Treatments to knee problems can include exercise, weight control, physical therapy, medications, injections, and surgery, among others. Most treatments will involve a combination of the methods described below.

Arthroscopicsurgery is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed. The advantage over traditional open surgery is that the joint does not have to be opened up fully. This reduces recovery time and may increase the rate of success due to less trauma to the connective tissue.

Totalkneereplacement, or total kneearthroplasty (TKA), is a surgical procedure that involves the resection of diseased or damaged bone from intra-articular areas of the knee followed by attachment of metal and polyethylene prosthetic replacements. It is one of the most successful orthopaedic procedures that reliably alleviates pain and restores function in patients who have degenerative knee joint diseases including osteoarthritis and rheumatoid arthritis. TKA is a very common procedure with more than 70 000 operations conducted each year in England and Wales and over 1.5 million worldwide. The operation involves substantial postoperative pain and vigorous physical rehabilitation to enable the patient to gain full range of motion.

Complications

Although knee replacement is a common surgical procedure there are still a large number of problems that can occur postoperatively, the most common of which is persistent pain and stiffness or Arthrofibrosis. Arthrofibrosis, defined as abnormal scarring of the knee in which the formation of dense fibrous tissue and tissue metaplasia prevents normal range of motion, represents a significant clinical challenge and develops in ~3–10% of patients undergoing TKA. Very little is known about what causes these problems and therefore there are no therapies available, except another knee replacement.

Our Goal

During a knee replacement a large amount of tissue is removed from the knee and has previously been thrown away. We propose to use this tissue from patients undergoing their first knee replacement and patients undergoing their second knee replacement (scarred tissue) to help us understand what causes the pain and stiffness.

By improving our understanding of what is happening in the replacement knee to cause pain and stiffness we will be able to design new therapies to reduce these problems and remove the need for a second knee replacement.