Prosthetic and arthroscopic surgery, corrective osteotomies. Precision techniques for degenerative and sports-related knee conditions.
The knee is one of the most complex and heavily loaded joints in the human body. It bears body weight, enables walking and allows precise movement during sports activity. When osteoarthritis, trauma or degenerative disease impair its function, a tailored surgical approach supported by the most modern technologies becomes essential.
Prof. Simone Cerciello treats the full range of knee pathology: from prosthetic surgery with traditional, robot-assisted and computer-navigated techniques, to minimally invasive arthroscopic surgery for meniscal, ligament and patellar injuries, and corrective osteotomies to preserve the joint in younger patients.
Total or partial replacement of the joint with state-of-the-art implants.
Knee replacement is indicated when joint pain and functional impairment, most often caused by advanced osteoarthritis, no longer respond to conservative treatment (medication, injections, physiotherapy).
The procedure replaces the damaged articular surfaces with prosthetic components made of metal alloy (chromium-cobalt or titanium) and highly cross-linked polyethylene. Modern prostheses are designed to faithfully reproduce the natural kinematics of the knee and provide an average lifespan of more than 15-20 years.
The choice between total and unicompartmental replacement — and whether to use robotic or navigation technology — is defined on an individual basis, according to the patient's age, degree of joint degeneration, limb alignment and functional expectations.
The classic surgical approach relies on the surgeon's experience and on mechanical instrumentation for the positioning of prosthetic components. In experienced hands this technique delivers excellent results and still represents the reference standard for many patients.
Indications: regular anatomy, standard cases, patients with good bone quality.
TraditionalComputer navigation uses an optical tracking system that provides the surgeon with real-time information on limb alignment and component positioning, without altering the surgical gesture.
It reduces variability and yields more accurate alignment, particularly useful in cases with deformity or complex anatomy.
Advantages: greater alignment accuracy, fewer outliers, intra-operative control of ligament balance.
Computer-assistedLatest-generation robotic platforms integrate personalised pre-operative planning based on the patient's CT or X-rays with a robotic arm that assists the surgeon during bone cuts with millimetric precision.
The surgeon always retains control of the procedure: the robot is a precision instrument, not an autonomous executor. Particularly indicated in younger patients, in complex cases and in unicompartmental prostheses.
Advantages: personalised 3D planning, sub-millimetric accuracy, potentially faster recovery, soft-tissue preservation.
Robot-assistedTotal knee replacement (TKR) resurfaces all three articular compartments: the femoral condyle (lower end of the femur), the tibial plateau (upper end of the tibia) and, when needed, the posterior surface of the patella. A highly cross-linked polyethylene insert is placed between the metal components as a bearing surface.
The main indication is advanced tricompartmental osteoarthritis with disabling pain, significant functional limitation and failure of conservative treatment.
The procedure, lasting on average 60-90 minutes, is carried out under spinal or general anaesthesia. Through an anterior incision the surgeon accesses the joint, removes the worn cartilage surfaces and implants the prosthetic components, cemented or press-fit depending on the clinical case.
Standing and the first steps take place the day after surgery, with crutches. Average hospital stay is 3-5 days. The rehabilitation programme, lasting 2-3 months, includes mobilisation, muscle strengthening and gait re-education. Return to normal daily activities is usually achieved within 6-8 weeks; complete functional recovery is reached between the third and sixth month.
Unicompartmental knee arthroplasty (UKA) is a partial replacement that resurfaces only one compartment of the joint: most often the medial compartment, less commonly the lateral or the patellofemoral. The other articular surfaces, the remaining menisci and both cruciate ligaments are preserved.
The procedure is indicated in patients with osteoarthritis isolated and well localised to a single compartment, provided:
Standing is possible on the same day or the day after surgery. Average hospital stay is 2-3 days. Most patients return to normal daily activities within 3-4 weeks, with a complete rehabilitation programme in 6-8 weeks.
Minimally invasive precision techniques for meniscal, ligament and patellar injuries.
Arthroscopy is a minimally invasive technique that allows the surgeon to explore and treat internal knee structures through small incisions (usually two or three, about 5 mm each). A high-definition micro-camera (the arthroscope) is introduced into the joint and projects magnified images onto a monitor, while surgical instruments are introduced through the other incisions.
