Joint problems will be the 21st-century complaint. We are living longer and our joints are suffering more wear and tear as a consequence. Not only that — more people than ever before are taking part in sporting activities, and sports injuries have escalated as a consequence. About 5 per cent of patients in hospital Accident and Emergency departments have a sports injury.

Whatever the cause, if you suffer from painful or damaged joints there are a number of different people who may be involved in your treatment, including nurses, physiotherapists and orthopaedic surgeons. If the problem is caused by arthritis you may see a rheumatologist. If you suffer from back pain, anaesthetists and others who specialise in pain management may also assist in your treatment.

For many problems, surgery can be effective. It is important to see a surgeon with the right skills and experience. Statistics show that there is a link between the number of operations carried out by an orthopaedic surgeon and the likelihood of a successful outcome. There is also a link between the number of operations conducted in a hospital (“hospital volume”) and the success rate for that hospital.

Large-scale US studies of hip and knee patients have found that there is a significant association between low hospital volumes and hospital re-admission (because the surgery was not successful), dislocation, and deaths from infection. Looking at total knee replacements, for example, the quality of outcome was found to be better at hospitals doing more than 200 operations a year compared with those doing fewer than 25 procedures a year.

Below we list some of the key questions to ask the doctors treating you. More information on consultants who specialise in particular areas or which hospitals do most of a particular operation can be found here.

KNEE PROBLEMS

Operations on the knee are relatively common. More than 100,000 arthroscopies (keyhole procedures) and 50,000 knee replacements were carried out in Britain last year.

Knee injuries are the result of damage to the bone, the surfacing of the bone in the joint (the articular cartilage) or the soft-tissue (cartilage, ligament, muscle and tendons). A doctor’s examination will show if the bones are tender or displaced and whether the ligaments are intact. X-rays can reveal a fracture but they do not reliably reveal cartilage or soft tissue injury. It may be necessary to carry out blood tests, a magnetic resonance (MRI) scan or a bone scan to diagnose a knee problem.

The majority of routine operations on the knee, even complex procedures like cruciate ligament reconstruction, can now be carried out arthroscopically (using keyhole techniques). The arthroscope consists of a fibre-optic telescope attached to a miniature camera which can be inserted into the joint through a small incision (less than ½in/1cm in length). This allows the surgeon to see and assess damage to the joint through images projected on a TV monitor.

The arthroscopic surgeon uses this and a variety of small, specialised instruments that are passed in and out of small incisions. Compared to conventional open surgery, arthroscopic surgery produces less scarring, less trauma and less pain. Most people return to normal activity after a few days. Problems are rare but may include swelling or infection in a small proportion of cases. Not all knee conditions can be treated by arthroscopy; knee replacements still need an open operation.

KNEE LIGAMENT SURGERY
A knee ligament injury can range from a sprain to a complete tear. A sprain or a partial tear may heal by itself. A complete tear may require surgery. The ligament most commonly injured is the anterior cruciate ligament (ACL), which gives stability to the knee and aligns the leg bones.

Operative treatment for an ACL injury should only be considered when the knee keeps giving way (usually when twisting or turning). Such instability causes a general lack of confidence in the knee and sport or other outdoor activities may be impossible. ACL reconstruction may also lessen the risk of further injury to the knee such as torn cartilage.

A torn ACL cannot be simply stitched together. Instead, the torn ligament is replaced by a graft. The graft can be made from two of the patient’s own hamstring tendons or a strip of kneecap tendon. It is inserted into the knee joint in exactly the same position as the original ACL, often using keyhole techniques that leave small scars and minimise post-operative pain.

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