Knee Arthroscopy

Knee Arthroscopy is a surgical procedure Orthopaedic surgeons use to visualise, diagnose and treat problems inside the joint.

The word arthroscopy comes from two Greek words; Arthro – joint & Scope – to look. The term literally means to look within the joint.

Professor Kohan uses Knee Arthroscopy as a tool to diagnose mechanical problems within the knee and to surgically repair certain conditions, such as torn cartilage or ligaments.

Arthroscopy is a minimally invasive procedure with diagnostic and therapeutic merits.

  1. Who is suitable for Knee Arthroscopy?
  2. What are the advantages of the procedure?
  3. What conditions does it treat?
  4. How is an Arthroscopy procedure performed?
  5. What happens after surgery?
  6. What complications and risks are there?
  7. Estimate of Fees

1Who is suitable for Knee Arthroscopy?

Arthroscopic surgery is undertaken when conservative treatment options e.g. physiotherapy, anti-inflammatory medications & corticosteroid treatment have not provided adequate improvement in pain levels.

Apart from treating the conditions listed above, arthroscopic hip surgery can:

      • Relieve pain
      • Improve joint stability
      • Delay the onset of osteoarthritis
      • Delay the need for total hip or knee replacement
      • Improve your quality of life
      • Make it easier to carry out your normal everyday activities

2What are the advantages of the procedure?

Arthroscopic surgery is an extremely valuable technique and is generally easier on the patient than open surgery. It is a minimally invasive procedure that is a reliable way to diagnose and correct knee problems.

Many patients have arthroscopic surgery as outpatients, either in a hospital or in a day surgery centre. They have the procedure early in the day, and leave in the afternoon or early evening.

The small surgical wounds from the arthroscopy, often not needing stitches, ensure a more pleasing appearance than the scars caused by open surgery. Because the wounds are small, the patient’s immediate post-operative pain is decreased. It is usual for patients to go back to work or school or resume daily activities within a few days.

3What conditions does it treat?

Arthroscopy is useful in evaluating and treating the following conditions:

        • Meniscal Tears

These often are referred to as tears of the cartilage. The medial and lateral menisci are semilunar fibrous type shock absorbers, which are situated on either side of the knee. Tears in the meniscus are a common cause of knee pain. They sometimes cause intermittent swelling, clicking and catching.

Most tears have a degree of degeneration and occur in the part of the cartilage that does not have a blood supply. This means that they are not usually amenable to repair and require removal of the torn unstable fragments. As much of the meniscus is left in position as it does aid in the distribution of loads throughout the knee. A small number of cases, particularly those associated with a cruciate ligament tear occur at the periphery of the cartilage and may be able to be repaired.

If this is a possibility then the surgeon will discuss it with you prior to surgery.

        • Loose Bodies

Sometimes a piece of bone or cartilage can break off from the surface and cause intermittent locking of the knee. These can be easily removed at surgery.

        • Osteoarthritis

Some patients with this condition can benefit from a knee arthroscopy. Although this will not change the underlying wear and tear it can sometimes be helpful for acute mechanical symptoms, such as, catching, locking or intermittent swelling.

        • Chondromalacia of the Patella

This is a common cause of anterior knee pain and is often bilateral. Whilst most patients are treated conservatively some patients do benefit from using a motorised shaver to remove unstable areas of articular cartilage behind the knee cap.

        • Inflammatory Synovitis

Arthroscopy can be used to diagnose and sometimes treat this condition by arthroscopically removing the inflamed synovial lining.

        • Assessment of Cruciate Ligament Injuries

This diagnosis can usually be made prior to surgery. However, an arthroscopy can sometimes be helpful when diagnosis is not clear cut. An arthroscopy is usually performed in the initial stages of an anterior cruciate ligament reconstruction.

        • Local Cartilage Damage

Sometimes a piece of the articular cartilage can be sheared off from the end of the femur bone. This can cause ongoing pain due to the damaged surface. Many patients will benefit from arthroscopic debridement. Newer techniques such as chondrocyte grafting can be used.

This procedure can be used for growing a culture of cartilage that is taken from the patient and insertion of a gel like patch to cover the defect. This procedure is relatively new but the results reported so far are very promising. It does involve two operations to the knee, including a second open procedure.

4How is an Arthroscopy procedure performed?

An arthroscopic surgical procedure requires the use of a hospital operating room under general anaesthesia.

A small incision is made in the patient’s skin and a pencil shaped arthroscope is inserted with a miniature lens and light system that magnifies and illuminates the structures inside the joint.

This small instrument varies from 3mm to 5mm in diameter. Light is transmitted through fibreoptic cables to the end of the arthroscope that is inserted into the joints. By using a miniature television camera and screen combination, the interior of the joint is seen.

The television camera attached to the arthroscope displays the image of the joint on a television screen. The large image on the screen allows the joint to be seen directly to determine the extent of the injuries and then perform the particular surgical procedure if one is necessary.

Click on the animation below for a step by step guide on Knee Arthroscopy:

5What happens after surgery?

Arthroscopic surgery is considered a day only procedure. This means that you come into hospital a couple of hours before your operation and go home a couple of hours after the operation is completed.

When you wake up you may feel a bit groggy from the anaesthesia. Professor Kohan and his staff will monitor you, checking your blood pressure, temperature and pulse. Dr Kerr will also assess your pain level. Following this examination & if all ok you will be able to go home.

