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Mr Kincaid answers knee questions on BBC Radio Cornwall
Thursday 11 August 2016

Mr Robin Kincaid, Consultant Orthopaedic Surgeon at Duchy Hospital answers BBC Radio Cornwalls listeners questions regarding knee problems on the Laurence Reed lunchtime show. If you missed the show here are some of the Q & A's:-

Presenter

Q. How busy is knee surgery in Cornwall at Duchy and RCHT?

A. Conditions relating to knees and hips are common problems. A lot of hip and knee replacements are performed in Cornwall each year, 500 -1000 of each.

Q. Knee problems, is it age related and what causes them?

A. Cartilage tears tend to be the younger generation – sport related injuries. Problems that occur as we get older are often related to arthritis and wear and tear. Can be genetic link or maybe related to previous injury e.g. cartilage removal which can lead to arthritis or infection or other kind of injury making you susceptible to arthritis

Q. How long does it take to perform keyhole surgery to the knee?

A. Under general anaesthetic, as a day case, the procedure lasts approximately half an hour. Normally patients are up and about 3 hours later. It is recommended to take a week to two weeks off work after surgery.

Caller 1

Q. Phoning about husbands’ knee which he injured when kneeling down, went to the GP in lots of pain. The results of an x-ray showed fragments floating round in the kneecap and he has been referred to the local MSK Physio.  Will a knee support cause any further damage?

A. Surgeon says won’t do damage by having a knee support. You can purchase one from a local walk in physio, some practices stock them. How long have you been specialised in knee surgery? 15 years.

Caller 2

Q. Following a motorbike accident advised to lose weight after an MRI scan and now has lost 6 stone. Locking knees since the accident and now can’t walk very far, what advice would you give?

A. Get up to date X- ray and a referral to see MSK specialist physios who deal with knee, hip and other orthopaedic problems, they may then refer you for surgery.

Caller 3

Q. In 1969 fell off a roundabout and dislocated kneecap. Now repeatedly ‘comes out’ when she moves her leg to the right and pushes down hard and something clicks at the back of the knee. This has occurred five times in past six weeks and as a result cannot walk properly.

A. Sounds like a partial dislocation and may well have arthritis underneath kneecap. Will need to get some scans carried out and see a knee specialist. Keyhole surgery may be an option to assess the joint properly and see what needs to be done. Advised to go to GP and ask for orthopaedic referral.

Presenter

Q. Are there any knee problems you can’t fix?

A. Most conditions we can at least provide an explanation. Some conditions are not treatable simply by surgery and are better sorted out by a physio. Often knee problems require building up muscle to make sure the kneecap is tracking in the right direction or if you have tight hamstrings that can cause problems as well. Also there might be a problem near the knee rather than in the knee like a cyst or inflammation of tendons, which isn’t best treated by surgery but might need an injection, physio or advice on which movements to avoid.

Caller 4

Q. About ten years ago had both hips replaced because of wear and tear and arthritis, now knees feel the same, with pain for the last six years, at the age of 74.  The pain is ok in the morning for a few hours and then by lunchtime I need to take pain killers as it feels like a knife turning inside the kneecaps. Seen GP and also had x-rays but specialist says no kneecaps there so doesn’t know what can be done. 

A. Something can be done about kneecap arthritis with surgery by inserting a plastic button underneath worn-out kneecap and a new shiny metal groove for the kneecap to sit in. The operation is like a partial knee replacement, 2-3 months to recover; this is a good procedure for kneecap arthritis. Needs to go to GP and if GP feels it appropriate then he can be referred to RMS and will get a phone call from them and they will offer him an appointment at the hospital of his choosing and he can also request to see a particular surgeon.

Caller 5

Q. Suffers with severe osteoarthritis and is currently under a Consultant at Duchy. Currently on medication and wears a support. 47 years old and is considered too young for operation. 

A. Might depend on where in your knee the arthritis is. If on one side but not the other nowadays we do something called an osteotomy an old fashioned operation but coming back into fashion again, we don’t replace the knee but change angle of leg so you are walking on the healthy part of the knee. If you are living in pain and there is nothing else we can do then we can replace the knee but the knee replacement may last only 10 years at the most.

Caller 6

Q. Two months ago I twisted my knee, think it is a tendon problem. How long will it take to recover?

A. Probably take a couple of months, advised to take anti-inflammatory painkillers if she can tolerate them and also recommend seeing a physio.

Caller 7

Q. Classical ballet dancer, not in first flush of youth and having difficulty with right knee, not giving way but very painful and uncomfortable when going downstairs. The pain is in the centre at the top of the kneecap.

A. It may be that there is a degree of inflammation in quadriceps tendon. Tendinopathy (inflamed tendons) if they are stretched repeatedly through dancing and they don’t get chance to heal. It is okay to do gentle squats or rowing / cycling, but if you lift leg then don’t bend knee.  Need to keep quads strong but let the tendon recover, advice is to rest and see a physio. 

Q. A classical ballet dancer with performances to do so would strapping it help?

A. Might be helpful but needs rest to heal.

Q.Could it be due to a pelvic imbalance?

A. Yes, if hips have a certain rotation if can affect the knee.

Caller 8

Q. Wife needs double knee replacement, aged 62 but has been advised that a second replacement may well be difficult for her when they need replacing again.

A. Okay to consider knee replacement in 60s. Bear in mind that knee replacement may wear out and a revision op is a more technically difficult, higher complication rate but if quality of life is what you need then it may be the right op for you.

Caller 9

Q. Had total left knee replacement in October 2013, no pain when walking but if she knocks it or touches it then pain shoots across front of knee.

A. Scar sensitivity is a possibility, the skin nerves get cut and sometimes they can become quite sensitive and form a neuroma - a ball ending of nerve. Treatments include a special cream, Capsicum cream (hot pepper cream), where it irritates to the skin to a point where it empties all the nerve endings. It is used by pain clinics for hypersensitivity of scars. A referral to pain team through your GP is advised and sometimes GPs may prescribe this cream.

GP thought it was the scar when she saw him last.

Caller 10

Q. My left leg has a pull effect and my hip aches when I go upstairs; also when I sit my leg pulls and my bottom hurts.

A. Could be related to hip or possibly sciatic nerve problem. An X ray to see what is going on in the hip would be advised.

Caller 11

Q. Both knees and hip replaced, x-rayed and fell down last August and been painful since then. Could kneecap be out of place?

A. Advice is to get this investigated by an orthopaedic Consultant.