What is it?
The surgeon needs to look inside your knee to find out exactly what is causing your problem.
- You may have a tear of one of your cartilages. These are half moon shaped pieces of gristle cushioning the bones in the knee.
- You may have torn one of the ligaments within your knee joint. These are strong bands of gristle holding the bone ends together inside the joint.
- You may have a loose piece of bone in your knee joint.
- You may have arthritis in part of your knee. This means that the surfaces of the knee joint are no longer smooth. The bones are rough and the cartilage lining has worn away. As a result, your knee can be swollen, painful and stiff.
- You might have an infection in your knee.
The arthroscope is a telescope about as wide as a pen, connected to a television. The surgeon will insert the arthroscope through one or two tiny cuts (about half an inch 1.2cm) around your knee. He will use it to look at the inside of your knee. This operation is called an arthroscopy.
If you have torn a cartilage, he will remove the torn part using fine instruments inserted through small cuts. Occasionally he has to make a bigger cut to remove the cartilage. This would be about three inches (7.2cm) long.
If you have torn a ligament within the knee, he will not replace it during this operation. He will discuss the possible treatments with you after your arthroscopy.
If he finds a loose bone fragment, he will remove it through the small cuts. If you have arthritis, he can see how severe it is. He will wash out the inside of the knee with salt water. This often improves your symptoms for some months.
If he sees evidence of infection (usually thick cloudy fluid), he will take a small sample of this fluid for examination to find out what bugs have caused the infection. He will then suction out the rest of the infected fluid and wash out the inside of the knee with salt water to remove any residual infected material. The cuts will be closed with paper tapes or stitches.
The operation can either be done as a day case, which means that you come into hospital on the day of the operation and go home the same day, or as an inpatient case, which means spending one night in hospital. Your surgeon will discuss with you which way you will be having the operation.
If you leave things as they are, the knee problem will probably get worse. More X-rays and scans will not help. Arthroscopy is the only way to give a direct view of the inside of the joint.
Before the operation
Bring all your tablets and medicines with you to the hospital.
On the ward, you will be checked for past illnesses and will have special tests, to make sure that you are well prepared and that you can have the operation as safely as possible.
You will have the operation explained to you and will be asked to fill in an operation consent form.
Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.
Before the operation and as part of the consent process, you may be asked to give permission for any 'left over' pieces to be used for medical research that have been approved by the hospital. It is entirely up to you to allow this or not.
Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
After – in hospital
You will have a bandage on your knee. Usually the wound is pain-free but you may feel some discomfort and your knee may feel a bit stiff. This will quickly get better. You will be given painkillers to take home. They should easily control this discomfort.
A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time.
The discomfort of the operation can make it difficult to pass urine and empty the bladder. It is important that your bladder does not seize up completely. If you cannot get the urine flowing properly after six hours, contact the nurses or your doctor. You may need a catheter (fine plastic drain tube) put in your front passage to drain the urine from your bladder until you are able to pass urine comfortably on your own.
The cuts will be held closed with paper tapes or stitches. There will usually be simple adhesive dressings or a crepe bandage over the tapes. You may take the bandages, dressings and the tapes off 10 to 12 days or so after the operation.
If there are stitches they will be removed 10 to 12 days after the operation. Wash around the dressing for the first 10 days. You can wash the wound area as soon as the dressing and any stitches have been removed. Soap and warm tap water are entirely adequate. Salted water is not necessary. You can shower or take a bath as often as you like once the wound has healed.
You will be given an appointment to visit the orthopaedic outpatient department 10 days or more after your operation. The nurses will advise about sick notes, certificates etc.
After – at home
You will not be able to drive for two weeks after your operation. You will not be able to perform an emergency stop as quickly as normal before then.
How soon you can return to work depends on your job. If you mainly sit at work, you may be able to return to work one week after your operation. This also depends on you being able to get to work. If your job is manual you will be unable to work for two or three weeks.
You may swim and play most sports three weeks after your operation. When you start playing, you will not be able to play for as long as normal. Your knee may ache at the end of a game. You will gradually improve.
As with any operation under general anaesthetic there is a very small risk of complications related to your heart or your lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are rare and seldom serious. Bleeding into the joint and infection of the joint may rarely happen after the arthroscopy.You will be given antibiotics to prevent an infection.
Although rare, if the infection is much more serious and spreads through your bloodstream, you will need to remain in hospital so doctors can give you intravenous antibiotics (through a vein in one of your arms).
Another possible complication is the formation of clots in the deep veins (draining pipes for the blood) of your legs (deep vein thrombosis (DVT)). This can happen in the initial days after the operation because you won't be moving around much. A piece of one of these clots can get detached and 'travel' all the way to the blood pipes of your lungs. There it can cause partial or complete obstruction of the blood vessels of the lungs, which can be lethal.
You will be given injections of blood-thinners (heparin) after the operation to prevent a DVT. In addition, being as mobile as possible and co-operating with the nurses and physiotherapists after the operation are very important in preventing a DVT. Sometimes a repeat operation is needed to remove a damaged cartilage.
If there is arthritis, the operation may do no more than confirm this, without making the knee better.
In addition, during the operation further damage to the knee joint or damage to the nerves and blood vessels of the area can happen and this may require another operation to deal with the problem.
The operation is a minor one. You should end up much better off after the operation. We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.