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Precision Surgery
Tel.: 0207 0346125
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What is keyhole knee surgery?

Who is suitable?

Preparation for your operation

Risks

What to expect afterwards

Recovering from knee arthroscopy

Is it too soon?

Is it too late?

Is my condition bad enough for an operation?

 

Keyhole Surgery (arthroscopy)

What is keyhole knee surgery?
Keyhole knee surgery uses 2 small incisions (<1 cm each) to allow the surgeon to place a telescope and a micro-instrument inside the knee joint. The telescope (arthroscope) allows the surgeon to diagnose and treat the following:

  • torn meniscal cartilage
  • damaged joint surface cartilage
  • torn anterior cruciate ligament
  • loose bodies

It’s role in treating arthritis is in the assessment of the joint surfaces (and is superior to MRI) and removal of torn cartilage. As with all types of keyhole surgery there is less pain, faster recovery and less risk of infection when compared with open surgery.

Who is suitable?
Your orthopaedic surgeon will assess whether your knee will benefit from keyhole knee surgery. He is likely to use plain X-rays and an MRI scan to help with this assessment. The conditions listed above are the most common reasons to recommend keyhole surgery.

At arthroscopy, loose and damaged pieces of joint can be removed, and if the main symptom is acute sharp pains with catching and locking, then an arthroscopy may well provide lasting relief. Arthroscopy cannot repair a worn out joint, so if there is already bone rubbing on bone because a part of the joint has worn out, causing pain and aching after exercise an arthroscopy may not help at all.

Preparation for your operation
A general anaesthetic is required and so you are best advised to stop smoking. You will need to fast for 6 hours prior to the operation although some anaesthetists allow sips of water until 2 hours before the operation (milk in tea counts as food so must be avoided). A marker pen will be used to label the correct knee. You will be asked to sign a consent form to confirm that you understand the risks, benefits and type of procedure.

Risks
Overall, keyhole knee surgery is very safe and has one of the highest satisfaction rates of any surgical procedure. The possible complications of any operation include reactions to anaesthetic drugs (these often cause nausea and sickness), excessive bleeding or developing a blood clot, usually in a vein in the leg (a Deep Venous Thrombosis, DVT).
Complications specific to keyhole knee surgery can include:

  • loss of feeling in the skin over the knee
  • bleeding into the joint
  • the surgery may not be successful or it may have to be repeated

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

What to expect afterwards
You will need to rest for a few hours until the effects of the anaesthetic have passed. The nurses and physiotherapists will help get you out of bed and start getting you walking, sometimes with the aid of crutches. In virtually all cases you will be allowed to place full weight the operated knee.

  • You may need pain relief to help with any discomfort as the anaesthetic wears off.
  • You can home home as soon as you feel ready. You will need to arrange for someone to drive you home.
  • You should try to have a friend or relative stay with you for the first 24 hours.
  • Your nurse will give you some advice about caring for your healing wounds before you go home.
  • You will need to see your surgeon after the operation, anytime between 2 and 6 weeks.

Recovering from knee arthroscopy
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.
You will have a large wool bandage over your knee. This can be removed the first morning after your knee surgery. The sticky plasters beneath this bandage are usually left for 5 days. Your knee needs to be kept clean and dry during this time to allow the wounds to heal.

  • Waterproof plasters can be used to you take a shower and don't soak your knee in the bath until the wounds are fully healed.
  • You should continue with the exercises recommended by your physiotherapist, as they will help to improve your knee movement and strength.
  • It is normal for your knee joint to feel sore and swollen for at least a week. This can last longer if you have arthritis. To help with the pain you can apply an ice pack wrapped in a towel.
  • You shouldn't drive until you're confident that you could perform an emergency stop without discomfort. This is usually about one week after the operation.
  • Your recovery time will depend on what, if any, treatment your surgeon performs on your knee joint. You should be able to resume your usual activities after three to eight weeks depending on the severity of your knee problems and your level of fitness.

Types of Meniscal Tears

Keyhole knee surgery showing
meniscal tear

   

Is it too soon?
Rule one is ‘keep away from doctors, and surgeons in particular’, so it is almost never wrong to postpone surgery. What we do know, is that to keep feeling well, everyone needs to take a reasonable amount of exercise. If you can no longer walk for pleasure, or play the ‘age-appropriate’ sport that you really enjoy because of a simply rightable wrong, then there is no harm in getting an opinion.

Is it too late?
Only rarely will we ever say, ‘I wish you had come sooner’, because the wearing out process usually takes a long time, even though a joint may hurt a lot.

Here are a few of the exceptions:

  • when a small problem can be sorted out by a small operation, but it is left too long, so a big operation is needed instead. The commonest example of this in the knee: a sore knee that is left too long can become unstable. One can manage to limp around, albeit rather slowly, and fear keeps you away until it is unbearable, by which time a total knee replacement has to be performed, instead of the smaller unicompartmental replacement, which usually prevents a total knee ever being needed.
  • when a simple ligament rupture leaves the knee unstable and consequently serious meniscal damage occurs.

Is my condition bad enough for an operation?
We measure how bad things are in a number of ways:

Firstly on a 0-10 scale, how much pain are you in? Is it steadily getting worse?
Secondly how much trouble do you get in everyday life and doing the things you enjoy?

Before your operation you will be ‘scored’ using a variety of functional scores. These are principally questionnaire based, and help put your problems in perspective. They also give a helpful comparison for your progress following surgery. Examples of these may be found below.

The oxford knee score


Precision Surgery : The London Clinic Consulting Rooms, 5, Devonshire Place, London W1G 6HL : Telephone 0207 0346125 : Contact form