What arthroscopic surgery patients should know
I. What is arthroscopic surgery
Arthroscopic surgery is an orthopedic surgical technique used to observe, diagnose and treat intra-articular disease. An arthroscope is an endoscope, which is a surgical instrument used to view lesions within the joint. It has the external appearance of a pencil, 5-6 mm thick in diameter, and a small opening of less than 1 cm in the skin allows the arthroscope to be placed into the joint. We attach a miniature camera to the back of the arthroscope, which can take a look inside the joint and discover the lesion directly and accurately.
Second, those diseases should be treated by arthroscopic surgery
Arthroscopy is applied to knee, ankle and shoulder joints. Damage to cartilage structures, synovial membrane, cartilage discs, ligaments and joint surfaces within the joint cannot be detected on x-ray, but can be seen at a glance under arthroscopy.
The following is a brief overview of arthroscopic surgery of the knee joint
1. Meniscal damage: This is the most resident cause of knee pain and interlocking. Arthroscopy allows a clear view of the meniscal damage and allows a decision to be made on whether to perform a partial, subtotal or total resection. Juvenile meniscus repair and disc meniscoplasty can only be performed arthroscopically.
2. Free body: The importance of arthroscopic surgery is not only to remove the free body through a small incision, but more importantly to find the cause of the free body formation and to treat the identified cause. To prevent the re-formation of free body.
3, Synovitis: Arthroscopic synovectomy is suitable for the early stage of synovitis, the postoperative pain is much lighter compared with open joint surgery, the chance of joint adhesions is also less, and the joint activity function is recovered quickly. Even if the synovitis recurs in the future, the operation can be repeated.
4.Osteoarthritis: It is suitable for medium-term osteoarthritis, especially those with joint jamming and strangulation. Through arthroscopy, the damage to the joint surface and cartilage can be clearly seen. By trimming the cartilage surface, removing the damaged meniscus, taking out the free body, grinding the bone flab that prevents joint movement, for the patellofemoral joint is too tight. In patients with obvious squatting pain, the pain can be relieved to a certain extent by releasing the lateral patellar support band.
5, cartilage fracture, synovial crease syndrome, fat pad extrusion syndrome and patellar subluxation: many sprain conditions of the joint are not always meniscal injuries. Rather, there are cartilage fractures, synovial crepitus syndrome, fat pad compression syndrome and patellar subluxation, which are often difficult to identify based on the physician’s experience with palpation and x-ray examination. However, dynamic examination under the arthroscope, the diagnosis is accurate, and can make the corresponding day treatment.
6, anterior cruciate ligament injury: not uncommon in sports injuries, and often combined with other injuries to the internal cruciate ligament of the knee. Arthroscopic reconstruction of the anterior cruciate ligament encounter of the knee when dealing with other lesions within the joint cross, is an important development in arthroscopic surgical techniques in the last year 10 years.
Arthroscopic surgery of other joints with good results, such as: synovium of the ankle joint, joint free bodies and traumatic arthritis. Synovitis of the shoulder joint. Glenoid labral tears, subacromial extrusion syndrome and joint free bodies, synovitis and free bodies of the elbow joint. Synovitis of the wrist joint, microscopic reduction of fractures. Fixation and complex resection of deltoid cartilage, etc.
Third, the advantages of arthroscopic surgery
The main advantages of arthroscopic surgery are as follows
1.Arthroscopy is a minimally invasive surgery.
2.The arthroscope can dynamically observe how the lesion in the joint is, and produce symptoms when moving in the joint.
3. The surgery is delicate.
The advantages of minimally invasive surgery are not only the small skin incision, relatively light postoperative pain, small skin scars so the aesthetic impact is small, but more importantly, the ability to restore joint function more quickly after surgery and to move off the ground earlier. This allows for the reduction of some common complications after joint surgery, such as joint adhesions and muscle atrophy. Phlebitis. Blood clots and wound infections, etc. The delicacy of arthroscopic surgery refers not only to the delicacy of the surgical instruments, but also to the delicacy of the cutting operation. It is able to preserve the physiologically functional tissue structure intact and limit the joint trauma to a minimum.
Because of these advantages, arthroscopic surgery requires excellent and special surgical equipment. And it is performed by experienced physicians, and the operation may take longer.
Fourth, the post-operative exercise methods and issues to be noted
1. Elevate your affected limb with a soft pillow after surgery, which is good for venous blood and lymphatic return. It can prevent the swelling of the affected limb. After arthroscopy, a plastic drainage tube is usually placed inside the joint to draw out the fluid and bleeding from the joint. This can cause you discomfort. The drain is usually removed after a day or so, during which time you can lie in bed and do ankle dorsiflexion (even toeing) and muscle stretching (leg tensing) without being in a hurry to get off the floor. The leg stretches are good for blood circulation in the limbs. Reduce swelling and discharge fluid.
