Mr Craig offers tailored treatments to address a range of knee conditions, from sports injuries to degenerative diseases and is dedicated to your renewed mobility, improved function, and a better quality of life.
BMedSci (Hons), BM BS, MSc (Distinction), FRCS (Orth)
Practises at: The Droitwich Spa Hospital
Most often the cause of knee osteoarthritis arthritis is unknown but can be related to previous injury or inflammatory diseases such as Rheumatoid Arthritis.
As arthritis in the knee progresses it is common for people to feel a deep-seated pain around the sides, front or back of their knee. This pain can travel down towards the inner aspect of the shin towards the foot. The pain is often described as a dull severe ache much like a tooth ache, with episodes of sharp stabbing pains superimposed. These pains are not always present continuously and people often will have good days and bad bays. The pain is often felt after a few minutes of activity and at night time. It is also common to find the person no longer “trusts” their knee and can be worried about it giving way.
Initially some of the pain can be managed through lifestyle modification such as weight loss, the use of a stick and/or simple pain killers. Sleeping with a pillow between the knees can also be of some value.
When seen in clinic a thorough medical history will be taken and an examination will be performed. Radiographs of the knee(s) will be requested at the appointment if not available already from the GP.
Taking all the factors into account and if pain is interfering with quality of life then surgery in the form of Total Knee Replacement may be suggested as an option.
Total Knee replacement surgery is an effective, reliable, and long-lasting solution to removing knee pain and allowing a return to a pre-arthritic level of function.
On the day of surgery you will be seen by the Consultant Anaesthetist to discuss the specifics of the anaesthetic. Usually this will involve an injection in the back (Spinal Anaesthetic) which numbs both legs. In addition an injection is placed around a nerve in the mid thigh. In addition to this, Mr Craig will inject further anaesthetic into the tissues around the knee during the procedure. Most people opt to be given some medicine to fall asleep for the duration of the surgery.
You will be positioned for your operation on your back with the knee bent. A torniquet is placed around the upper thigh but will only be inflated for 15 minutes - if at all – whilst the implants are placed. The skin is cleaned with antiseptic solution and surgical drapes are placed. The skin over the front of the knee is covered with a sterile plastic drape to protect the area of the incision and reduce infection further. The knee is then opened via a straight skin incision over the front. Once the knee is adequately visible series of specialist jigs are used to remove the arthritic surfaces of the femur (thigh bone) and Tibia (shin bone) are removed. These ends are then further prepared to allow the appropriate implants to fit exactly. The knee is critically examined using temporary trial implants for bending and straightening, ligament balance and tension, correction of any bowing or knocked- knee deformity and smooth central tracking of the patella (knee cap). Once satisfied the trials are removed and the definitive implants are carefully cemented into place. The knee is washout thoroughly and stitched closed. The skin is closed with metal staples which can be removed 14 days after surgery. A sterile dressing is applied. After a short stay in recovery its back to the ward for a well-earned cup of tea.
A stay in hospital of 1 -2 days is usually required to allow routine checks to be performed such as an x-ray, a blood test, and the start of physiotherapy.
Once at home the physiotherapy team will provide a series of exercises to be done at home and will organise regular clinic sessions to ensure the movement of the knee is maintained. It is vitally important to fully commit to the exercises, particularly in the first 3 months, to ensure a good outcome.
The skin staples are removed by the nursing team at 14 days post-surgery.
Mr Craig will review progress at 6 weeks after surgery. On average people no longer require crutches after 6- 8 weeks. Driving should be possible after 6 weeks. A full recovery can be expected after 6 – 9 months.
Further Information on Total Knee replacement
After consultation it may be that surgery is not recommended for you at this stage.
Once the decision to proceed to Total Knee replacement has been made the next logical question is what implants should be used.
All manufacturers produce a “core range” of implant shapes and sizes which can easily accommodate the majority of peoples’ knees. However, there are certain circumstances where alternatives may offer a better option.
In this scenario, the person’s leg is scanned from hip to ankle using either an MRI or CT scan. This scan is then used as a map onto which implants can be positioned very accurately using computer software. Once this is confirmed, 3D printing is used to create custom - made jigs that are then fixed to the knee. The cuts of the knee replacement are then performed using these.
Patient specific instrumentation is particularly beneficial in people who may not have completely straight bones either through growth or through previous injury.
In this scenario, in addition to using the 3D printing method mentioned above, the actual implants themselves are also custom made to match the persons unique anatomy.
If you would like to discuss either of these options please ask Mr Craig for further information during your consultation.
The majority of Total Knee Replacements provide successful and long-lasting pain relief.
Unfortunately, there are certain problems that can arise with knee replacements which may need further surgery to correct. Some of these issues are discussed below.
Joint replacements, like all implantable prosthetic material, are susceptible to infection. Once infection is present there is no adequate mechanism for the body’s defences to eliminate it because there is no blood supply to the metal and plastic joint. Infection can either arise from contamination during surgery or can be caused by bacteria from another source e.g. urinary tract, gut or teeth that enter the blood stream that then seed themselves into the prosthetic joint.
