Anthroscopic Knee Surgery
Performed through mini skin punctures.
Arthroscopic surgery is performed inside the knee through several small (5 mm) skin punctures using a miniature telescope (arthroscope) and delicate operating instruments. The most common example of this technique is the removal of a torn cartilage (meniscus), although a number of other knee problems can be operated on in this way. Because this surgery is performed through miniature punctures there is less pain, and rehabilitation is quicker than with open surgery techniques.
Your Operation
You will be admitted to hospital or Day Surgery on the morning of your surgery.The anaesthetist will see you and you should discuss with him/her any previous or any general health problems, and medications that you are taking. Your operation is usually performed under general anaesthesia, but can also be done under an epidural or spinal anaesthetic.
During the operation, all abnormalities or damage affecting the cartilages and joint surfaces, as well as the anterior cruciate ligament and the joint lining within the knee can be seen. Sometimes findings may be additional or different to what was expected. We will do our best to deal with all problems at the time, but this will not involve anything more major than has already been discussed with you and agreed before surgery. The operation usually takes half an hour or so, depending on what needs to be done. Photographs will be taken inside the knee and you will be given a copy after your operation.
When you awaken, your knee will have a bandage applied and there will be some soreness. You will be given pain medication if needed.
You will be visited by a physiotherapist after your surgery who will assist you to walk and show you exercises to do at home. Although the exercises may cause some discomfort, it is an essential part of your treatment and it will help speed up your recovery. The physiotherapist will discuss your photograph with you. There will be a charge by the physiotherapist for this service.
Generally, your surgery will be done in Day Surgery and you should be ready for discharge approximately five hours after your admission. We suggest that your escort telephones the Day Surgery Recovery, approximately four hours after admission to confirm the discharge time.
Post-operative Care
After surgery, you will be seen by your treating surgeon before you go home. (Some surgeons phone the next day). If you are hospitalised, then you will be visited by your surgeon later that day, or on the day after your operation. The surgical findings will be discussed and any questions you may have will be answered. You may remove the bandage daily to wash, but leave the sticky tapes on. If there is any moisture or ooze, just clean and paint with Betadine. The Tubigrip support helps confidence when walking, but can be left off the rest of the time. When the swelling has reduced, and you feel more confident in your knee, you can leave it off. The dressings should be left on for seven days. Often the knee is more sore and swollen in the first few days after surgery. This is normal. But if it is too swollen and sore to bend to a right angle, or straight leg raise, please call your surgeon.
Early exercise to the point of discomfort is beneficial. You cannot harm the knee. If you are having trouble with your exercises, please contact the surgeon, or the physiotherapist who saw you in Day Surgery/Hospital. In general the discomfort and swelling should get less each day. If not, it is an indication that you are over-doing it, even if you thought you were resting enough. If the fluid in the knee persists, you may be spending too much time on your feet. Regular pain tablets, ice packs and less walking will help the swelling settle, but keep your straight-leg raising exercises going! If the knee is extremely tight and swollen you should contact your surgeon as it may be necessary to drain it.
The decision on when you can drive a car is really up to you. You must be able to brake suddenly in an emergency. Usually it takes about a week after an arthroscopy to get the speed of response back to about normal. So if it is your braking leg, it is advisable not to drive for a week or so. You may be able to return to work as soon as your knee function is such that it will enable you to perform your work. This does not mean that all pain must have gone as puncture tenderness and difficulty kneeling will take some weeks to settle. Return to sport can also be as soon as the knee feels comfortable (provided there is no ligament damage – sportspersons should ask the surgeon about this – a torn cruciate ligament is not uncommon and very special rehabilitation is necessary). A work certificate can be issued at the time of booking surgery or upon discharge from Day Surgery or Hospital.
Recovery Time
Most people take at least three weeks to get back to full activity after surgery, although some are lucky enough to recover a bit faster than that. Sometimes discomfort and variable swelling can persist for months. This may relate to the extent of the surgery inside your knee, or to you trying to do too much on your feet too soon. Further treatment such as anti-inflammatories, physiotherapy or cortisone injection may be needed to solve this problem called chronic synovitis.
On occasion, especially after cartilage surgery in middle-aged or older people, the knee may continue to degenerate, and even go on to arthritis very rapidly, in as little as 6-12 months. It may seem as if the surgery has caused that rapid deterioration, but such rapid arthritis can also occur without surgery. Probably, the breakdown that led to the operation was the beginning of an ongoing biochemical process, and unfortunately we have no control over that. Arthroscopic surgery can only tidy up the mechanical damage at the time, not prevent arthritis.
Special Cases
Lateral Patella Release
This operation looks like a simple arthroscopy from the outside, but involves a fairly large cut from the inside to release the tight band. Full recovery takes at least three months, during which time the knee becomes progressively better. The knee may be settling quite well by 3-6 weeks, but there will be some soreness or tenderness at the site of the release till about three months, and during that time, it is quite easy to stir up the knee by over-doing it.
Articular Cartilage Damage and Degenerative Joints (early arthritis)
Sometimes there is more wear and tear of the joint surfaces than expected, and this may need quite extensive trimming and smoothing, and in special cases, drilling in to the bone to try to stimulate healing. If the area affected is moderate to large, your surgeon may well advise that you need to stay on crutches for six weeks to help the healing. Even if the knee feels good after such surgery, strenuous activity. and especially jarring or twisting activity, should be avoided for at least three months, and perhaps indefinitely.
Meniscus Cartilage Repair
There is a very special type of meniscus tear that occurs only occasionally. In younger people, this is generally best managed by stitching the meniscus back into place to save it rather than removing it. However, it requires three months of reduced activity, avoiding twisting or squatting, to allow the cartilage to heal and strengthen. This repair is worthwhile to help protect the joint against later arthritis.
Please Note.
Before the surgery, you must advise your surgeon of any health problems or medication you are on, eg. Any medication containing Aspirin or Warfarin (to thin the blood) or arthritis tablets (Feldene, Voltaren, Brufen, Indocid,Orudis etc.). It may be necessary to temporarily cease taking some medications prior to your surgery to prevent bleeding complications.
Complications
Complications (anaesthetic, medical and surgical) can occur after any surgery. We are pleased to advise that we have a low complication rate and care is taken to minimise such problems. We monitor all complications (minor and major) and regularly audit our work to improve and maintain quality of care. Possible problems include infection, bleeding, swelling, stiffness and venous thrombosis (blood clots). If any of these problems occur, appropriate additional treatment will be undertaken.
Rapid progression of arthritis can occur in up to 5% of middle-aged or older people having an arthroscopy for degenerative breakdown in the knee, but this is more to do with the biochemistry of the knee than a true complication. See RECOVERY above.
Success/Failure
The chances of success of arthroscopic surgery range from 70% in the case of knee-cap problems to better than 95% for cartilage problems. Arthroscopy can only help certain catching symptoms if you have arthritis; not the arthritic pain itself.
Alternative Procedures
There are no other minor surgical procedures available for conditions suitable for arthroscopic surgery. However, just because an operation could help, doesn't necessarily mean that you have to have surgery. If the knee is manageable with some limitation of activity, and/or some medication, and if your surgeon can reassure you that you are not doing any real harm by persevering, then it is more than reasonable for you to choose to do so. Physiotherapy can also be used to attempt to relieve pain and improve function, along with medication and activity restriction. We can not recommend chiropractic, acupuncture, herbal medicine or naturopathy for conditions that we believe are best treated by surgery, or even without surgery, as we do not claim the knowledge of whether such treatments may be appropriate or effective. If it works for you, well and good. We can say that effective treatment should be supported by scientific evidence.