When is surgery indicated?
Knee pain, unclear predisposition to swelling, limitation of motion, loss of stability, blockages, damage to the meniscus, cartilage, cruciate ligament documented on MRI.
Alignment of the knee joint after insertion of a special camera through a small skin incision (so-called “minimally invasive surgery”). Alignment, removal or stitching of damaged parts of the meniscus, treatment of cartilage injuries or cruciate ligament injuries are possible in the same session.
Surgery is usually performed on an outpatient basis or for pre-existing conditions and/or lack of home care in a day hospital setting.
Depending on the treatment, immediate or gradual exercise recovery is possible. Additional therapeutic exercise and thrombosis prophylaxis.
The knee joint is the largest joint in humans; it is composed of the femur, tibia and patella, which are covered by a layer of cartilage. The elastic meniscus tissue serves to increase the contact surface and transfer force between the gliding surfaces of the femur and tibia. The anterior and posterior cruciate ligaments as well as the collateral ligaments mainly provide stability to the joint. Damage to the structures within the knee with residual stress usually results in premature wear and tear, so-called osteoarthritis.
That is why today, thanks to an endoscopic surgical technique called arthroscopy, it is sought to repair the damage in the knee without opening it up in the process. In this way, normal function and physical endurance can be restored or maintained.
When is knee endoscopy indicated?
If pain with accompanying swelling of the knee occurs as part of an accident or unfortunate movement, damage to structures within the knee, such as the meniscus, cruciate ligament or cartilage, is suspected. If there is wear and tear on the joint, damage can occur without external factors. Damage to the knee is indicated by pain, motor limitations, blockages, or a feeling of instability.
If there is no relief of pain despite relief and gentle handling, an endoscopy of the knee joint is necessary in most cases. In unclear cases, the diagnosis can be clarified by magnetic resonance imaging.
How is surgery performed?
Surgery is performed under partial or total anesthesia and is mostly bloodless. A camera and small surgical instruments are inserted through two small skin incisions and the image is transmitted to a monitor. If a tear of the meniscus lobe is present, the “damaged” part, which causes pain, is removed with small cutting instruments to possibly healthy strong tissue. In certain fresh forms of tearing, stitching and thereby complete preservation of the meniscus is possible. Methods with special suture anchors and systems are used here. Cartilage injuries can also be treated by various methods. If the cruciate ligament is torn, surgery with autogenous tendon tissue can be performed.
How long does one have to stay in the hospital?
The stay depends on the type of surgery. Generally, endoscopy of the knee joint is performed on an outpatient basis or with a short hospital stay. This means that you come to our clinic shortly before the operation and return home after the operation on the same day or the next day. Depending on the method of surgery you require, you can be treated within a few days.
A prerequisite for outpatient surgery is guaranteed home care from family or friends. Previous illnesses should not affect functional ability, and of course the doctor at home must guarantee postoperative treatment. Preparation for surgery takes place a few days before the surgery and includes, in addition to examinations, information about the surgery, making new X-rays and laboratory monitoring, also a conversation with the anesthesiologist.
What does postoperative treatment look like?
After the surgery, therapeutic physical training with motor exercises, muscle strengthening and gait training is especially important. This is used by us to ensure that the joints function quickly.
If a meniscus rupture involves the removal of the damaged area, some of the strain must be transferred to crutches for about a week. In the following week, the load is gradually increased depending on the disease pattern. The duration of the disability is about two weeks in these cases. If the meniscus is stitched, the cartilage is treated or the cruciate ligament is replaced, in addition to the restriction of movement due to the splinting, only partial or even no weight-bearing may be necessary for a long time. Heparin injections are necessary during this period to prevent thrombosis.
Knee arthroplasty is one of the most popular orthopedic services. This is because these joints are subjected to serious stresses on a daily basis, wear out gradually, or are injured as a result of carelessness. Regardless of the etiology, a joint deformity causes severe pain that is very difficult to relieve. Knee arthroplasty is the only effective way to get rid of the pain.
Types of endoprosthetic
In each case, the doctor chooses the most suitable type of endoprosthesis, depending on the extent of the problem and related factors:
- Unicondylar design;
- Interposition knee cartilage prosthesis;
- Endoprosthesis on a movable base (platform);
- Bound prosthesis;
- Special prosthesis – the design is made
When is an endoprosthesis needed?
Unambiguous indications for knee prosthetics are the consequences of problems such as:
- Post-traumatic arthritis;
- Rheumatoid polyarthritis;
- Degenerative-dystrophic diseases;
- Abnormally fused bones;
- Tumors that interfere with the normal function of the joint;
- Damaged ligamentous apparatus of the knee joint with pronounced changes in the articular ends of the bones.
Often, problems in the functioning of the joints occur as a consequence of arthritis, arthritis, gout, and frequent trauma. In these cases, the surgeon’s recommendation to perform an endoprosthesis is also objective.
Factors that do not allow endoprosthesis can be divided into psychological – this is the moral unpreparedness of the patient for surgery, and physical. The latter include:
- problems with the cardiovascular system;
- The presence of bacterial inflammation in the body;
- problems with blood clotting – thrombophlebitis, thromboembolism;
- infectious processes in the area of the knee joint;
- bone or cartilage dysplasia (e.g., in pediatric patients).
- Risk factors may include immune pathologies, neurological and psychological disorders.
During the consultation, the doctor will determine the indications and contraindications for arthroplasty of the joint, conduct the necessary examinations and select the appropriate prosthesis. The radiological examination will clarify the degree of wear of the joint, to make the necessary measurements. You will be warned about the possible risks and complications of surgery. The complications of surgery include the following:
infection in the surgical area
Blood loss during surgery or after surgery
Thromboembolism (clogging of a vessel with a blood clot)
Preparation for knee arthroplasty
At the preparatory stage, a complete clinical examination of the patient’s condition is performed (analysis, specialist consultations, examination by an anaesthetist, lung X-ray and electrocardiogram). This allows us to determine whether there are any contraindications, or to be sure that there are none. The patient is hospitalized 1-2 days prior to surgery.
The operation to replace the defective part of the joint lasts an average of 2-3 hours. As agreed with the patient, the anaesthetist will decide whether general or epidural anaesthesia will be used. The type of prosthesis is selected on the basis of X-ray data. To increase the chances of a successful knee replacement, the operation is done using computer navigation.
The surgical algorithm is as follows:
- A layer-by-layer dive into the soft tissues;
- Careful exposure of the knee joint;
- sawing away the abnormal bone tissues;
- placement of prepared articular implants;
- cleaning and treatment of the surgical field;
- layering of sutures.
- During the operation we take measures to prevent infectious complications, if necessary, replenish blood loss, drainage of the wound in order to prevent blood accumulation.
Rehabilitation after knee replacement lasts about 3 months. During the postoperative period, antibiotics and pain killers and symptomatic treatment continue to be administered.
Rehabilitation treatment in hospital
It is allowed to be in bed on the first day after surgery. From the second day you may sit up in bed, start static exercises for the limb muscles, do breathing exercises. Walking with dosed load on the operated limb and additional support (crutches, manege) is possible from 3 days. Stitches are removed on the 10th-12th day.