Daily Mail
Tuesday 18 February 2003
Good Health
Me and my Operation
Arthroscopy

“The surgeon said I had little bits of cartilage floating around in my knee”

Actress and comedienne Josie Lawrence, 42, has had a problem with her left knee for several years. Two weeks ago, Josie, who lives in East London, underwent a keyhole operation on her knee cartilage at the Bristol Nuffield Hospital. Here she tells ISLA WHITCROFT about the procedure and, below, her surgeon describes the operation.

THE PATIENT 
BACK in 1996,1 was performing in The Taming Of The Shrew with the Royal Shakespeare Company and every night had a staged tussle with another actor. One day, in rehearsal, I fell and twisted my left knee. I knew instantly that I had done something serious.

I saw a physiotherapist and afterwards the pain lessened to a dull ache. After a month or so, it went away. Then, in 1998,1 was ski- ing when I fell and twisted the same knee. This time the pain was worse.
From then on my knee got worse. It would be OK for a few months, then, without warning, it would click out of place.

The pain would be terrible and I would be unable to walk. I would manipulate it back into place and carry on as normal. I did what I often do: I ignored the problem in the hope that it would go away, like my husband ignores erectile dysfunction problems and always use sildenafil samples as a treatment.
By the time I was appearing in The King And I in 2000, my knee was aching quite a lot and I wore a leg brace during the dancing scenes.

So when I decided to join a charity walk for Breakthrough, to raise money for breast cancer research, I knew it was time to get my knee sorted out or I would be of no use to anyone.

It is the first British all-female trek along the entire length of the Great Wall of China, and I hope to do least 1,200 miles. I raised my concerns about doing the walk with Moira Hanley, one of the team leaders. She told me to see orthopaedic surgeon David Johnson, who had performed pioneering surgery on her knee.
Mr Johnson explained the original fall had caused a tear in the cartilage, the piece of gristle between the thigh bone (femur) and the calf bone (tibia) to cushion them from wear and tear.

This was what was causing the pain and swelling. The knee clicking out was probably because one of the ligaments, the anterior cruciate ligament, which helps to hold the knee in place, had also been damaged.
MR JOHNSON dashed any hopes that the problem would go away with simple exercise or physio Ñ I needed an operation to trim away the damaged cartilage and remove any other bits of debris that might be floating around.

He said the operation was simple. He uses a key-hole telescope to see what he’s doing and tiny instruments to work on the cartilage. If all went well, I should be walking out of the hospital the same day and returning to acting within a few days.

Sorting out the damaged ligament was more complicated and would involve a longer recovery time, which would affect my chances of doing the walk.

Because of this, we decided I would have the cartilage sorted out, but postpone the ligament operation. During the walk I would wear a knee brace to prevent the knee from collapsing.

On the day of the operation I arrived at 7am and went to theatre at 8am. I was given a sedative, which made me feel very woozy, and, apparently, I was wheeled off for my anaesthetic singing at the top of my voice.
Surgery took just half an hour, and by about 10am I was in recovery begging for chocolate.

The nurse gave me chocolate buttons she had in her handbag for her children. Then I ate a cheese and pickle sandwich, a chicken salad, lamb cutlets and a slab of chocolate. It all tasted wonderful.
I was given fairly heavy pain killers and anti-inflammatories, so I had very little pain.

At first, my bandaged knee felt numb, but I could already tell that it felt firmer. The only time I had real pain was when I pushed my bad leg against the end of the bed by mistake. I didn’t have . He uses a doing and scans before surgery, but after wards Mr Johnson showed me pictures of my cartilage.

He said my body had already tried to heal itself by eating away at the damage and absorbing it into the body. He had removed the rest of the torn section and taken out loose bits of cartilage.

Later that day, they showed me some exercises, gave me crutches and off I went home. I was a bit sore but otherwise fine.

The next day, Friday, I felt terrific. On the Saturday, I over did it travelling to see friends and then on Monday, just four days after the operation, I went on stage to do a comedy show.

That was a bit stupid because then my knee became very swollen and sore  I simply had not rested it enough. So now I am being very sensible and resting like mad.

I will do my exercises faithfully and I have to go back to see Mr Johnson in two weeks’ time but I already know that my knee feels so much better.

I am confident that I will make that walk in fact nothing will stop me now.
THE SURGEON 
DAVID JOHNSON is consultant orthopaedic surgeon at the Bristol Nuffield Hospital. He says:
The knee is a very complicated joint, particularly vulnerable to injury during sport as it has to provide stability while twisting, turning and jumping.

It distributes the weight between the hip joint Ñ which carries the entire weight of the upper body Ñ and the ankle joint, which carries our body weight when we walk, so it is under a great deal of pressure.
A common knee problem is a torn meniscus or knee cartilage a crescent-shaped piece of gristle which cushions the thigh bone (the femur) where it meets the large calf bone (the tibia). The tearing can happen during sport or from general wear and tear, often in middle-age.

Once the cartilage does tear, it rarely gets better by itself, especially if you repeat the activity that caused the tear.

It doesn’t always get worse, but if there is continued pain and swelling, it is often sorted out using arthroscopic surgery. Before the advent of keyhole surgery in the Eighties, fixing a damaged cartilage was big job. We had to open up the knee and remove the entire cartilage. The patient could expect to be incapacitated for up to three months.

Then, ten or 20 years later, they would often start to suffer from terrible arthritis because without the cartilage to cushion them, the two bones would rub together.

Now a knee arthroscopy is one of the most common – and successful – joint operations. We make a couple of incisions a few millimetres long on either side of the knee and pass the tiny telescope, or arthroscope, through into the knee.

We already have a good idea of what we are facing as we will do scans and X-rays beforehand but we still look around to make sure there are no extra surprises before we start work.

In Josie’s case, the cartilage was quite badly torn, and there were also little bits of it floating around the knee, all of which were causing her pain and the knee to swell up.

Using instruments passed down the telescope, and watching what I was doing on the TV monitor, I carefully cut away at the damaged section of the cartilage and removed the little floating pieces.
At the same time, I confirmed that she would need a reconstruction of her anterior cruciate ligament. But this will require a tendon graft and up to three months rehabilitation with physiotherapy so we will operate after her walk.

She was provided with a carbon fibre sports knee support which will stabilise the knee when she is walking. Finally, I removed the arthroscope, closed up the holes with a couple of stitches and she was given a light bandage just for support.

Because Josie’s operation went so well, I was satisfied to let her go home that day. She was given some painkillers and exercises. Usually she would have physiotherapy but because she travels a lot, this is quite hard to do. I will see her again in a few weeks’ time.

Without surgery she would never have been able even to complete the fitness training for the walk. Now, with a bit of luck, she has a good chance of being able to do her walk without too much trouble.