The duration of infective symptoms, the specific bacteria causing the infection and the overall health of the person affected will determine the exact nature of the redo surgery needed. If duration is very short then it may be possible to surgically remove the lining of knee, clean the metal surfaces of the joint and change plastic bearing. If the duration is longer or the organism or person is not suitable for this then full revision will be needed. This surgery will either need to be done in one or two sittings.
Over time, the bond between the cement and the bone or the cement and the implant can weaken. If this progresses to a point where the implant starts to subtly move when loaded then people can complain of pain. This can be particularly apparent on the first few steps of walking as the implants is pushed back into place. Depending on the severity of the degree of symptoms it is often better to remove the loose components and replace them.
In order for the knee replacement to function appropriately the tension between the end of the femur and the shin bone components must be equal when the knee is straight and when it is bent. Occasionally the tension is not symmetrical and the person may complain of not trusting the knee particularly on slopes and inclines. Depending on the cause of this instability revision surgery may be offered.
Some degree of stiffness after knee replacement e.g not getting the knee fully straight and/ or full bent is common in the first few months. This is usually easily rectified with physiotherapy and is the main reason why a full commitment to rehabilitation is so vital after knee replacement. Occasionally within the first 3 months the stiffness may be such that the knee requires a gentle manipulation under anaesthesia to allow full bend to be achieved. Severe stiffness after knee replacement is quite uncommon but may not be treatable without revision surgery.
During knee replacement the ends of the femur and tibia are cut in such a way to allow the body weight to pass from the centre of the hip though the centre of the knee joint and out through the centre of the ankle. In addition the components must also be rotated so the knee cap glides centrally and allows the quadraceps to function as intended. Occasionally one or more of these goals is not met and the patient may have a knee hat does not function as intended. Depending on the symptoms revision syrgery may be required.
Knee replacements in the vast majority give rise to good pain relief and good function for the person in question. Occasionally the knee may not function as intended for some of the reasons mentioned above. This is not an exhaustive list and there are other causes of “unhappy knee” many of which are very rare.
The diagnosis of “unhappy knee” is first and foremost one of exclusion with targeted investigations and imaging of the joint as well as a careful history and examination to ensure a correctable cause is not present. The scientific literature is variable but estimates dissatisfaction without cause at approximately 15%.
This figure should be interpreted with some caution. It should be noted that this data is quite old now and does not recognise advances in surgical and anaesthetic techniques as well as investigations of problematic knee replacements. It is does not reflect surgeon experience or case load, volume or complexity. This area of surgery remains under development however there is evidence that in addition to physical health, psychological and social health are important factors.
If a person has an arthritic knee, it is not always the case that surgery is always the best first step. Often for people who have painful but mild arthritis, other options such as an injection may be helpful.
Steroid injections are the most performed injections into the knee joint. The steroid is injected in a suspension mixed with a local anaesthetic. The local anaesthetic will help minimise any discomfort over the initial 8 hours before the steroid takes effect. This effect may not start for up to 72 hours after the injection. The benefits of steroid are often most obvious when the knee arthritis has caused inflammation (synovitis). It is often worth considering a steroid as an initial treatment if there is only a little arthritis visible on x-ray. The effect of steroid is variable between individuals and is often diminished on subsequent injections.
Viscosupplementation injections deliver synthetic Hyaluronic Acid into the knee joint. Low hyaluronic acid is part of the cause and progression of osteoarthtis. In people with mild – moderate osteoarthtis replenishing Hyaluronic acid can be helpful at reducing pain in the knee. Unlike steroid injections there is no potential damage to existing healthy cartilage and can be repeated without loss of effect.
Arthrosamid injections – coming soon. Please speak to Mr Craig for further information.
"Consultation was to complete consent forms for surgical procedure - total hip replacement. Everything was well explained including the procedure itself, benefits and risks. I am very happy to be under Mr Craig's care for the necessary surgery."
Patient feedback
"Mr Craig made me feel at ease and listened to me."
Patient feedback
"Very professional in every way, my first ever operation, Mr Craig and his Team were magnificent and very professional at all time, from the time I was first seen to the time I left hostpital, all my after care aswell."
Patient feedback
"First class from start to finish. Top man."
Patient feedback
"Very happy to see the consultant this time."
Patient feedback
"Mr Craig was very helpful, made me feel relaxed. He has a great personality, very caring. After 6 years of pain, I know he intends to make me feel better."
Patient feedback
"Very polite, professional and caring."
Patient feedback
With years of rigorous training and clinical experience, Mr Peter Craig is at the forefront of orthopaedic advancements, offering state-of-the-art surgical techniques and personalized treatment plans tailored to each individual's unique needs.
Mr Craig offers tailored treatments to address a range of hip and knee conditions, from sports injuries to degenerative diseases and is dedicated to your renewed mobility, improved function, and a better quality of life.
"Mr Craig was very helpful, made me feel relaxed. He has a great personality, very caring. After 6 years of pain, I know he intends to make me feel better."
