What is an arthroscopy?
An arthroscopy is a keyhole operation on the knee, during which knee problems can be diagnosed and usually treated.
Why do I need the operation?
Your surgeon will explain the reasons for doing your operation and will also discuss the alternatives. It is usually known what is wrong with your knee before your operation, which is being performed to treat the problem. However, sometimes the operation is performed to find out what is wrong within your knee or as an assessment before deciding on further treatment.
Will I be asleep?
Arthroscopy is almost always performed under a general anaesthetic, which means you would be asleep. Sometimes it is performed using a spinal anaesthetic, which makes the legs numb, or occasionally a local anaesthetic, which makes only the knee numb.
What will the operation involve?
Once under anaesthetic your knee will be examined. You will have two small incisions made (0.5 – 1 cm long) just below the knee cap on either side. Sometimes additional incisions may need to be made. Your knee is then filled with fluid. An instrument (the arthroscope) is then inserted into your knee to look round the joint with the aid of a camera. Any problems identified within your knee will either be dealt with there and then (such as cartilage tears) or will be recorded so that they can be discussed with you after the operation. Where possible any injury is repaired, but often this is not possible and the damaged tissue has to be removed. Local anaesthetic is usually inserted at the incision sites to ease discomfort. Stitches are rarely inserted in the wounds. The operation usually takes 30 – 60 minutes to perform.
I’m also having a lateral release – what does this mean?
In a small group of patients the arthroscopy is being performed to assess the way the knee cap runs in its groove. Sometimes it tilts towards the outer side of the knee and symptoms may be improved by releasing the tight soft tissues, called a lateral release. This is performed at the same time as the arthroscopy, usually using an additional incision. After operation your knee can be a little more swollen, bruised and uncomfortable compared to patients who have not had a lateral release. To help you mobilise your knee you will be referred for a course of physiotherapy starting about a week after your operation.
How long will I be in hospital?
The length of stay in hospital will depend on your age and fitness as well as the type of operation. Most arthroscopies are performed as a day case, which means that you will go home later the same day. You must not drive or operate machinery for at least 24 hours after the operation. Someone must be at home to look after you for the first 24 hours.
What can I expect after the operation?
When you wake up your knee will be in a light bandage. There may be some discomfort in your knee, but you should be able to go home comfortably without crutches. You will be given instructions on what to do / not to do and you will be given some pain killers to take home. Your knee may have an odd squelchy feel, which disappears after a day or so.
Will I be seen after my operation?
Yes. Although most patients are seen following their operation by their surgeon it is common to forget what you have been told. You will therefore be seen again 2 – 4 weeks after discharge to discuss the operation and assess your progress. This may be in your surgeon’s clinic or at the dedicated Arthroscopy follow up clinic, which is staffed by trained physiotherapists. Additionally an out-patient course of physiotherapy is sometimes arranged prior to discharge.
How long will it take for me to recover?
This will depend on your age and the underlying problem. Most patients, however, feel much better 1 – 2 weeks after operation and have achieved a full recovery six weeks later. However, it can take several months to feel that the knee is fully right.
When will I be fit to return to work?
This depends on your age, the problem and your job. Most people with a sedentary job go back to work within a few days. If you have a heavy manual job it may take a few weeks. You must not drive for 24 hours after the operation because of the anaesthetic. Thereafter you should not drive until you feel safe to do so. It can take up to 6 weeks to be able to kneel on the knee. Your surgeon or insurance company may help you further if you have any queries about this.
When can I go back to sport?
This will depend on your age, fitness, underlying problem and the type of sport you are involved in. As a rough guide, people who have had a cartilage removed should be back to sport 4 weeks after the operation.
How soon after my operation can I fly or go on holiday?
You should be able to go away within the UK after 24 hours, providing any long journey is appropriately broken. Flying immediately after lower limb surgery is associated with an increased risk of deep vein thrombosis (see below). Although no fixed guidelines exist we recommend that you should not fly for 2 weeks following an arthroscopy.
Will the operation definitely make my knee better?
We can never guarantee the result of any operation. The possible outcome of your operation will be discussed with you before the procedure. Patients who have a definite cartilage injury and no other problems should return to normal. If there are any changes of wear and tear in the knee (osteoarthritis) then there is usually an improvement in symptoms but some may persist.
Can the operation do me any harm?
Arthroscopy is a safe operation that is highly unlikely to damage your knee further or lead to any long-term problems. There are some potential minor problems and a few rare complications:
Anaesthetic: Rarely problems can occur related to your general health and the anaesthetic. The majority of potential problems will be picked up at the pre-assessment clinic. Your anaesthetist will be able to discuss this further with you.
Bleeding: It is not unusual for a little bleeding to occur into the bandage and this should not cause concern. Rarely more severe bleeding occurs into the knee making it very swollen and painful.
Infection: The wounds can ooze after the operation, which usually settles without problems. Occasionally they develop a minor infection becoming red or continuing with discharge. Treatment is with dressings and antibiotics. A deep infection in the knee happens in less than 1 in 1000 operations, but can be difficult to treat, leaving the knee stiff and uncomfortable. It can potentially rule out further surgery to the knee.
Deep vein thrombosis: This can occur to any one under going lower limb surgery. The risk is greater if you have had one before or are on the oral contraceptive pill/hormone replacement therapy (which should be stopped 6 weeks before operation). They rarely cause direct problems, but can potentially be serious because of the risk of spread to the lungs (pulmonary embolism). Treatment usually involves taking warfarin (to make the blood clot less easily) for a 3 month period.
What do I do if I have a problem after my operation?
During the daytime you can contact the ward where you stayed for your operation for initial advice. Out of hours you should contact your GP or attend the Accident and Emergency department.