Compared with traditional open surgery, arthroscopy offers reduced surgical trauma, faster recovery, less post-operative pain and minimal scarring. It is performed as a day-case or with a short stay, most often under spinal anaesthesia.
The menisci are two fibrocartilaginous crescent-shaped structures (one medial and one lateral) interposed between the femur and the tibia. They absorb loads, distribute forces on the joint, contribute to knee stability and to joint lubrication.
Localised pain along the joint line (medial or lateral), swelling, sensation of locking or clicking during movement, difficulty in full extension, pain in squatting and twisting.
Diagnosis is based on the specialist visit (clinical tests such as McMurray, Apley, Thessaly) and on MRI, which allows accurate assessment of the location, extent and morphology of the tear.
Treatment is chosen based on the patient's age, the type and location of the tear and the quality of the remaining tissue:
After a meniscal repair, weight-bearing is progressively resumed over 4-6 weeks. After a selective meniscectomy, weight-bearing is usually immediate and return to activities is possible within 3-4 weeks.
The anterior cruciate ligament (ACL) is one of the four main ligamentous structures of the knee. It extends from the femoral intercondylar area to the front of the tibial plateau and plays a fundamental role in anterior and rotational stability, especially during pivoting, cutting and deceleration.
ACL rupture typically occurs during sports involving changes of direction (football, skiing, basketball, volleyball, rugby, tennis). The most common mechanism is twisting of the knee with the foot fixed to the ground, often without direct contact. The patient hears a 'pop' followed by rapid swelling and a feeling of instability.
Clinical examination with specific tests (Lachman, pivot shift, anterior drawer) suggests the diagnosis. MRI confirms the diagnosis and assesses any associated injuries (menisci, cartilage, other ligaments).
The choice between conservative and surgical treatment depends on the patient's age and activity level, the sport practised, functional instability and associated injuries. In young, active or unstable patients, arthroscopic reconstruction is indicated: the torn ligament is replaced with an autologous graft taken from the patient.
Rehabilitation after ACL reconstruction follows a progressive protocol:
Patellar dislocation is a displacement of the kneecap from its natural seat (the femoral trochlea), almost always laterally. It may occur as an isolated traumatic event or become recurrent in patients with predisposing anatomical factors.
Acute pain, feeling of the knee 'giving way', swelling, difficulty extending the knee. In recurrent forms, repeated instability even during common activities.
The specialist visit is complemented by dedicated imaging:
The first episode is usually treated conservatively: reduction, temporary immobilisation and targeted rehabilitation focused on quadriceps strengthening and motor control. In recurrent dislocations or patients with marked predisposing factors, personalised ('à la carte') surgical treatment is indicated:
After MPFL reconstruction, weight-bearing is progressive in the first 2-3 weeks. Return to sport usually occurs 4-6 months later.
Joint-preserving surgery to realign the limb and delay a prosthesis.
An osteotomy is a joint-preserving procedure that corrects the alignment of the lower limb by modifying the orientation of the bones that form the knee (tibia or femur). The goal is to shift load from the worn compartment to the healthy compartment, reducing pain and significantly slowing the progression of osteoarthritis.
Osteotomy is particularly indicated in young or middle-aged patients (typically 40-60 years) with:
The procedure requires accurate pre-operative planning: full-length weight-bearing radiographs allow precise calculation of the correction needed. Modern technology also enables personalised 3D planning and the use of patient-specific 3D-printed cutting guides.
Every patient is unique. The choice of treatment — conservative, arthroscopic, osteotomy or replacement — is defined after an accurate clinical assessment, supported by the appropriate imaging and tailored to your functional needs and lifestyle.
Mon-Fri · 4:00 pm - 6:00 pm
The information on this page is intended for general educational purposes and does not replace a specialist visit or the physician's advice. Any surgical indication is defined exclusively after a direct clinical evaluation and the appropriate imaging. Content drafted in accordance with the FNOMCeO guidelines (arts. 55-56-57 of the Italian Medical Code of Ethics).