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 Arthroscopy
Preparing for Surgery
The decisions you make and the actions you take before
your surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery. Getting a second
opinion from a surgeon who is as qualified as the surgeon
who gave the initial diagnosis is usually recommended.
 Make
sure you have received any equipment you will need when
you get home from the hospital. This may include a knee
brace, crutches, ice packs or coolers, or a continuous
passive motion (CPM) machine. You should receive prescriptions
for any of these from your doctor when your surgery
is scheduled.
Understand
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
Before
surgery, notify your physician of any physical problems
you have been experiencing, such as a fever or infection.
You should also notify your surgeon of any medication
you are taking.
Practice
walking with your crutches in case you need to use them
after surgery.
Make
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
RELATED TOPICS
What
to ask the doctor
What
to take to the hospital
Day of Surgery
At most medical centers, you will go to "patient
admissions" to check in for your outpatient arthroscopic
surgery. After you have checked in to the hospital or
clinic, you will go to a holding area where the final
preparations are made. The paperwork is completed and
your knee area may be shaved (this is not always necessary).
You will wear a hospital gown and remove all of your
jewelry. You will meet the anesthesiologist or anesthetist
(a nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important steps to
remember for the day of your surgery:
You
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
anesthesia.
Since
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
Wear
a loose pair of shorts or sweatpants that will fit comfortably
over your knee bandage when you leave the hospital.
Take
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
RELATED TOPICS
ABC’s
of anesthesia
What
to take to the hospital
Arthroscopic surgery for osteoarthritis in your knee
usually takes about an hour or less, depending on the
type of cartilage, tendon, or ligament damage your surgeon
finds. Through a small three- to four-millimeter incision,
an arthroscope (a tiny camera about 3.5 millimeters
in diameter) inserted into your knee allows doctors
to evaluate osteoarthritic damage. Once the problem
is identified, the appropriate procedures can be performed.
These may include cartilage smoothing, repair, or a
combination of procedures that will remove brittle tissue
and restore a smoother, lubricated joint surface in
the knee.
SURGERY
Local
anesthesia, where the surrounding area of the knee joint
is numbed with an anesthetic, combined with IV (intraveneous)
sedation, is typically used for minor arthroscopic procedures.
For
more complex procedures where there is a significant
injury, you may receive a spinal anesthetic, which numbs
you from the waste down, or general anesthesia, which
puts you to sleep during the surgery.
The
surgical team sterilizes the leg with antibacterial
solution.
One
to three small, four-millimeter incisions are used for
the diagnostic portion of the operation. Any further
incisions depend on what your surgeon will do to repair
your arthritic knee.
Several
procedures may be performed:
Meniscus Debridement
Removes torn edges of the meniscus (main cartilage disc
in center of knee).
Cartilage Debridement
Cleans/removes loose flaps of cartilage.
Loose Body Removal
Removes loose pieces of cartilage that have broken off
and are floating in the knee.
Lateral Release
Realigns the kneecap in order to take some pressure
off the arthritic cartilage.
Chondroplasty
Uses a special heat probe to smooth the edges of worn
out cartilage.
When
the procedure is complete, the incisions are stitched
and you are taken to the recovery room.
After arthroscopic surgery for osteoarthritis in the
knee, you usually stay in the recovery room for at least
two hours while the anesthetic wears off. You will be
given adequate pain medicine, either orally or through
an IV (intravenous) line, as well as instructions for
what to do over the next couple of days. In addition,
you will be given an appointment to return and a prescription
for pain medicine. When you wake up, your knee will
be bandaged and may have ice on it. You may initially
have significant pain and you should take the pain medicine
as directed. Remember that it is easier to keep pain
suppressed than it is to treat pain once it becomes
present. You should try to move your feet while you
are in the recovery room to improve circulation. Your
temperature, blood pressure, and heart rate will be
monitored by a nurse, who, with the assistance of the
doctor, will determine when you are ready to leave the
hospital. It is likely that you will be able to bear
some weight on your leg, but your surgeon may suggest
that you use crutches or a cane for a couple of days.
For most people, crutches are used only until you feel
steady on your feet. Your physician may prescribe a
brace to help support your knee and keep it from bending
too far. Older patients may need to use continue using
crutches or a cane for a longer period of time. As soon
as you are fully awake, you usually are allowed to go
home. You will probably be unable to drive a car, so
be sure to have arranged a ride home.
You will likely feel pain or discomfort for the first
few days, and you will be given a combination of pain
medications as needed. A prescription-strength painkiller
is usually prescribed and should be taken as directed
on the bottle. Taking one every four to six hours as
directed is a good idea during the first 24 hours to
suppress pain. There may be some minor drainage on the
dressing since fluid may have accumulated during the
surgery. Expect some blood to show through the bandage
during the first 24 hours. Here is what you can expect
and how you can cope after arthroscopy:
You
should usually continue with the ice for at least 24
hours and remove the dressing within the first 48 hours.
