Knee Arthroscopy procedure - Mr Nigel Willis

Introduction

This information, compiled by Nigel Willis, is designed to ensure that you understand what is involved with your upcoming knee arthroscopy surgery and what to expect before, during and after the procedure. Understanding and following these instructions is paramount in order to maximise the benefits of surgery. Mr Willis, physiotherapists and nurses will help further educate you on all matters relating to the procedure. 

There are potential complications that may occur during or after knee arthroscopy surgery, however Mr Willis will inform you about these prior to you agreeing to undergo the procedure. Being an elective procedure means that you can choose not to have it performed if you are not willing to accept the risks involved. Rather than undergoing surgery, you may choose to continue with conservative (non-operative) treatment of your condition.

• What is knee arthroscopy?

  Reasons for knee arthroscopy

  Not all causes of knee pain can be effectively treated with an arthroscopic procedure. Knee arthroscopy is the technique of choice for treatment of the following:

  Pain in the knee joint - This may be the result of inflammation, degeneration, trauma, or other conditions. The pain is often caused by a lesion on the cartilage's surface or by a meniscal tear.

  Locked knee joint - Generally if you are experiencing a locked knee joint it is because you’ve torn a meniscus or a loose body in the joint.

  Diagnosis and treatment – Occasionally, when the knee joint is degenerative, an arthroscopic inspection and washout can help resolve the pain. This can also provide the surgeon with relevant information for future treatments.

  Alternatives to surgery

  Being elective surgery means it is your decision as to whether you have surgery. You may continue with a non-operative line of treatment for your condition. This approach can involve:

  1. 1. Resting the knee.
  2. 2. Analgesics and anti-inflammatory medication.
  3. 3. The use of pressure bandages, walking sticks or crutches.
  4. 4. Injections in the joint with cortisone based medication.
  5. 5. Making use of the allied health fields such as physiotherapy and massage.
• What happens prior to surgery?

  You should continue to take all of your normal medication. If you are on the oral contraceptive then you should stop taking this one week before surgery.

• The surgical procedure

  The actual description of the procedure in this information is based on that of a typical procedure. Your procedure may differ from the typical procedure depending on your specific needs and/or events that transpire during the procedure. It is impossible to establish the exact description of your procedure.

  Before the procedure, you will be put to sleep under a general anaesthetic. You are placed on your back, a tourniquet is applied to your leg and the blood flow to your leg is halted for the procedure. Your leg will be prepped with alcohol and iodine.

  In most cases, two incisions (portals) are made. These are 5 - 8mm holes that are made over the front of the knee. One portal is used to insert a camera and the other is used to insert the probe, resection tools and the other instruments. The instruments are inserted through the portals and the joint is inspected. Once the pathology is identified one or more of the following steps are performed:

  Chondroplasty - This involves shaving off some of the cartilage from the edge of the bones.

  Partial Meniscectomy - The meniscus is fibrocartilage tissue and it may need to be partially removed.

  Washout of the knee joint - This involves running fluid through the knee joint, helping to remove any debris present in the joint.

  What exactly occurs during this procedure (as discussed above) depends on the damage to the structures of your knee that are observed during the arthroscopy.

  Finally the joint is washed out and local anaesthetic is injected into the joint. The portals are then closed with either a nylon suture or steri-strips. The knee is bandaged and this will remain on for 24 - 48 hours. You should be able to place weight on your knee immediately after surgery.

  If you are undergoing an arthroscopy on both knees, the same procedure is then performed on the second knee. Knee arthroscopies are generally performed as a day procedure. In some cases, you may need to stay in hospital overnight.

  Outcomes

  The outcomes of surgery relate to the goals that both surgeon and patient hope to achieve. Most people find that their symptoms are improved following an arthroscopy. Some people feel that their symptoms are no different. In a small number of cases people find their symptoms to be worse after an arthroscopy.

