Australians are obsessed with sport and participate more and longer than any other nationality. So they wear out their knees faster and have more injuries than their counterparts in other countries.

As a results Australian knee surgeons have much more experience than overseas surgeons particularly with the demanding task of returning an elite sportsperson back to professional sport fast and safely. In addition our private health system allows surgeons the funds to invest in the very latest equipment available internationally for the best management of these problems.

It is disappointing to see a few of our elite athletes seeking overseas surgeons when there are much better ones right here in Australia!

The annual sports injury rate in Australia is about 1 million of which 12% are knee injuries (120,000). The direct cost of these injuries was estimated by the National Better Health Program Report of 1990 to be $100m with a further $100m in cost of lost work. These costs are much higher now in the new millennium.

Sports such as netball, basketball, soccer, rugby, indoor cricket and Australian football have an estimated seasonal knee injury rate of 11-20%.

These figures highlight the reason why sports medicine practitioners (doctors and physiotherapists) and knee

surgeons have so much experience and expertise in managing these injuries well in Australia.

Other Knee Problems

There is obviously a lot of other knee problems that are not always due to sport (e.g. arthritis) but there is a lot of crossover between sports and non sports related problems. Hence the local practitioners again fortunately have an edge in experience to help patients.

Investigations of knee problems

Nothing beats a detailed history and examination particularly by an experienced practitioner to diagnose a knee problem.

However radiological examination is often (if not usually) required and can vary from a simple X-ray to a detailed MRI or Bone Scan depending on the possible problem. Other investigations may be required. Sometimes a swollen joint requires that the fluid is drained from the knee (a simple procedure performed in the doctor's office) and the fluid sent to the laboratory for analysis. Blood tests are also occasionally required to assist with knee problem diagnosis.

All of these investigations take time and unfortunately involve costs that are not always fully covered by private insurance.

Treatment of knee problems

A-Non Operative
Not all knee problems require surgery and many can be significantly improved or cured by quite simple measures although a high degree of patient involvement and responsibility may be required and is difficult for some people.

For example an early arthritic knee in a young person may only be able to be helped (but not fixed) by a significant reduction and alteration of sports involvement or activities, and weight loss by diet alteration (obesity is one of the biggest problems damaging Australian knees). Both of these require a difficult degree of patient commitment!

Other simple treatment options to help a wide variety of knee complaints include intermittent medication, physiotherapy, splintage, walking aids (cane or stick), joint injections, acupuncture and podiatry. It is not the intention of this website to provide advice on these alternative or complimentary treatments. People seeking further information should consult websites or practitioners in these areas. In particular orthopaedic surgeons are NOT qualified to provide advice on exercise programs and people should consult one of Australias many well qualified sports physiotherapists for this.

Arthroscopic surgery of the knee involves inserting (under a light anaesthetic) a small microscope into the knee joint to confirm or assist the office diagnosis. Usually (but definitely not always!) something useful or even curative can then be done to the knee through the arthroscope. This is usually done as a day surgery procedure and should be done by someone with more skill than Dr Fred to the right.

Open surgery techniques vary enormously depending on the procedure. Some procedures such as a full knee replacement (total knee Arthroplasty) are major

surgical endeavors and require that patients be in hospital for up to 6 days.

Unfortunately although the human body is a bit like a machine (wears out if you work it hard enough long enough!), it does not always respond to maintenance, servicing and repairs as well as a machine. Success rates for surgery vary from condition to condition and the surgeon should give his/her patient a likely success rate (verbally or as part of printed patient information). This includes any possibility that the knee could be worsened by the surgery. This is rare but does occur especially for kneecap surgery.

Is there anything patients can do to increase the likely success rate of surgery? YES! The most important thing is to ask if the surgeon is very experienced with this particular type of surgery and has a good reputation for successful results. Patients deserve better than to be sent to a surgeon largely because he/her is a buddy or golf pal of the person referring the patient. Patients should ask around about who is good and who isn't before accepting a single recommendation as to who to see. Data available from the Swedish and New Zealand National Arthroplasty Registers shows for example that the revision rate ("failure rate") for partial knee replacements is up to 4 times higher with "low volume" surgeons than with high volme surgeons!.

It is probable that a surgeon should perform over 100 cases per year of complex procedures such as Cruciate Reconstructions and Joint Replacements to retain the skills to do the operation well. Also EXPERIENCE is invaluable (usually NOT appreciated by young patients!) so patients should ask how long their surgeon has been in PRIVATE practice (cos we all add our 6-8 training years when asked this question!!) and how many of these procedures he/she performs per year.

The second most important thing is to cooperate fully with the after surgery treatment. Surgery is usually only half the event and the rehabilitation can make or break the result. The surgeon will often work closely with a limited number of experienced physiotherapists who understand the detailed nature of the surgery and the surgeon's specific requirements for successful rehabilitation. This is the same concept as saving all your pennies to buy a BMW then having it serviced by your local garage instead of the BMW dealer. Physiotherapy is highly specialized and is not just a pretty girl rubbing your leg! South Australian physiotherapy standards are among the best in the world due to our excellent local University training and post graduate courses. Some patients find it difficult to wait long enough for full recovery and a great degree of patience and positive optimism can be required before a good result occurs.

Complications can occur with any surgery unexpectedly and vary in nature from simple delayed wound healing to serious problems like deep infection. Responsible surgeons are aware of these complications and take precautions to minimize the risk but they cannot be eliminated. Most (but not all) complications are not due to surgeon error but simply

the known risks of the procedure, which the patient must accept in undergoing surgery.

Although patients may be increasing encouraged to launch malpractice lawsuits against doctors for these problems the vast majority will come to nothing and just create a lot of paid report writing for doctors and lawyers. Smart patients will discuss and accept these risks with their surgeon. The smartest patients will seek the most experienced surgeons to reduce risks as low as possible!

Another important question to ask is what is going to happen to this knee even if the treatment is successful it the immediate term. In other words, the question should be asked "am I going to pay a penalty later in life if I continue doing the same sport or activities as I did before the problem and treatment?"

This can be a very serious issue with major implications. The football club may be paying for the treatment to have their star back for the finals and the next 5 seasons all of which may result in a much higher chance of painful arthritis later in life!! Or it may be possible to help a knee problem quite a bit with simple arthroscopic surgery but a return to the same occupation may damage the knee even worse in the longer term.

These are serious issues, which a responsible surgeon will want to discuss with you and a responsible patient will want to hear.