Dr. Gold's Orthopedic Surgery Blog

A common question I get from patients is “What is arthroscopic knee surgery?” That said, here is some information about the procedure, the risks and the success rates.

When mechanical knee pain, such as a meniscus tear, persists an arthroscopy of the knee would be indicated

. This surgical procedure involves placing a telescope into the knee, which is in turn connected to a camera and monitor. The incisions for this type of surgery are very small. One incision is used for the telescope and one or two others are created for instruments, which are used to correct and deal with the cause of the pain and mechanical symptoms.

Overall this is a low risk procedure, but as with any surgery, not risk free.

Besides anaesthia risks, there is a small chance of:

• infection
• thrombophlebitis
• residual pain
• stiffness.

In some patients post operative swelling can linger for weeks.

In most cases the success rate is very high and predictable, usually about 90% improvement of preoperative pain, as well as significant improvement in function. Ligament reconstructions can also be done arthroscopically.  Loose body removals as well as local treatment for early arthritis as well as focal areas of advanced arthritis can be treated this way as well. Arthroscopy for advanced cases of arthritis has not been very effective.

I hope that helps you learn more about arthroscopic knee surgery, its risks and success rates.

Until next time,

Stuart

I strive to make sure my patient’s expectations are appropriately managed during recovery. Just the other day a patient asked me, “Dr. Gold, What’s going to happen during my recovery from knee replacement surgery?” To help her and you, I jotted down some ideas below…

So we are on the same page, knee replacement surgery, or knee arthroplasty, involves the removal of the diseased joint and the insertion of a prosthesis. During the procedure, the bones of the thigh and shin are prepared to accept the artificial joint and any damaged tissue is removed.

The ligaments are balanced and alignment corrected. Once the new joint is in position, the surgeon sutures and bandages the incision, the patient is moved to the recovery room and the healing process can begin.

In many cases, the patient is immediately asked to move his foot or flex his ankle. Early movement can help increase the flow of blood in the leg and reduce the risk of clots or swelling. The patient may be given blood thinners or placed in compression boots as a precaution against clotting.

Most patients begin working with a physical therapist within 24 hours of surgery. The therapist may manipulate the leg to demonstrate exercises that the patient is to perform. Patients who follow instructions and faithfully practice their exercises typically experience the most satisfactory results

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Initially, patients will follow a graduated exercise program to regain strength and mobility. They may exercise by walking indoors, moving to outdoor strolls when they achieve a level of comfort with their movements. Going up or down staircases may be avoided at first, and  then encouraged as healing progresses. Crutches, walkers and canes may be appropriate at certain points during the healing process and discouraged at a later date. Every patient’s recovery is different, and only his physician can decide the exact nature of his rehabilitation program.

Normal light activities, such as walking or shopping, can typically be resumed three to six weeks after surgery. If the patient has enough flexibility in the knee and sufficient muscle control to operate the pedals safely, driving may be resumed in three to six weeks. Although low-impact sports, such as golf or swimming, can likely be resumed once recovery is complete, some patients can return to sports such as tennis or skiing. Since each case is different, however, patients should discuss such limitations with their surgeons.

During recovery, patients should protect themselves from falls. A fall can damage or loosen the prosthesis and lead to another surgery to correct the damage. Although physical activity is an important factor in a successful recovery, patients should not push themselves beyond their limits, since counter-productive injuries may result. Every patient is unique, therefore a comprehensive discussion with your surgeon prior to surgery  needs to occur to establish expectations and goals.

I hope this helps you learn more about knee replacement surgery recovery!

Until next time,
Stuart

A complete knee replacement surgery is often performed on patients whose own joints have been damaged by rheumatoid arthritis or osteoarthritis. It may also be an option for patients who have suffered a traumatic injury and developed post traumatic arthritis. The goal of the surgery is to alleviate the pain and restore functionality to the joint.

Knee replacement surgery began during the 1950s. Since that time, numerous improvements have been made to the prosthetic, the materials used, and surgical techniques. The most common technique to expose the joint is to divide the quadriceps muscle along the side where it attaches to the kneecap, or patella. The patella is then moved aside so that the surgeon can shape the ends of the femur and tibia. Cartilage is removed, and the anterior cruciate ligament is sacrificed and depending on the type of knee replacement, the posterior cruciate may be removed as well. The prosthesis is normally cemented in place, but other methods, including a process to integrate the prosthetic with the bone (porous ingroeth), are occasionally used.

On the end of the femur, the surgeon implants the femoral component, which is contoured to imitate the normal end of the bone. The component for the tibia is normally flat, with a stem that is inserted down into the bone to add greater stability. A polyethylene “cushion” is inserted into the tibial plate to replace the cartilage and provide a spacer between the two components. The patella or the kneecap may then be resurfaced with a polyethylene button. This decision is made by the surgeon and currently is more commonly done than not.

