Knee arthroscopy

Knee arthroscopy is one of the most frequently used orthopaedic procedures. This surgical procedure is done using an instrument called an arthroscope (keyhole). Keyhole surgery is not just confined to the knee and can be used in most joints in the body. Dr Balakumar frequently performs knee athroscopy for a variety of paediatric, adolescent and adult knee conditions.

What are causes of the knee pain?

Injuries, overuse, weakness or aging can harm your knees and cause pain and discomfort. It can be caused by osteoarthritis (wear and tear), inflammatory arthritis (ie.rheumatoid), mechanical problems (loose body, meniscal tears) or ligamentous injury. Very rarely it is used as a diagnostic tool.

What are the benefits of knee arthroscopy?

Knee arthroscopy is an effective tool in diagnosing your joint condition and for confirming treatment for knee problems such as meniscus tears and cartilage wear. An arthroscopy can ultimately provide relief from knee pain and improve mobility. Maintaining a normal and active lifestyle with greater comfort is a key benefit of this procedure.

What are the risks of knee arthroscopy?

While knee arthroscopy is a safe procedure for the treatment of knee injuries, there are some risks that patients should be aware of. Depending on the patient and joint condition, these risks may include swelling and stiffness of the joint, bleeding, blood clots, infection, or continuing knee problems.

How do I prepare for arthroscopic knee surgery?

• Do not eat or drink anything after midnight the night before surgery.

There are many things that you can do to prepare for knee arthroscopy. Prior to your surgery, you will have a physical examination .You will also have an appointment with the physiotherapist of your choice and will fit you with crutches and instruct you how to use them. It is important that you complete all of your testing and appointments prior to surgery, including bloodwork, X-rays, MRI, ECG and anesthesia clearance. Surgery may be postponed if clearance for these tests is not obtained. If you develop any health changes prior to knee arthroscopy, such as cold, fever, infection, rash or wound, you should contact your surgeon’s office prior to surgery.

To prepare for the day of surgery, arrange for a responsible adult to drive you home after surgery and stay with you the first night after surgery. You should also bring your crutches with you to knee surgery, as you will need them to walk following your surgery, in addition to loose-fitting shorts or non-constricting pants (warm-up style) that will fit over your dressing after surgery.

What do I need to do the day of knee arthroscopy?

On the day of knee surgery, patients are admitted . The physician’s assistant will advise you as to what time you will be admitted on the day of surgery. Parking is available at Erin Street in Richmond (Epworth) or at the underground car park at the Avenue.

What happens during surgery?

The arthroscope has a light source and a camera. During the knee scope Dr Balakumar shines a light into the joint, and with the help of the camera, an image of the knee joint is then viewed on a TV monitor. By seeing the knee joint through the arthroscope, Dr Balakumar does not need to make a large incision. Sterile fluid can be used to expand the joint, which increases visibility in the joint area and makes it easier for the surgeon to work.

Dr Balakumar administers a local anesthetic during surgery to numb the area being examined. A regional (spinal) or general anesthetic will be used for better pain control during surgery. The general anesthetic is the preferred anesthesia method. Then, several small incisions (at least two incisions approximately half an inch long) are made in the knee. An arthroscope is inserted, and Dr Balakumar looks inside the knee. Other instruments may be used during surgery to cut, shave, remove particles in the joint, or repair tissue.

What happens after surgery?

Knee arthroscopy surgery lasts for approximately one hour. Following surgery, once patients are comfortable, able to walk on crutches, able to take fluids orally, and able to urinate, they will be discharged to go home in the care of a responsible adult. In the majority of cases, patients are discharged from the hospital to go home on the same day of surgery.

After surgery, a dressing will be applied to the knee, wrapped with an Ace bandage, which will help protect the knee and minimize swelling and pain. An ice pack will be applied to the knee, which will also help prevent swelling and pain. Patients should leave the bandage in place until their physical therapy appointment two days after surgery. You will also be given pain medication after surgery to reduce the knee pain. Do not attempt to drive or attend work or school while taking pain medication.

Many times there will be small amounts of bloody drainage on the dressing. Notify your surgeon’s office if you have any of the following: steadily increasing drainage on the dressing, elevated temperature above 38 degrees, pus-like or foul smelling drainage from any of the incisions, breathing difficulties, pain in your calf when you flex your foot up and down that is unrelieved by rest or elevation, or swelling in your calf, foot or ankle.

When resting, make sure to elevate your knee higher than your heart level on two or three pillows with your back flat on the bed. This will also aid in preventing swelling of the knee joint after surgery. Also, make sure to use crutches to walk. They will protect your knee from undo stress until it is fully rehabilitated. Your physical therapist will recommend any other special knee equipment that you’ll need to use following surgery.

