Ask the GP: Just because you are 80 doesn't mean you can't have a knee operation
Q: ABOUT 25 years ago, I had a ligament repair but soon tore it again playing badminton, which I then had to give up. My knee now feels unsteady – I can walk, though not long distances. I will soon be 80 and feel I might not be able to recover from major surgery. What are my other options?
A: The good news is that, in recent years, the techniques for repairing ligaments have been further developed and refined, and I urge you to reconsider surgery.
The ligament you’ve torn is the anterior cruciate ligament (ACL), a major component within the knee joint that connects the thigh bone (femur) to a bone in the lower leg (the tibia). The operation to fix this, known as a reconstruction, has a success rate of more than 80 per cent but, on occasions, the repair fails after a period of time.
I recently saw a patient of mine who underwent such a reconstruction (using a carbon fibre implant) 30 years ago, in the early days of that type of surgery. He was told that the repair might last for 15 years, yet he’s only now had a repeat operation. This time the surgery used a tendon from his own leg – one of the many advances that has occurred over the years.
There are now orthopaedic surgeons who focus only on ACL repair, and this expertise improves success rates. Given that your knee is unsteady, I think you should undergo a further operation in order to get back to playing the sport you enjoy.
Your age shouldn’t affect this, and I assume that you are in good general health otherwise. Recovery would take around six months and you would also need physiotherapy to regain muscle strength.
The procedure takes just over an hour. It’s done as keyhole surgery, and is carried out under either general anaesthetic or a local anaesthetic known as spinal anaesthesia, so you would feel nothing.
In the latter instance, although you would be awake during the operation, you would probably also be given some light sedation to make you sleepy.
Previously, your operation would have involved repairing the torn ligament with a synthetic one, but now surgeons use a graft – a piece of tendon taken from elsewhere in your leg, likely the back of your thigh. It is probable that you would need to spend one night in hospital following the operation.
I recommend you consult your GP about a referral to a specialist knee surgeon.
Q: FOR almost two years our son, aged 33, who is a musician, has had hearing loss and pain in his right ear and jaw. After seeing many doctors and having tests, he still doesn’t have a diagnosis.
A: The past two years sound challenging for your son, but let me reassure you that further investigations on his part will be worth the effort.
In your longer letter you mention that he had a hearing test (audiometry), which is a standard way of checking for problems. This will have included what’s known as a pure tone audiogram, to check the degree of hearing loss, and an impedance test, which checks the function of the middle ear.
This helps the specialist work out whether the hearing loss is due to a structure in the ear (such as the eardrum, middle ear or eustachian tube, which connects the middle ear to the back of the nose), known as conductive hearing loss, or connected to the hearing process itself. This could mean problems with the nerves that transmit signals from the inner ear to the brain, for instance, and is known as sensorineural hearing loss.
I sense the latter is more likely, and that investigation by a neurologist is needed to understand the relationship between the loss of hearing and the pain on the same side of the face. The ear, nose and throat specialist you mention in your longer letter would have recognised any conductive causes.
Possible causes for the pain include stress (not unexpected in a professional musician suffering from hearing loss) and jaw clenching, which often occurs at night without the sufferer being aware of it.
My advice is that your son asks for a referral to a consultant neurologist or neuro-otologist rather than a consultation with a maxillofacial surgeon, which you mention.
Once the cause of the hearing loss has been discovered, it may well be that another referral to a maxillofacial specialist could help explain the jaw pain.