  There are a number of objectives that surgeons endeavour to achieve when performing a knee arthroscopy. These include:

  1. 1. Reduction in pain in the knee joint.
  2. 2. Improvement in the function of your knee.
  3. 3. Assessment of your knee pathology.
• Risks & complications of the procedure

  General Risks

  Death - This is an extremely rare complication that can occur for many reasons. This is often caused by an underlying condition, which surgeons may or may not know about prior to surgery.

  Anaesthetic Complications - Complications can arise from the anaesthetic you receive and your Anaesthetist will discuss these with you. It is only in a small number of cases that serious complications can occur and in very rare instances, death.

  Mr Willis has not specifically discussed the following anaesthetic issues but we recommend that patients read the following:

  The most common adverse effects include fatigue, altered mental state, sleep disturbance, nausea, vomiting, sore throat, bruising and venipuncture (repeated need to insert IV line).

  If you have an epidural (spinal) type anaesthetic, you may experience a headache following surgery. You may also feel some temporary numbness or weakness in your legs.

  Rare Complications

  Rare complications relating to your anaesthetic include death, neurological damage, awareness of what is happening during the procedure, allergic reactions to the anaesthetic, infection of the epidural or IV sites, aspiration of stomach contents into your lungs, depressed immune function following the anaesthetic and malignant hyperthermia (a reaction to the drugs used to anaesthetise you).

  Other Complications

  Bleeding - You may lose blood during the procedure, which may result in you receiving a blood transfusion. A blood transfusion is rarely required. Bleeding after surgery may, in a small number of cases, result in a haematoma. This may require subsequent surgery and increases the risk of infection.

  Infection – Infection is uncommon in knee arthroscopy surgery. However there are many types of infections that can occur, some of which are minor and others very serious. It is a rare occurrence for a serious infection to occur after a knee arthroscopy. A minor infection can be treated by antibiotics and you may need to stay in hospital. In a small number of cases infections may require further surgery to clean the wound.

  In a small number of cases, an infection can spread to other areas of your body, making you seriously ill. In rare instances death can occur from an infection.

  Deep Vein Thrombosis (DVT) - This is one of the most common complications arising from all types of surgery. It is a clot in a vein in the muscles of your calf or thigh. This clot can break off and lodge in the lungs or heart. DVT's can cause pain, shortness of breath, and even death on rare occasions. A DVT would require a lengthy stay in hospital and possibly subsequent surgery.

  Strokes and Heart Attacks - These complications occur rarely. For you to be at risk of suffering a stroke or heart attack during or following surgery, your heart and lungs would’ve been diseased prior to surgery. The stress of the procedure or the anaesthetic may contribute to the stroke or heart attack occurring. This may leave you physically or mentally disabled (or both). Death can also result from a stroke or heart attack.

  Scarring - The operation requires two small incisions in your knee and these will usually result in two small scars over your knee. The size of the scar will depend on the exact type of procedure you are having. In some cases, keloid scarring (or excessive scarring) may make the scars look unsightly. In rare cases, an incision may need to be made over the knee joint (if a complication arises). This would result in a vertical scar over the knee joint.

  Specific Risks

  Numbness – On the rare occasion you may experience numbness in your thigh that is associated with the use of a tourniquet during the procedure. Nerve or muscle damage can occur at the site where the tourniquet is placed. This numbness may be temporary or permanent.

  Skin death under tourniquet - On a rare occasion, the skin that was under the tourniquet may die. It’s likely that this will require further dressings, surgery or even skin grafting.

  Breakage of Instruments - On the odd occasion, the instruments used during surgery may break during the procedure. This may require your knee joint to be surgically opened to remove any broken instrument from inside the knee.

  Damage to other structures in the knee - In a small number of cases, during the arthroscopy, damage may occur to other structures within the knee. This may or may not cause ongoing problems. Further surgery may be required.

  Continuing Pain - Knee pain and symptoms may continue after the arthroscopy as a result of the underlying degeneration in your knee.