Total knee replacement surgery has continued to evolve

. The equipment and components have improved where smaller incisions and in some cases customized components can be used. The key point to remember regarding incision size is that it may smaller and less invasive, but should be as large as it needs to be to do the job properly. Computer navigation is also continuing to be developed and may lead to better results.

Depending on the patient’s health, the average hospital stay is 3-4 days. A walker or crutches will be necessary until sufficient time has passed for the extensor (quadriceps) mechanism to function well. Physical therapy is required for several months if the patient is to recover strength and motion in the knee. It is often possible to achieve the functional range of motion by the end of the second or third week. By the first week, most patients can place full weight on their leg. Full function, with proper physical therapy, normally takes about three months, but some patients may experience a more gradual recovery that lasts longer.

Due to the demands that post-operative therapy can require, some surgeons have their patients prepare for the surgery over a three to four week period. The patient may be asked to perform daily exercises to strengthen the ankle, knee and hip and to maximize the range of motion in the leg. Some patients may need to take iron supplements for about the same length of time. If the surgeon allows the patient to store his own blood (referred to as autologous predonation) in case it is needed after surgery, arrangements must be made to accomplish the task. In addition to a full medical clearence, numerous tests must be completed before admission, such as blood tests, X-rays of the knee and chest, and an electrocardiogram.

I hope that helped you learn more about complete knee replacement surgery.

Until next time,

Stuart

The human knee is among the most complex joints in the body, as well as the largest. It can be damaged through injury, disease, or wear. One common injury is a torn meniscus. Meniscal (cartilage) tears can during activities of daily living and work, but more frequently with sporting activities in weekend warriors as well professional athletes.

The knee joint is formed by three bones: the femur, or thighbone; the tibia, or shinbone; and the patella, or kneecap. In between the femur and the tibia lie two shock absorbing wedges of cartilage, called the menisci. These are comprised of a rubbery material and not only cushion the knee but help it maintain stability. Most often, when an individual refers to a torn knee cartilage, they mean the meniscus.

The meniscus can be torn in several different locations. Tears are denoted by their appearance and the position of the tear within the meniscus. Common references include the flap, longitudinal, parrot beak, transverse, and complex tears. The tear may happen in conjunction with another knee injury, such as a ligament tear. However, in older patients, the tear may result from a meniscus that has thinned and weakened over time. If the cartilage is sufficiently degenerated, a patient may experience a tear just from arising awkwardly from a seated position.

Patients with a torn meniscus normally experience pain in the knee, swelling and stiffness. The knee may “catch” or lock, or it may feel as if it is about to buckle. Motion may be restricted as well. Left untreated, a piece of the cartilage can come free and migrate to the joint, causing slippage or locking of the knee.

The need for knee surgery meniscus depends on the size, location, and type of the tear, but should be decided based on the patient’s symptoms. The outer third of the menisci receive an excellent blood supply. Tears in this area are normally easily repaired through surgery if they do not heal without it. However, the rest of the meniscus does not have a blood supply, meaning that tears will not heal. Tears in this area are frequently in worn, thin cartilage

. Since tears cannot mend, they are normally trimmed during surgery.

Surgeons may recommend knee surgery meniscus if the patient’s symptoms do not abate with conservative treatments. The procedure is normally performed through a minimally invasive surgery, or arthroscopy. This is among the most frequently performed surgeries, and carries a minimal risk of infection as well as minimal scarring.

After knee surgery for meniscal tears, the patient usually does not need a cast or brace to immobilize the joint. Braces may be used after a meniscal repair for 4-8 weeks. Most patients will a period of therapy or rehabilitation. The majority return to the activity level enjoyed prior to the injury. Typical results include reduction or elimination of pain, increased stability of the knee, and a reduction or elimination of swelling.

I hope that helps you better understand knee surgery for the meniscus!

Until next time,

Stuart

Every so often, a patient asks me, “Dr. Gold – What will my knee look like after a total replacement?”

To help them understand the post-operative knee structure, I like to show them a picture of a knee replacement X-Ray after surgery.

That said, here is an x-ray of a patient who had successful knee replacement surgery. I thought you might like to see it as well.

As you can see, the structure of the knee is restored to provide a smooth, flexible joint. Another way to consider the positive impact of a successful knee replacement surgery is to consider a before-and-after drawing. Here is a good illustration of the knee structure after knee replacement surgery

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I hope that helps you better understand the structural enhancements of a good knee replacement surgery.

Best regards,
Stuart Gold