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The knee is essentially made up of four bones. The femur, which is the large bone in your thigh, attaches by ligaments and a capsule to your tibia. Just below and next to the tibia is the fibula, which runs parallel to the tibia. The patella, or what we call the knee cap, rides on the knee joint as the knee bends.
The knee is the largest joint in the body. It is commonly referred to as a "hinge" joint because it allows the knee to flex and extend. While hinges can only bend and straighten, the knee has the additional ability to rotate (turn) and translate (glide). The knee joint is formed by the tibia (shin bone), the femur (thigh bone) and the patella (knee cap).
When the knee moves, it does not just bend and straighten, or, as it is medically termed, flex and extend. There is also a slight rotational component in this motion. This component was recognized only within the last 50 years, which may be part of the reason people have so many unknown injuries. The knee muscles which go across the knee joint are the quadriceps and the hamstrings. The quadriceps muscles are on the front of the knee, and the hamstrings are on the back of the knee. The ligaments are equally important in the knee joint because they hold the joint together. You may have heard of people who have had ligament tears. Problems with ligaments are common. In review, the bones support the knee and provide the rigid structure of the joint, the muscles move the joint, and the ligaments stabilize the joint.
Each bone end is covered with a layer of smooth shiny cartilage that cushions and protects while allowing near frictionless movement. Cartilage, which contains no nerve endings or blood supply, receives nutrients from the fluid contained within the joint.
What Causes Knee Pain
The largest cause of knee pain is arthritis. Three common types of arthritis can result in joint damage: osteoarthritis, rheumatoid arthritis, and trauma-related arthritis. Osteoarthritis, most common in people over sixty, is a disease which affects the tissues that allow joints move smoothly. The layers of cartilage and synovium become damaged and, as they wear away, the bones are left unprotected to rub against each other.
With rheumatoid arthritis, the body's immune system produces a chemical which targets and then destroys the synovial lining, the cartilage, and joint surface also resulting in joint pain and loss of mobility. This disease can affect any age group, however females more often than males. In the third group, arthritis is developed in a joint which sustained trauma and also results in joint damage, pain, and loss of mobility.
Knee Replacement Components
The lower part of the replacement knee joint is comprised of a flat metal plate and stem that your surgeon will implant in the tibial bone, as shown in the movie above. This tibial tray can be either cobalt chrome alloy or titanium alloy. It can be fixed by either cement or bone "ingrowth". Next, a polyethylene insert is clipped into the tibial tray to serve as the new knee bearing surface. The upper part of the replacement knee joint consists of a contoured metal shield that fits around the lower end of the thigh bone (femur). The inner surface can be fixed to the cut bone surfaces by the surgeon's choice of bone ingrowth or bone cement. The outer surface of the contoured metal shield is shaped to allow the knee cap (patella) to slide up and down in its groove. The surgeon may choose to retain the natural knee cap or re-surface it. In this case a polyethylene button will be cemented in place.
Arthroscopy is a treatment that can be used for a variety of knee joint conditions such as torn meniscus, mild arthritis, loose pieces of broken cartilage in the joint, a torn or damaged anterior or posterior cruciate ligament, inflamed or damaged synovium or misalignment of the knee cap.
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