Knee > Arthritis > Treatments


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.


   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.


   ABC’s of anesthesia

   What to take to the hospital

Surgery Procedure [top]

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.


   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.


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.

Recovery Room [top]

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.

Home Recovery [top]

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.


   Recovery-proof your home

   When to call the doctor after surgery

Rehabilitation [top]

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.


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.


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.


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.


   Knee strengthening exercises: Cartilage injuries

Prevention [top]

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.


R.I.C.E., Bracing, and Physical Therapy
Intra-articular Corticosteroid Injection
   Preparing for Surgery
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Home Recovery
   Treatment Introduction
Unicompartmental Knee Replacement
Total Knee Replacement

Copyright 2007 | Insall Scott Kelly® Institute. All Rights Reserved.