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.
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.