Microsoft word - arthroscopy 2007.07.03.doc

MR IAIN D McLEAN
ARTHROSCOPIC KNEE SURGERY (ARTHROSCOPY)

Please take a few minutes to carefully read the following information on your arthroscopy. It is designed
to answer many frequently asked questions and to assist you to prepare for your pre and post-surgery
needs.
1. ARTHROSCOPY
An arthroscopy is performed in hospital, under a general anaesthetic. The arthroscope is a small (6mm)
instrument with a light, which enables us to see almost every part of the inside of your knee. Small
instruments are used to trim and tidy the torn or damaged cartilages (menisci) or the cushioned-surfaces of
the bone (articular cartilage). We cannot give you a “new knee”, and the body cannot re-grow these
damaged areas – however with appropriate, progressive activities, the majority of knees are improved or
“stabilised” following these procedures. The arthroscope is not a “magic wand”.
2. BEFORE THE OPERATION
a. Notify me of specific medication allergies, bleeding disorders or clotting problems, or previous adverse reaction to surgery/anaesthetics Specific medical history – i.e. diabetes, previous heart, respiratory problems, etc. check with your treating physician b. Stop medications containing Aspirin, anti-inflammatory, or other blood thinning tablets (including garlic and herbal supplements) 5 days prior to surgery c. Practice your quadriceps and calf exercises. Remove compressive bandages/supports when d. Morning of surgery: wash the knee with soap/water only. Do not shave or apply creams/lotions 3. DISCHARGE FROM HOSPITAL
After review by me or my assisting surgeon on the same day (day case) or next morning (overnight stay),
you are discharged with crutches, support bandage (Tubigrip) and Naprosyn (anti-inflammatory
medication – if you tolerate them).
4. AT HOME
You should sit with your leg elevated on a pillow, on the bed, couch or chair. You should get up on
crutches (partially weight bearing) to go to the bathroom, refrigerator and a short wander, before returning
to leg-elevated position. Take it easy during the first 5 to 10 days, but you must do the light exercises and
progress with weight-bearing.
5. EXERCISES
a. Calf exercises are commenced immediately post-operation. Move your
foot and ankle whenever you think of it. This is done to keep the circulation going in your calf muscles and to prevent DVT’s (blood clots). b. Quadriceps setting with your leg on a pillow or rolled towel, tighten your
thigh muscle and push down lightly (not forcibly). Hold for a second or two, then relax. c. Straight leg raise initially tighten the thigh muscle then slowly raise the leg
off the bed. Raid to the count of 3, hold for a second, and then slowly lower. Quadriceps setting and straight leg raising exercises are to be done slowly and
carefully, with no forced or sudden/jerky movements. These exercises are done to
‘have the muscles working’, and are not to be forced.
Quality not quantity – start doing these exercises for approximately 5 minutes, 3 or 4 times per day.
6. POST-OPERATIVE DRESSINGS
On the second day after surgery, take off the wool and crepe bandage. Leave the steristrips (tape) on the
wounds, but check the edges have not formed a blister. Use the Tubigrip support given to you at the
hospital. This should cover the knee area and be firm and supportive – yet not as to cut into the leg or
constrict blood circulation.