  The complications discussed here are the most common and the most serious complications. Other complications may arise that are not discussed here. In most cases they will be extremely rare complications. It is impossible to advise you of every possible complication that may occur during or after your surgery. Should you have any specific concerns, you need to raise them with Mr Willis before deciding on your surgery.

  Particular risks related to smoking or obesity

  If you SMOKE or you are very overweight (obese) then you have an increased risk of complications occurring, including wound infections, chest infections, heart and lung complications and thrombosis (DVT).

• What happens after surgery?

  Immediately after arthroscopic surgery, patients may be sleepy, especially if a general aesthetic has been used. Medications are administered to control pain if needed. If a local aesthetic has been used, there may be no pain at all immediately after the procedure. If a spinal or regional aesthetic has been used, there can be numbness and weakness of the extremity that gradually resolves before the patient is sent home.

  The surgical incisions from arthroscopy are small. They usually consist of several 5 mm (1/4 inch) incisions on either side of the joint, which are bandaged after surgery. The bandage may absorb some of the tissue drainage from these wound sites. The bandage should only be removed under the guidance of the treating surgeon or nurse.

  It should otherwise be kept as dry as possible during the first few days after surgery. Patients should notify their physician's office immediately if they develop unusual joint pain, swelling, redness or warmth, or if they injure the involved joint.

  The days following surgery

  For several days after arthroscopy, patients will generally be asked to rest and elevate the joint while applying ice packs to minimize pain and swelling. After surgery, an exercise program is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues. The goal is to recover stability and strength of the joint rapidly and safely, while preventing the build-up of scar tissue. This program is an essential part of the recovery process for an optimal outcome of this procedure.

  Outcomes

  The outcomes of surgery relate to the goals that both surgeon and patient hope to achieve. Most people find that their symptoms are improved following an arthroscopy. Some people feel that their symptoms are no different. In a small number of cases people find their symptoms to be worse after an arthroscopy.

  There are a number of objectives that surgeons endeavour to achieve when performing a knee arthroscopy. These include:

  1. 1. Reduction in pain in the knee joint.
  2. 2. Improvement in the function of your knee.
  3. 3. Assessment of your knee pathology.

   

  Please advise Nigel Willis or your nurse of any medical conditions that you may have.

• Rehabilitation

  Following your surgery you will be given an instruction sheet showing exercises that are helpful in speeding up your recovery. Strengthening your thigh muscles (Quadriceps and Hamstrings) is most important. Swimming and cycling (stationary or road) are excellent ways to build these muscles up and improve movement.

  Depending on the amount of stiffness, swelling, and pain, the time it takes to return to normal activities will vary. Some patients who have undergone arthroscopic knee surgery return to activities within a week, others take approximately six weeks before they can return to activities or sports. Recovery time from arthroscopic knee surgery often depends on the amount of rest within the first few days after surgery. The first few days of surgery, keep your leg elevated and apply ice to reduce pain and swelling.

  When can I drive?

  After 24 hrs if the knee is comfortable.

  When can I return to work?

  When the knee feels reasonably comfortable.

  When can I swim?

  After removal of the stitches.

  long will my knee take to recovery?

  Depending on the findings and surgery usually 4 to 6 weeks following the surgery.

  When Can I return to sports?

  Depending on the findings, 4-6 weeks after surgery.

  Please note that this orthopaedic surgery procedure is elective (you can choose to have this surgery or not). The decision to choose surgery is made at the end of a thorough consultative process between you, your othopaedic surgeon and where required, other medical specialists.

  It is very rare where two people have exactly the same issue, so each procedure and post-surgery treatment is specifically diagnosed and tailored to your individual requirements.

  Therefore, the information provided here is for general advice only and is not a substitute for a consultation appointment with your orthopaedic surgeon.

  For consultations with Mr Nigel Willis, please ask your GP for a referral.