• Call your surgeon’s office if you have any questions or concerns.
  After hours you may call 9387 1000 or speak to Dr Balakumar at his rooms on (03) 9329 5525

How long is the recovery period after knee arthroscopy?

The recovery period after knee arthroscopy surgery depends on the patient and his or her condition. For most cases, patients can return to office work within a week. And many return to a more active and normal lifestyle within one to two months.

What is the rehabilitation after knee arthroscopy?

A patient’s physical therapy program after knee arthroscopy can be divided into three phases: regaining control of the leg muscles and weaning from crutches, regaining full knee motion and strength and returning to normal activity. The following exercises are designed to optimize patients’ recovery for these phases. The timeline for the phases depends on the specific patient and his or her physical condition and progress following surgery.

Phase 1

Exercises during this early phase help patients regain balance and coordination and should be started immediately following discharge from the hospital. Crutch walking is not considered an exercise, but it is an important part of the physical therapy program after knee arthroscopy. Patients should use crutches until they have good muscular control over their leg and can bear weight on the knee without much discomfort.

The isometric quadriceps exercise (also known as “quad sets”) may be started in the sitting or lying position. For patients with low back trouble, this exercise is best done in the sitting position. During the exercise, press your knee down against a table or floor, holding the position for 6 seconds. The exercise can be repeated 10 to 15 times for each set. Two to three sets should be completed in each exercise period.

The straight leg raising exercise is done sitting or lying. The ankle of the leg to be exercised should be bent at a 90-degree angle, and the knee is straightened as much as possible. Then, the entire leg and thigh are lifted off the floor to a height of approximately 1 to 1-1/2 feet and held in the air for 6 seconds. The exercise should be repeated 10 to 15 times for each set; two to three sets should be completed in each exercise period. Patients may add weights for this exercise, beginning with 2 lb weights and adding increments of 1-2 lbs.

Phase 2

These exercises help patients regain full knee motion and strength once they discontinue using crutches.
The range of motion exercise is done by sitting on the table and letting the leg hang over the edge. Patients may use their good leg to help straighten (extension) and bend (flex) the knee.

Patients can begin doing bicycle exercises on a stationary bicycle as soon as the knee has a fairly good range of motion.
Short arc quadriceps extensions are used for the development of the quadriceps muscle. To perform this exercise, patients should be lying down with the unaffected knee bent placing a flat foot on a resting surface. The affected knee is supported off the table by a firm, padded object. The knee is then extended fully to zero degrees from its bent position of approximately 30 to 40 degrees. The leg is then held straight for 6 seconds and then gently lowered.

Initially, no ankle weights are used for this exercise, but as patients gain strength, they may choose to add weight to the ankle. Patients can start with 2 lbs and add increments of 1-2 lbs.

The knee flexion exercise is done while lying face down. The foot is rested on a rolled towel to prevent the toes from striking the table. The foot is slowly raised and lowered to the table. Initially, no weights are used, but as the patient’s knee gains strength weights may be added.

Phase 3

When patients have reached Phase 3 of the physical therapy program, they will be ready to return to normal physical activity. The length of time leading up to this phase depends on the individual patient and their recovery progress following surgery.

How can I manage at home during recovery after knee arthroscopy?

Once patients are comfortable, able to walk on crutches, able to take fluids orally, and able to urinate, they will be discharged to go home.

Patients are usually able to go home from the hospital on the day of surgery.

To reduce pain and swelling, make sure to elevate your leg while at home, and for the first several days (48 hours), ice the knee for 20 to 30 minutes a few times per day to minimize pain and swelling. On discharge, patients will receive a prescription for pain medication.

Patients should not drive or operate dangerous equipment while taking prescription pain medication.

Patients are able to shower when they receive the confirmation that it is okay to do so from their doctor. Patients may be asked to cover their leg with plastic to avoid wetting the bandage and incisions, which increases the chance of infection.

Patients may drive a car as soon as they have good control and mobility of the knee. When patients can comfortably put full weight on their leg, and have good muscular control, they may discard their crutches.

• If patients develop a fever of 38.5 degrees or higher, redness or increasing amounts of pain not relieved by rest, ice or pain medication, they should contact Dr Balakumar at his rooms on (03) 9329 5525.

How frequently should I schedule follow up appointments with my doctor following knee arthroscopy?

Patients will schedule a follow up appointment with their surgeon ten days to two weeks following their knee surgery. Additional appointments may be scheduled based on the patient’s individual condition and recovery.