2.After surgery, your affected limb will be wrapped with elastic bandage. If the affected limb appears swollen and painful, the extremity is numb. Contact your healthcare provider immediately. Get timely treatment.
3.After extubation, the pain will be significantly reduced and you can go down to the ground. When you first get off the floor, you should stand upright for a while and then walk two steps with the help of a walking frame. If there is no discomfort, then increase the amount of exercise. If you experience dizziness and panic, sit down and rest. This is a manifestation of head ischemia. Usually will disappear after a while.
4, in addition to practice straight leg raising exercise every day. The specific practice is: first force the back of the foot on the hook, then force the knee joint straight, and then raise the whole leg no more than 45 degrees to maintain the height of 10-30 seconds. Finally the leg down and completely relaxed, the exercise should be carried out in groups, 5-10 times per group, 3-5 groups per day, and gradually increase. If the exercise is too heavy at the beginning, there will be pain in the back of the knee and calf muscles. Then the amount of exercise should be reduced appropriately.
5. Leg press: You can place your knee straight out on the bed and place your hands above the knee. Gently press down to straighten the knee joint as much as possible, and maintain it for about 5 minutes each time. This is the best way to exercise hyperextension of the knee joint.
6. You also have to practice the knee flexion function. The knee flexion activity is performed on the side of the bed by first holding the leg on the surgical side with the good leg, making the body sit up and turn to support the side of the bed. The knee joint drops under the bed by gravity, i.e., it can reach 90 degrees and then put the good leg in front of the leg on the operated side. Apply gentle pressure. Press backwards to increase the knee flexion angle of the operated knee. The amount of force is as much as can be tolerated, and it is better if the force can be maintained for 10 minutes or longer at a certain knee flexion angle.
It is not the quantity but the quality of the daily flexion activities. Try to straighten and flex the joint to a certain degree so that there is progress every day. And note that must not do hot compresses.
7, usually 7-10 days after surgery to remove the stitches, you can be discharged from the hospital. After discharge from the hospital, you need to continue to perform appropriate exercises, most notably straight leg raising exercises that are beneficial to exercise the quadriceps. Joint swelling and calf muscle pain are signs of excessive exercise and should be taken care of. The number, frequency and intensity of exercises should be appropriate. Complicated and frequent and excessive exercises do not lead to better recovery of your joint, and inappropriate exercises aggravate the damage and prolong the recovery period.
In addition, post-operative recovery varies from condition to condition. Generally speaking, the older you are, the longer the duration of the disease and the longer the recovery period.
V. Possible complications of arthroscopic surgery
Arthroscopic surgery should not be considered as a minor surgery, because it requires meticulous manual skills, experience and patience to avoid additional trauma. If the same procedure is done with the joint open, it may be faster. However, in the interest of the patient’s future, the greatest post-operative benefit of choosing a troublesome procedure now is for the patient himself.
Because general anesthesia is more relaxed, the patient is not fatigued and the anesthesiologist can easily control it. However, patients are prone to postoperative pharyngeal pain and pulmonary inflammation. Fluid accumulation in the joints, blood accumulation and short-term joint swelling, are extremely common and anti-plastic drainage tubes, which reduce the chance of such complications, still cannot be completely avoided. Some people have to have the fluid aspirated by arthrocentesis for final resolution.
Infection is a possible complication of every surgical procedure. To reduce the chance of infection, antimicrobials are usually used routinely for 3 days or more after surgery. Calf swelling, phlebitis, and thrombosis are related to many factors, such as obesity, thick blood, and localized pressure bandaging of the knee joint to stop bleeding. This can lead to poor blood flow. We use postoperative elevation of the affected limb and the use of elastic bandages to wrap the lower limb from far to near to reduce the incidence of such complications.
VI. Discharge guidance
1. After discharge, continue to follow the medical advice for functional exercise, especially knee flexion and extension mobility, and pay attention to gradually increase the amount of activity, avoiding excessive activity for 3 months to prevent joint swelling and fluid accumulation.
2.Ensure sufficient sleep.
3.Keep your mood relaxed.
4.Follow the medical advice and take the medication on time.
5. Engage in daily household chores and light physical activities according to the situation. For example, walking. Avoid heavy work and strenuous sports activities.
6.If there is infection of the incision, redness, swelling, heat, pain, temperature higher than 38.5 degrees, knee pain or trauma, etc., you should seek medical treatment immediately.
7. Follow-up time: 1-3 months after discharge from the hospital.