Cyst > Treatments
Preparing for Surgery
While you are preparing to undergo an excision of a
baker's cyst, the decisions you make and the actions
you take before your surgery can be as important as
the procedure itself in ensuring a healthy recovery.
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
the potential risks and benefits of baker's cyst excision,
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.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
possible, practice walking with your crutches in case
you need to use them after surgery.
insurance companies require a second opinion before
agreeing to reimburse a patient for a surgical procedure.
Getting a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
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.
Here are some important steps to remember
as you prepare to go to the hospital or outpatient clinic
for your baker's cyst excision surgery:
most medical centers, you will go to "patient admissions"
to check in for your aspiration procedure. Aspiration
is usually an outpatient procedure but there may be
a separate department for inpatient surgery, so be sure
to ask your doctor.
you have checked in to the hospital or clinic, you will
go to an area where the final preparations are made.
Paperwork regarding your medical history and medication
allergies 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.
will meet the anesthesiologist or nurse 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.
will probably be told not to eat or drink anything after
midnight on the night before your surgery.
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.
a loose pair of pants or other clothing that will fit
comfortably over your knee bandage when you leave the
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.
Surgery to excise a baker's cyst usually
takes about an hour or less, depending on the size of
the cyst. A larger cyst requires a more delicate procedure
that takes more than an hour because it may have swollen
around nerves and blood vessels. After anesthesia is
administered - which may be local, regional, or
general - the surgical team sterilizes the leg
with antibacterial solution. Then, the instruments are
set up and the television monitors are turned on.
surgeon makes two small three- to four-millimeter incisions
directly above the cyst.
tissues surrounding the cyst are cut away and the cyst
is drained of fluid. The knee problem that has caused
the cyst, usually a cartilage (meniscus) tear, is repaired
cyst usually resolves on its own. Physicians do not
typically make an effort to remove the entire cyst.
incisions are closed with stitches.
are awakened and taken to the recovery room
Following excision of your baker's
cyst, 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 during the next few days. In addition, you
will be given an appointment to return and a prescription
for pain medicine. Your knee will be bandaged and may
have ice on it. There will likely be pain, and you can
expect to be given pain medication as needed. Be sure
to ask for medication as soon as you feel pain coming
on, because pain medication works best on pain that
is building rather than on pain that is already present.
The nurses will not give you more than your doctor has
prescribed and what is considered to be safe. You should
try to move your feet while you are in the recovery
room to improve circulation. Your temperature, blood
pressure, and heartbeat will be monitored by a nurse,
who, with the assistance of the doctor, will determine
when you are ready to leave the hospital or, if necessary,
be admitted for an overnight stay. 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. As
soon as you are fully awakened, you are usually allowed
to go home. You will probably be unable to drive a car
so be sure to have arranged a ride home.
It typically takes around four weeks
after baker's cyst excision for the wound to completely
heal. A firm bump of scar tissue will form in the incision.
As the wound heals, the bump will slowly go away. Stitches
are usually removed about two weeks after surgery. 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 in the first 24 hours to suppress pain. Here
is what you can expect and how you can cope after excision:
may be some minor drainage on the dressing since fluid
may have accumulated during surgery. In addition, expect
some blood to show through the bandage during the first
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 two to three times
a day during the first two days will help reduce pain.
Ice therapy is most effective in the first 24-48 hours.
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.
until you can stand comfortably for 10 or 15 minutes
at a time before you take a shower. You can probably
shower the day after excision. A stall type shower is
usually the best. If you have a tub shower, be careful
entering and exiting the tub.
or a cane may be needed for a few days, but you can
usually put your weight on your knee and begin walking.
The pain typically feels like you bumped into a table.
The incision may sting if you flex and extend your knee,
so try to minimize movement for about a week.
two or three days after surgery, you may experience
night sweats and a fever of up to 101. Your physician
may suggest acetaminophen, coughing, and deep breathing
to get over this. This is common and should not alarm
soon as possible after surgery, you should begin doing
physical therapy as directed by your surgeon.
may return to work the next day after excision, depending
on the severity of your pain.
The underlying cause of your baker's
cyst, whether it was arthritis, torn cartilage, or other
knee problems, usually dictates the specific rehabilitation
program you need to undergo. You can begin physical
therapy within 48 hours after excision in most cases,
depending on the overall condition of your knee. After
excision, you usually need to avoid strenuous activities
that put pressure on the bones in your knee. Running,
jumping, or twisting may aggravate the synovial membrane
and increase its production of fluid, causing your cyst
to swell again. The rehabilitation program to help heal
your knee after a baker's cyst excision is usually similar
to the program used to heal a meniscus tear. Your physician
or physical therapist usually designs a custom rehab
program that follows a general pattern. For one to two
weeks after surgery, you should typically rest your
knee to allow the incisions to close properly. Your
physical therapist can teach you stretches and mild
exercises to increase your range of motion. After healing,
it usually takes two to six weeks of strengthening exercises
to ensure you have proper muscle strength to support
your knee. Continuing to visit your therapist can help
you learn the proper form and approach to the recommended
workout. After about six weeks of rehab, physical therapy
can typically become activity-oriented as you regain
the ability to perform complicated movements, using
stationary bikes, elliptical machines, and cross-country
skiing machines. When you feel comfortable performing
these gym activities, you are usually ready to return
to your favorite recreational activities. Physicians
usually suggest that you continue strength training
even after your knee has been rehabilitated. Have your
physician periodically check your knee for strength
and signs of a recurring baker's cyst.
The best way to prevent a recurring
baker's cyst is to properly treat the knee problem or
disease that caused the cyst. In the absence of other
knee complications, the amount of caution you should
use during activities to prevent a baker's cyst from
recurring depends on your age as follows:
Baker's cysts rarely effect joint function. Once
cysts heal, they rarely return.
The cyst could be a sign that you have sustained
some degree of cartilage damage. Becoming less involved
in strenuous activities, like contact sports or long
distance running, may help prevent future baker's cysts.
But you do not need to avoid activities or be overly
concerned with prevention unless the underlying cause
of your baker's cyst was a severe disease or injury
that warrants extra prevention measures.
Because baker's cysts are common companions of
rheumatoid and osteoarthritis, you should strongly consider
cutting back your activity level to avoid situations
that could strain your knee joint. A baker's cyst may
be more problematic later in life, harming the function
of your knee joint, and you should continue to visit
your physician for check-ups after the cyst heals.
Weight control is also important. One extra pound of
body weight translates into three or four pounds of
weight across your knee every time you take a step.
Lightening the load on your knees helps them to function