Before the operation
You must have seen the anaesthetist in a pre-anaesthetic consultation at least 48 hours before the actual surgical operation. This procedure is obligatory.
Declare if you are taking any anticoagulants, aspirin, or any particular drugs.
You must arrange to have some walking sticks, even if your operation is only a short one.
The skin of the knee must be in perfect condition, or the arthroscopy will be deferred.
Remember to take a bath and wash yourself carefully with desinfectant soap on the morning of the operation.
Don’t forget to bring with you your x-ray, MRI and scan reports relating to your knee condition.
Being admitted to a hospital casualty ward involves the same requirements as a surgery ward.
Notify the staff of any deviation from this principle.
Your welfare is at stake.
Top The anaesthetic
Several types of anaesthetic can be proposed: - General anaesthetic
- Local anaesthetic by partial spinal anaesthesia, anaesthetising the limb to be operated.
The advantage for you is that you can then follow the progress of the whole arthroscopy on the video screen.
In any case, you must follow the advice of the anaesthetist, before leaving the clinic. A waiting period is always necessary for your observation, whichever the type of anaesthetic.
Top During the arthroscopy
You will be lying on your back, a pneumatic tourniquet will be tightened around the thigh to prevent any pre-operational bleeding.
The arthroscopy takes place under a liquid circuit, with the articulation being washed throughout the operation.
The operation lasts between a quarter of an hour and an hour
Depending on the case, the arthroscopy ends with a local infiltration of anaesthetic or corticoid.
A removable knee splint is fitted if required.
Top In the observation ward
A period in the observation ward is obligatory, whatever type of anaesthetic is used. There your observation is carried out by a different team from that in the operating block, which only checks patients’ recovery and post-anaesthetic state. These people are specially trained to monitor the immediate post-surgery stage, and they work in collaboration with, and under the control of your anaesthetist.
Your return to the care of the outpatient surgery ward will be determined by the data gathered by your anaesthetist.
However, in case of recovery difficulty or of too much pain, a one or two-day admission to the hospital surgery ward may be necessary.
This is designed to improve your comfort and your safety.
Top After the arthroscopy
At the end of your operation, you will receive a written report on your operation, maybe accompanied by a set of photographs if appropriate, and a letter will be prepared for your local doctor, as well as a prescription for analgesics and sometimes anti-coagulants.
If the arthroscopy is entirely for exploratory purposes or if the intervention is only minor (meniscal resection, ablation of a foreign body, for example) you will be able to get up a few hours after the operation, once the effects of the anaesthetic have worn off and if the instructions given to the nursing staff permit.
Put all the documents you receive after the arthroscopy safely in your medical file.
Keep these documents in a safe, dry place.
Top Complications
An arthroscopy is a surgical act. Complications are rare, but can happen and, if so, require specific treatment. EFFUSION: - Of synovial liquid: fairly frequent after 40 years, especially with a more or less mature arthrosis. This requires the application of ice, taking anti-inflammatories for several days and limited activity. It can take 3 to 4 weeks to resolve itself.
- Of blood: due to the absence of the usual drainage after the arthroscopy, a hematoma can arise. It is sometimes necessary to drain this with a puncture.
INFECTION:
Extremely rarely, in about 0.5 % of all cases, this necessitates an urgent bathing, removal and surgical drainage. In the case of obvious infection, do not blindly take antibiotics, always contact your surgeon urgently. ALGODYSTROPHY:
Of a reflex nature, this induces a demineralisation of the bone and a retraction of the tissue. It is characterised by a painful, inflammatory phase, and then develops into a stiffness in the joint. It should be given a long-term treatment with calcitonin IM. It often arises during the re-education period. PHLEBITIS:
It occurs with a frequency of 2%. A blood clot obstructs a vein, usually in the calf. Prevention can be ensured with the use of anticoagulants and getting up early. A brace may be desirable in cases with circulation difficulties. A Doppler test will be carried out if there is the slightest doubt, as well as the detection of hypercoagulability with tracers. VASCULO-NERVOUS SORES :
A few cases have been reported in world literature. They require surgical repair, which is urgent in cases of vascular lesion.
Top Nursing care No dressing is necessary.
You must keep your bandage dry.
The removal of the stitches or steristrip will take place on the 10th day.
Top Re-education
Re-education is not needed by everybody. It is used in cases of longer and more complicated arthroscopies, or where there is a risk of slower recovery.
If walking sticks have been prescribed, they will be relinquished once walking is considered to be physiologically correct by the physiotherapist and with the surgeon’s agreement.
Top Time off work This depends on your professional activity and the degree of arthroscopic intervention. It rarely exceeds one month, but any time is possible.
Top After your release from the clinic
Never take your car to go home in. Always be accompanied. You can walk moderately and if accompanied, unless instructed otherwise. If a splint has been fitted, it must be worn day and night, moderately tightened. Never make a tourniquet through tightening too much. The length of time you have to wear the splint will be advised to your local doctor in the letter, as well as to yourself and your family.
If, due to “temporary post-anaesthetic amnesia," you cannot remember your post-operation instructions, please contact your local doctor.
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