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MR IAIN D McLEAN

7. PUNCTURE WOUNDS
There are usually 2 or 3 punctures sealed by steristripes. This area should remain dry until the tapes are
removed after 5 to 7 days. When showering, cover the knee with ‘Gladwrap’ or a garbage bag sealed at
the top with masking tape.
The puncture wounds may remain a little tender and puffy for a month or two. Gentle rubbing and
massaging may be helpful once the wounds are healed.
8. MEDICATIONS
Anti-inflammatory medication (e.g. Naprosyn, Nurofen) is recommended after surgery. This helps reduce
any swelling and thins the blood (to reduce the chance of blood clots). Take as prescribed with meals –if
they cause indigestion, STOP taking them. Panadol or Panadeine may be used for pain as necessary.
9. ICE
Ice is often helpful, particularly in the first few days following the operation or for continuing pain and
swelling. Use for 20 to 30 minutes, 3 to 4 times per day. Initially use plastic over the wound area, to
prevent getting wet and risking infection.
10. KNEE FLEXION OR MOVEMENT
Only a small range of movement is encouraged in the first week, until the dressings and steristripes are
removed. Following this, the range of movement is gradually increased.
11. CRUTCHES / WALKING
Walk initially between the crutches, the leg taking weight as is comfortable. Crutches are abandoned as
soon as you are comfortable to do so – usually 3 to 5 days after the operation – UNLESS YOU ARE
DIRECTED OTHERWISE.
Walking and standing are limited particularly in the first 3 or 4 weeks to only that which is necessary. Do
not walk any great distances or walk for exercise – this will be discussed with regards to your pathology.
12. DISCHARGE FROM HOSPITAL
Knee swelling is highly variable. This is aggravated initially by walking or standing for an excessive
period of time or any loaded bent-knee exercises.
It may be helped by elevating the leg, a firm elastic bandage (when up and about), anti-inflammatory or
aspirin medication, or the use of ice or washing-soda packs.
Washing soda packs can be useful to leave on overnight, or for a couple of hours when resting. These
“draw the fluid from the knee”. The washing “electric” soda crystals are placed in a cotton pillow slip
and placed on the knee (do not allow crystals to be directly on your skin).
13. SWIMMING
Swimming is excellent exercise. This should be commenced as soon as your wounds are well healed
(approximately 10 to 14 days). Start by walking in the water. Follow that by doing some gentle freestyle
or backstroke with a floatation or ‘pool buoy’ between your knees (use such a device until you are
comfortable with your swimming). DO NOT do breaststroke or use kick boards.
14. EXERCISE CYCLE
Cycling is usually commenced around the 2 to 4 week mark – depending on your particular knee problem.
ALWAYS ride with the seat high. Start with no resistance and only cycle for a couple of minutes – be
sure there is not swelling or soreness the following day. If this is okay, then gradually increase sessions
to 10 minutes or so. Gradually increase the resistance before commencing the outside bicycle (use low
gear ratios, no hills). If there is pain or swelling during or after cycling, reduce or stop the activity for the
time being.
15. RUNNING
The level of running depends on your pathology. This is recommended if your articular surfaces are
intact. Running is only commenced after the previous activities have caused no problems and you have
discussed it with me and/or the physiotherapist. Start by wading in the water, running on the spot on
carpet, followed by a little hopping. Once you are hopping equally, you can commence some easy “run-
throughs” on grass.
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MR IAIN D McLEAN

HOSPITAL
In and out on the one day. Use crutches for 3 or 4 days with elevation. You need to be very cautious
during the first 3 or 4 weeks – i.e. “the irritable period”. During this time, if you are loading your knee
too much or pushing the exercises too hard, the knee may swell and become more painful. The aim is to
regain the range of movement, muscle control and have the swelling subside. This is a frustrating period
for active and athletic individuals. After the first 3 or 4 weeks – depending on your knee, your
pathology and your biological response – a progressive programme of mainly swimming and cycling is
recommended, to take you on until 3 or 4 months after surgery. It takes this length of time for any
cartilage/cushioned surfaces to “seal or stabilise” following injury/surgery.
WHAT NOT TO DO
Do not use foot weights, unless directed by me. Do not use leg extension machines. Do not squat, kneel
or twist suddenly for at least 8 to 12 weeks. Do not do any exercises that create pain, clicking or cause
swelling afterwards.
COMPLICATIONS – PROBLEMS OF SURGERY
Any procedure involving anaesthesia or surgery carries a small risk. These problems are rare for
arthroscopic surgery, but nevertheless can occur. If you are worried by any of these, have a family
history or had a personal complication with previous surgery, then discuss it further with me BEFORE
booking surgery.
Haemorrhage/Bleeding:
To reduce the risk you must be off all anti-inflammatory medication, aspirin, or other anti-coagulant
therapy and garlic supplements, for a minimum of 5 or 6 days prior to surgery. If you have a history of
bruising easily or bleeding at previous surgery (or your family has such a history) then let me know so as
to discuss before booking surgery.
Bleeding may occur at the wound site but this generally responds quickly to firm pressure applied to the
point, firm bandaging and ice. If bleeding occurs inside your knee, an increase in pain, tightness and
swelling occurs. Icing, compressive bandages and leg elevation are warranted.
DVT or blood clots in the calf:
This may occur, particularly if you do not commence your exercises immediately following surgery. The
risk is increased if you have a past history of blood clots, you are a smoker, are on the contraceptive pill,
or have a family history of the problem. The risk of DVT is reduced by doing your exercises and taking
anti-inflammatory tablets (e.g. Naprosyn).
Infection:
Infection is very uncommon in arthroscopic surgery, but can occur, causing increased pain, swelling and
temperature. If worried about this, please contact me.
Clicks:
Clicks may be noticed or become more pronounced for a time following arthroscopic surgery. These may
continue for a period of weeks or sometimes months before gradually settling.
Small Skin Nerve Damage:
This is uncommon although may occur. This causes a small area of numbness or altered sensation over
the front of the knee, which usually settles with time and massaging.
“No better – worse” following arthroscopic surgery
This may occur because of the nature of the pathology in your knee or your body and tissue response to
the surgery. Generally if this occurs the knee is “stirred up”, however with time, patience and modified
activities, they generally stabilise. There can be rare occasions when the knee will remain “irritable”, or
due to anxiety and other factors, you can develop a condition called Reflex Sympathetic Dystrophy.
SUMMARY
Knee Swelling:
Either resistant or recurrent, should be reported. It probably means there has been too much weight
bearing (walking, running, etc), but you can continue swimming and straight leg exercises.
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MR IAIN D McLEAN