Because the anaesthetic and pain medication may make you sleepy, arrange ahead of time to have someone drive you home.

A postoperative appointment is normally scheduled for a week to 10 days after the surgery.

        • Dressing

A dressing will be applied to the incisions after your surgery. If the dressing becomes moist or blood stained, there is no need for alarm. You may change the dressing 2 days after the surgery, unless otherwise directed.

Once a dressing has been removed, cover the small cuts with bandaids.

        • Incisions

The small surgical incisions are usually left open to allow drainage of fluid used during the surgery, but may on occasion be stitched. The point of entry may be sore and may develop bruising during the first few days after surgery. This bruising around the wounds will eventually disappear and does not require any special care.

        • Medications

Rest can help to relieve pain. In addition, prescription medications following your procedure may be required such as Panadine Forte or Nurofen.

Do not take Asprin for the first few days following surgery as it may increase bleeding.

        • Walking & Exercises

Crutches may be required depending on your level of discomfort and the type of procedure undertaken. Crutches may be needed for one to two weeks, or even longer.

Physiotherapy treatment is also often required however this also depends on the type of procedure undertaken.

6What complications and risks are there?

The complication rates for arthroscopic surgery have been found to be between 1.5% and 2%. This complication rate was determined by a 1985 retrospective survey 375 000 arthroscopy procedures, and a multi-centre study recorded a further 10 262 procedures. In this study, the complication rate was 1.7%.

The most frequent complication was haemarthrosis or bleeding in the joint. This occurred in approximately 1% of cases.

As with all surgery however there are certain risks and potential complications. Although the incidence of these risk factors is low each patient needs to be informed of the possible complications prior to surgery:

Infection

Infection is uncommon occurring in less than two percent of operations. It is usual for each patient to be is given intravenous antibiotics at the time of their joint surgery however, this cannot possibly cover all types of infection which may be encountered. Infection in the postoperative period in most patients is treatable.

Blood Clots (The medical term for this is Deep Venous Thrombosis)

Another potential risk is the occurrence of blood clot or thrombosis after an arthroscopic procedure however as our patients are mobilised very soon after surgery, this potential risk is small. In addition to early mobilisation patients are treated with calf compressors to prevent Thromboembolic disease (the development of clots in the lower extremities) during surgery. Post surgery TED stockings and low doses of anticoagulation (blood thinners) medications are prescribed depending on the patient’s medical history.

Nerve Damage

Nerve damage is another potential risk factor when considering arthroscopic surgery. The nerves can be traumatised at the time of the operation through stretching and occasionally due to postoperative swelling. Precautions are in place to protect the nerves via superior surgical technique but the risk nevertheless, exists for these potential complications to occur. The risk factors are small and are dependant on the age and prior medical condition of the patient.

Diabetes, smoking and peripheral vascular disease are risk factors, as is the presence of previous back problems.

If nerve damage occurs rest and further examination of the nerve will be required and possible further surgery.

Ligament injuries

There are a number of ligaments surrounding the knee. These ligaments can be torn during surgery or break or stretch out any time afterwards. Although rare, surgery may be required to correct this problem.

Medical

Medical risks are varied. They can range from minor to more serious complications. These may include cardiovascular, (Heart attack), respiratory, gastrointestinal, neurological (stroke) and genitourinary systems in the body. Each occurrence of medical complication is addressed on an individual basis.

Other Complications

Other complications that can occur include, instrument scarring, muscle wasting, artery or vein trauma, drug reactions, instrument breakage and loss of income may result from these complications.

While Orthopaedic surgery carries with it certain risks, it would be safe to say that these risks can be encountered with any surgical procedure. Careful pre surgical screening and education, a superior surgical technique and a closely monitored post-operative period all add up to minimising the occurrence of any of these complications.

It is our conscientious effort to adhere to these criteria whenever a patient is under our care. With this in mind, the potential risks are reduced.

7Estimate of Fees

Generally our ‘Estimate of Fees’ is accurate however, on occasion unforeseen circumstances can arise during the operation which may require additional medical services or a different, more costly prosthetic device to be used. If this happens there may be additional costs to you that are not covered by the estimate.

This will be fully explained to you after the operation should it occur.

Estimate of Fees

  • Aftercare Consultation Fees

There will be 1 ‘no charge’ consultation after your Knee Arthroscopy procedure.

Follow-Up Appointment

Your aftercare appointment with Professor Kohan following your procedure includes:

  • 5 – 7 Days Post Surgery – This appointment is in order to check the skin cut & for Professor Kohan to asses your overall recovery.

Consultations after this time attract a fee which is reimbursed in part from Medicare.

  • Professor Kohan’s Surgical Fees

Medical Item No: 49561 – 49557

  • Surgical Assistant Fees

The surgical assistant fees will either be billed to you directly or Professor Kohan will bill you on his behalf.

Medical Item Number: 51303

  • Anesthetic Fees

You will meet with Dr Kerr, the anaesthetist before your operation so that you can obtain an estimate of his fees. These will be billed to you directly.

Medical Item Numbers: 18225, 22045, 23111, 21402, 17620, 17690

  • Hospital Fees

These fees should be discussed with the hospital directly. Please be sure to check with your health fund regarding a gap or out of pocket expenses.