prevention, offering athletes a smarter, safer path to the playing field.

Treating an ACL Injury

While the ‘Power Up to Play’ warm-up program is a valuable tool in preventing knee injuries, it’s essential to understand the steps to recovery should an ACL injury occur.

The course of treatment, whether surgical or non-surgical, hinges on various factors, including the severity of the injury, the patient’s overall health, and their activity levels.

Treatment focuses not only on physical healing, but also providing patients with strategies to optimally recover and get back on their feet. It is critical to approach the healing process with patience, diligence, and proper guidance.

To find out more, book a consultation with Mr Shah Punwar by calling 020 8194 8541.

Experienced consultant knee and hip surgeon, Mr Shah Punwar is now able to offer patients extended appointment times at The Blackheath Hospital, London.

Evening consultations are available between 5.30pm and 8.00pm, on alternate Tuesdays.

Contact the clinic on 0208 318 7722 or email Punwar.admin@lips.org.uk to book an appointment.

Arthrogenic muscle inhibition (AMI) can occur after knee injuries or surgeries, resulting from neural inhibition that causes failure in quadricep activation. Its impact on quadricep strength is significant, as knee extensor peak torque may decrease by 80 to 90% within one to three days following knee joint surgery.

While this effect lessens over time, residual levels of AMI can persist for up to four years after the initial joint trauma. AMI also seems to be a constant presence in arthritic joint diseases, contributing to a considerable amount of quadricep muscle weakness.

Here, we look at how AMI can impact rehab after knee surgery, and how it can be effectively managed.

AMI could prove to be a barrier to rehab after knee surgery

AMI poses a major challenge in the rehabilitation process for those with arthritis or recovering from knee injuries and surgeries. By better understanding its root causes, improved treatment methods can be created that will benefit patients with knee joint issues. AMI can also hinder the process of strengthening the quadriceps, especially during the initial months following an injury or when there is significant joint damage.

The severity of AMI can depend on factors such as the angle of the knee joint, extent of joint damage, and the time since the injury. Its cause is linked to alterations in the output of sensory receptors within the joint, influenced by joint looseness, inflammation, damage to joint receptors, and swelling.

Spinal reflex pathways that may contribute to AMI include the group I nonreciprocal (Ib) inhibitory pathway, flexion reflex, and gamma-loop. There is also initial evidence that suggests higher-level pathways could play a significant role.

How can AMI be effectively managed?

Potential treatments to combat AMI include cryotherapy, transcutaneous electrical nerve stimulation, and neuromuscular electrical stimulation. In cases where there is strong inflammation alongside joint issues, nonsteroidal anti-inflammatory drugs and intra-articular corticosteroids (injected into the joint) may also be effective.

A recent study has shown that cryotherapy and physical therapy can help to effectively manage AMI. A comprehensive review of intervention effectiveness was carried out, following the guidelines and methodologies established by Arksey and O’Malley, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

The search terms used included a range of keywords related to knee injuries, quadriceps activation, arthrogenic muscle inhibition, and neuroplasticity. Each article’s risk of bias was assessed using the PEDro criteria, while the overall quality of evidence for each intervention was evaluated using the GRADE approach.

The review found moderate-quality evidence supporting the effectiveness of cryotherapy and physical exercises in boosting quadriceps activation after ACL injuries and reconstruction. As a result, these treatment methods are recommended for managing AMI.

Mr Shah Punwar has occasionally seen AMI in patients after knee surgery. Book an appointment today if you suspect you have AMI following a recent surgery, or to discuss the risk involved if you are due to undergo a knee procedure.

Having travelled the World in the military, and working as a chef at top class events including the London Summer Olympics 2012, Brian knows all about excellent service. After his total knee replacement surgery with Mr Shah Punwar, he likened the procedure to ‘a five star plus hotel experience’.

Having led a very active life, including playing football and working long shifts on his feet, Brian developed arthritis in both knees. Brian was taking medication for the pain and received regular injections from his physio. But his pain was getting more severe, so he was referred to Mr Shah Punwar for total knee replacement surgery.

He takes us through his knee surgery experience with Mr Punwar and his team.

Discharged in 19 hours!

On the day of surgery 5th January, Brian remembers signing in and going straight up to the ward at The Blackheath Hospital. There he was greeted warmly by the surgical team that all introduced themselves.

“Everyone was so friendly. They were just gorgeous people!” He said.

“When I went down for the surgery, the anaesthetist explained everything that was going to happen. The whole thing was so pleasant!”

Not squeamish, Brian was happy to watch them perform the operation on his right knee under a spinal anaesthetic. “I was peeking over the screen to see what they were doing,” he chuckled. The surgeon fitted the implant, then closed the wound with staples and a special surgical dressing.

After the surgery, when Brian was back in the recovery room he enjoyed being given pots of tea. He recovered that night on the ward, already using a walking frame to move around and visit the toilet, refusing any manual support offered by the nurses.

Keen to get home to get home to his girls (two beautiful black cats) he was determined to pass his early morning checks with the physio. He proved that he could walk with crutches and get up stairs – making it up a whole floor! He was given some pain relief medication to take away, and was able to leave the hospital just 19 hours after his surgery began.

Brian’s recovery – preparing for his other knee replacement

“My neighbours, everybody, couldn’t believe I was walking so quickly,” said Brian. He was already visiting the local shops, and using uneven steps down to his garden to play with his two cats.

Now building up strength with more walking, he said that he feels no pain in his operated knee. The only evidence of the surgery is a very neat, straight line. Mr Punwar has been monitoring his progress in readiness for his second surgery, expected before the Summer. Then, he is planning to go back to living in Tanzania in Africa with ‘his two girls’.

His final word on knee surgery with Mr Punwar,

“I highly recommend it. I’m just so pleased! I couldn’t give Mr Punwar and his team high enough praise.”