Leg or Foot Swelling (Calf Pain):
Due to bandage too tight, or occasionally there can be blood clots in the veins – LET ME KNOW!
Gradual improvements are to be expected
Nevertheless, it may take a period of 3 or 4 months to “stabilise”. Any set-back is usually related to
inappropriate or over-enthusiastic exercise.
Ligamentus damage and instability:
This is not amenable to simple arthroscopic surgery. This may require larger operation “ligament
reconstruction” at a later date.
Articular surface damage:
This is irreversible. Symptoms may be temporarily relieved by debridement (the “trim and tidy”, but lost
joint surfaces are not replaced, and may give continued symptoms (arthritis) and require a modification of
activities.
Following Meniscectomy (Cartilage Operation):
The kneecap sometimes becomes more painful for the first time. This should subside if you avoid
loading the knee in a bent-position – i.e. stairs, squatting, climbing, hills, heavy quadriceps exercises or
running. You cannot “push through” this pain as it may become worse.
TIME OFF WORK / SPORT
This will depend on your joint pathology and your work demands. A rough guide is:
Office work – 3 or 4 “working days” (i.e. one week) Work involving a lot of standing/walking – 3 to 4 weeks More manual work – 1 or 3 months depending on your work and respective knee problem Work involving climbing/squatting/kneeling – you may need to avoid and/or modify your work pattern. For example: use a stool for low-height work, take the lift and not stairs, etc. Driving a car: Right knee – when you feel confident of being able to “slam on the brakes” in an emergency – usually 5 to 10 days Left knee – automatic-transmission vehicles, 3 to 4 days; manual [clutch] vehicles, 5 to 14 days
HOSPITALS
I operate at two Private Hospitals that specialize in orthopaedic procedures.
Linacre Private Hospital – 12 Linacre Road, Hampton. Tel: 9598 9666
Operating Lists: Tuesday afternoon and Friday afternoon Mercy Private Hospital – 159 Grey Street, East Melbourne. Tel: 9928 6555
Hospital Cost – This will depend on your private hospital insurance. Check this with your insurance
company or with the Finance Department of the Hospital.
Medical (Doctor’s) Costs – Myself, my assistant, and Anaesthetist are partially (approximately
60%) covered by Medicare. There is a definite gap that you will need to pay that is not completely
covered by private insurance however. This gap varies depending on your type of policy and insurance
company. The surgical fees and Item Numbers are outlined on the ‘Cost Sheets’.
If you have any questions or problems, please speak with my Secretary.
PLEASE NOTE
It is not just the operation that determines you progress or future problems. There are a combination of
factors – your knee, your pathology, and your biological response.
We encourage you to work with a mix of patience, caution and persistence. Dedicate time to your
progressive exercise programme – swimming and cycling for example – as these should see your knee
condition stabilise.
Modification of your activities in relation to your sport, recreation or work may be recommended.
Caution or avoidance should be taken with squatting, kneeling, twisting, climbing or running. These
matters are discussed with you during the post-surgery follow-up.
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Source: http://iainmclean.com.au/doc/IDM07_ARTHROSCOPY.pdf