What is Knee Arthroscopy (Key hole surgery)?
Knee arthroscopy is a daycare procedure in which the surgeon inserts a camera into the joint through very small (~3-5 mm) incisions. It is a relatively minor procedure with low risk and a quick recovery in most patients. It can be useful to treat traumatic meniscal tears (cartilage tears), certain cartilage injuries or remove loose bodies in the joint if they are causing symptoms. However, arthroscopic surgery is generally not useful when treating arthritis in the knee. There are several excellent research studies that have shown that knee arthroscopy for arthritis provides no better pain or symptom relief than non-operative management.
Knee arthroscopy typically takes 20-30 minutes but you should expect to be at the hospital most of the day. The anesthesiologist will discuss options with you but generally knee arthroscopy is done with the patient under general anesthesia, meaning asleep. You will need someone to drive you home and you must have someone at home with you for the first night.
Crutches - You will benefit from crutches for the first 1-2 weeks after surgery. Most commonly, the sugeon will allow you to fully weight bear on your leg but the crutches will help you balance as you recover your strength and the pain improves. Use the crutches to train yourself to walk with a normal gait. When you are able to walk without a significant limp, get rid of the crutches.
Postoperative Discomfort - After surgery you will have mild-moderate discomfort. There is ‘freezing’ in your knee that will wear out 4-6 hours after the operation. Make sure you take some pain medication as you feel the pain start. You should plan to spend several quiet days on the couch after surgery. You will be provided with analgesic medication to help manage your pain in the first couple of weeks. You can taper off of the medication as soon as your pain starts improving which will help avoid some of the side effects of narcotic medication such as drowsiness and constipation. Make sure to let your surgeon know if there are medications you cannot take and a different plan will be formulated for you.
Consistent icing in the postoperative period dramatically improves pain and decreases swelling and inflammation. After knee arthroscopy icing 4-5 times per day for 20 minutes each is recommended. There are automatic icing machines that both cool and compress the knee. In most cases with simple knee arthroscopy a bag of ice or a bag of frozen peas will suffice but if you have access to one of these units they can be helpful. Extended benefits will typically cover most of the cost of one of these machines if you are interested. If you wish to find out more about a cryocuff please contact your surgeon’s office assistant.
Dressing & Wound - You will have a bulky dressing and a tensor bandage on your knee when you leave the hospital. This should be worn for the first 2-3 days and then it can be removed. If the tensor bandage feels too tight do not hesitate to loosen it. You will see thin tapes (Steri-strips) over the incisions when the dressing is removed. Leave these on until you see your surgeon or until they fall off. A light, protective dressing should be reapplied after the bulky dressing is removed. These can be purchased at a drug store. You may shower after 3-4 days but should avoid soaking the wound (e.g. bath, swimming pool) until about 2 weeks after surgery. When you shower you should sit on a stool in the shower to lessen the risk of falling and damaging your repaired knee.
If you notice signs of infection such as fevers, chills, or increasing redness around the wound you should see your family doctor, contact your surgeon’s office or go to the emergency department.
Physiotherapy - Physiotherapy is necessary after any surgery. You will need to attend physiotherapy and the government does not cover this cost. If you do not have insurance (e.g. extended benefits) you will need to save money in order to attend physiotherapy after surgery. A physiotherapy prescription will usually be given to you when you leave the hospital and you should attend within the first 10 days after a surgery to get a plan in place to expedite your recovery.
Return to Work - Everyone is different and every job is different. You should expect to take 7-10 days off of work if you have a ‘desk-type’ job. Some people may need more time off depending on how much pain they experience. Patients with more labor intensive jobs will require at least 4-10 weeks off of regular duties prior to returning to work. This can be reassessed as you recover from your surgery.
Follow-up Appointments - Your surgeon will typically see you in the cast clinic at Lions Gate Hospital (link) or WHCC (link) after surgery at 2 weeks post-operatively to see how you are doing and answer questions. Depending on your diagnosis and your recovery you may be seen one or more times following the first visit. The first visit will be in the cast clinic and it will be very busy. It is not uncommon for the clinic to run significantly behind schedule as a result of factors out of your surgeon’s control.
If questions arise prior to your surgical date feel free to make an appointment to discuss your concerns with your surgeon in the office or cast clinic.
Removal of loose bodies and joint debridement