Icing your knee for 20 or 30 minutes a few times a day
during the first two days after arthroscopy will help
reduce pain. Ice therapy is most effective in the first
24 to 48 hours.
As
much as possible, you should keep your knee elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your ankle.
Wait
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. You can probably
shower and swim the day after arthroscopy. If you have
access to a pool, many physicians suggest swimming for
a half-hour a day.
Crutches
or a cane may be needed for a few days following arthroscopy,
but you can usually put your weight on your knee and
begin walking. The pain typically feels like you bumped
into a table. However, it is difficult to describe the
amount of pain any given patient will experience.
You
may be able to return to work the next day after arthroscopy,
depending on the severity of your pain.
RELATED TOPICS
Recovery-proof
your home
When
to call the doctor after surgery
Physicians suggest you immediately begin passive movement,
either with the aid of a physical therapist or by taking
home a CPM (continuous passive motion) machine, which
flexes and extends your knee in a limited range of motion.
You can obtain CPM machine through your physician's
office. Your physician and physical therapist can help
design a custom rehabilitation program that will start
slowly with stretching and build to strengthening exercises.
Rehabilitation is a long process and may require temporary
bracing. In the best scenario, people respond to strengthening
exercises and stop wearing the brace after the first
three to six months. Light exercise is one of the most
effective ways to relieve arthritis pain by stimulating
circulation and strengthening the muscles, ligaments,
and tendons around your knee. Strong muscles take pressure
off the bones so there is less grinding in the knee
joint during activities. In conjunction with a healthy
diet, exercise can also help you lose weight, which
takes stress off your arthritic knee.
STRETCHING
In the first few weeks of rehabilitation, your physical
therapist usually helps you stretch the muscles in your
hamstrings, quadriceps, and calves while flexing and
extending your knee to restore a full, pain-free range
of motion.
AEROBIC EXERCISE
When pain has decreased, physicians generally recommend
at least 30 minutes of low-impact exercise a day for
patients with arthritis. You should try to cut back
on activities that put added stress on your knees, like
running and strenuous weight lifting. Cross-training
exercise programs are commonly prescribed when you have
arthritis. Depending on your preferences, your workouts
may vary each day between cycling, cross-country skiing
machines, elliptical training machines, swimming, and
other low-impact cardiovascular exercises. Walking is
usually better for arthritic knees than running, and
many patients prefer swimming, which takes your body
weight off your knees and makes movement easier.
STRENGTHENING
Strength training usually focuses on moving light weights
through a complete, controlled range of motion. You
should generally avoid trying to lift as much as possible
with your quadriceps and hamstrings. Your physical therapist
typically teaches you to move slowly through the entire
movement, like bending and straightening your knee,
with enough resistance to work your muscles without
stressing the bones in your knee. Once your physical
therapist has taught you a proper exercise program,
it is important to find time each day to perform the
prescribed exercises.
RELATED TOPICS
Knee
strengthening exercises: Cartilage injuries
After rehabilitation, preventing osteoarthritis is
a process of slowing the progression and spread of the
disease. Because patients remain at risk for continued
pain in their knees after treatment, it is important
they are proactive in managing their conditions. Maintaining
aerobic cardiovascular fitness has been an effective
method for preventing the progression of osteoarthritis.
Light, daily exercise is much better for an arthritic
knee than occasional, heavy exercise. When you have
arthritis in your knees, it is especially important
to avoid suffering any serious knee injuries, like torn
ligaments or fractured bones, because arthritis can
complicate knee injury treatment. You should avoid high-impact
or repetitive stress sports, like football and distance
running, that commonly cause severe knee injuries. Depending
on the severity of your arthritis, your physician may
also recommend limiting your participation in sports
that involve sprinting, twisting, or jumping. Because
osteoarthritis has multiple causes and may be related
to genetic factors, no simple prevention tactic will
help everyone avoid increased arthritic pain. To prevent
the spread of arthritis, physicians generally recommend
that you take the following precautions:
Avoid
anything that makes pain last for over an hour or two.
Perform
controlled range of motion activities that do not overload
the joint.
Avoid
heavy impact on the knees during everyday and athletic
activities.
Gently
strengthen the muscles in your thigh and lower leg to
help protect the bones and cartilage in your knee.
Non-contact activities are a great way to keeping joints
and bones healthy and maintain fitness over time. Exercise
also helps promote weight loss, which can take stress
off your knees.
| Treatment
Introduction |
[top] |
Arthroscopy is a surgical procedure that uses an arthroscope,
an instrument that allows a surgeon to see inside the
knee joint. Using an arthroscope, a surgeon can determine
which cartilage surfaces, ligaments, and tendons have
been damaged by osteoarthritis. Small areas of damaged
cartilage can sometimes be smoothed over or repaired
using the arthroscope and microsurgery instruments.
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