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Arthroscopic Knee Surgery

This information has been designed to give you a basic understanding of your arthroscopic knee surgery and what to expect during your hospitalisation. Please keep in mind that this is a guideline only and that each individual has different needs so you may progress at a different rate to that which is outlined.

Your Orthopaedics SA specialist will be happy to address any questions which might arise after reading this information.

 

Arthroscopic surgery of the knee is performed using a small telescope (arthroscope) and operating instruments which are inserted through, three punctures (usually) approximately 5 millimetres long.

Using this technique, it is possible to remove torn cartilage and other loose pieces as well as perform various other forms of surgery within the knee using special instruments without the necessity for opening the knee.

This procedure enables a more rapid recovery than with the older traditional methods, the pain is reduced and the hospital stay is much shorter.

Hospital Admission

Your operation will involve admission to hospital, usually just for the day. Only rarely is an overnight stay recommended.

Anaesthesia

A general anaesthetic is usually required. The anaesthetist will see you prior to your operation. Generally, if your operation is in the morning, then you should fast from midnight, however, if it is in the afternoon, you should fast after a light breakfast at 7.30am. You will be advised of a fasting time relevant to your scheduled surgery time, prior to admission.

Recovery

On recovery from the anaesthetic, you may experience some soreness in your knee and pain relief will be given if this is troubling you. You will be given a prescription for a strong pain killer prior to discharge, to use at home if necessary.

When you have recovered from your anaesthetic fully, you may get up and walk about, unless instructed otherwise. You will usually not need crutches.

Going Home

Prior to going home, you will be given advice regarding exercises and if required, arrangements made for you to be seen by a physiotherapist. It is important to do the exercises after surgery, as per the sheet provided, to minimise muscle wasting.

Bandages

The bandages can be removed the next morning. You will be given a tubigrip bandage prior to discharge, which should then be applied for at least one week although it can be removed at night for showers.

The risks involved

This surgery has a very low complication rate. The worst complication is infection, which occurs about once every 300 cases and requires further hospital treatment.

Stitches

Normally, there are no stitches. The steri-strips and bandaids should be left in place for 5-7 days. After showering, the area around the bandaids should be dried and the tubigrip reapplied.

Swelling

Some swelling and discomfort is expected. Simple analgesia should cover this. Excessive pain, prolonged or offensive discharge from the puncture holes or a high fever may indicate infection and should be reported to your surgeon. Infection is a rare complication, which needs special treatment.

Bleeding

IIt is common to get some bleeding or clear yellow joint fluid for the first few days. Replace the bandaids if necessary.

Tenderness

Some prolonged tenderness of the puncture holes, especially with kneeling is common and some minor surrounding numbness also can occur.

Return to work

You could return to work in a few days if you have a sedentary job. Those with heavy manual jobs will need longer and this will depend on your fitness and the type of arthroscopic surgery performed.

Driving

You should not drive for 24 hours after the anaesthetic, but can resume when your knee is comfortable.

Follow-up appointment

A follow-up appointment will be made for you to see your surgeon a few weeks after surgery.

The results

For simple torn cartilages the results of surgery are very reliable and a near full return of function and relief of pain can be expected.

For older patients where arthritis is present in the joint, the aim is for a significant improvement in symptoms with reduction in pain and improvement in function, but there may never be complete relief of symptoms.

Knee cap problems are also rarely completely cured.

Rehabilitation after surgery: Walking

  • Restrict walking to essential needs for 3 days and elevate leg when resting
  • No excessive walking for first 7 days.
  • It is important that you walk as naturally as possible, try not to limp.
  • When walking try to weight bear on a straight knee, then bend the knee easily to step through.

General Information

  • The morning after surgery, the bandage should be taken down and the tubigrip applied. You may remove the tubigrip to shower (leave the bandaids on) but the tubigrip should be reapplied afterwards.
  • Do not stop blood circulation to the lower limb.
  • The steri-strips and bandaids may be removed in 7 days, together with the tubigrip.
  • If your knee is swollen, pack it in ice for 10-15 minutes several times per day.
  • Using crushed ice inside a damp towel ensure ice is wrapped around the entire knee.
  • Never apply ice directly to the skin.
  • If your knee swells significantly and you cannot bend the knee to a right angle, or if you are in a lot of pain, please contact your Doctor.

Post-operative Exercises

  • Unless instructed otherwise, commence the following exercise program the day after surgery.
  • Try to do the exercises at least 3 times per day but do not overdo it if the knee is very painful or swollen.

1 Quads exercise:

A.

  • Place a rolled up towel under the knee.
  • Tighten the thigh muscle, bracing kneecap up tight.
  • Feel the back of the knee pressing down on the towel.
  • Lift heel off the bed.
  • Lower and relax leg.
  • To progress lift the straight leg off the towel.

Repeat 10 times

B.

  • Place towel under your heel.
  • Brace knee tightly, straightening knee down onto the bed.
  • Lift straight leg off the towel. Hold 3 seconds.
  • Lower and relax.

Repeat 10 times

2 Knee Bending

A.

  • Sit on bed with legs out straight.
  • Bend your knee as far as possible, pulling your heel towards your buttock.
  • You may help with your hands around the thigh, initially.

Repeat 10 times

B.

  • Sit on the edge of a table/bed.
  • Bend your foot under the table (do not lift the buttock, help by pushing with the other foot)

Repeat 10 times.

If you have any additional questions please feel free to contact the Orthopaedic Liaison Nurse on (08) 8267 8267.

Information regarding your planned surgery.

It is in your interest to read this carefully. It concerns what is going to happen to you in hospital. If you do not understand, you should approach your specialist or his secretary, for clarification of any point.

If you are not correctly fasted for your anaesthetic, the operation may be cancelled or postponed until you are correctly fasted.

If you are taking regular cardiac medications, please do not stop taking them (with the exception of aspirin or anti-inflammatory medication). Take all medications with a sip of water.

Please TAKE YOUR X-RAYS TO THE HOSPITAL

*If you do not understand the nature of the operation or the possible complications of the procedure, you should arrange to again see your Orthopaedic specialist.

Accounts

You will be liable for several accounts in relation to your hospitalisation and operation. An account may be received from:

  1. The Hospital: This will include a bed fee, theatre fee and a fee for any disposable items and surgical implants used in the operation. If covered by Private Health Insurance, you should check your level of cover and the amount of rebate with the Insurance Company and hospital.
  2. The Anaesthetist: If you wish to discuss the Anaesthetist’s fee, please contact the Practice secretary for his/ her name. You can then contact him/ her directly.
  3. The Assistant: An assistant is required for all major cases and some lesser cases. You may find out if an assistant is required from the Practice secretary.
  4. The Pathologist: If pathology is required. (Not all cases require pathology).
  5. The Radiologist: Not all cases require radiology.
  6. The Physiotherapist
  7. The Surgeon’s fee: There is sometimes a difference between the fee charged by the doctor and the amount you can obtain from the Health Insurance Commission or your Health Fund. The difference is the “gap”. You should find out if your surgeon is using an “EZI CLAIM GAP” COVER SYSTEM, where the Private Health Fund pay for some or all of the “gap” on your behalf.