Many people are afraid of anesthesia. And many are hesitant to undergo knee arthroscopy, being sure that it is performed under anesthesia. But if you understand the medical terminology, it turns out that this is not so. Intrigued? Well, then let's figure it out.
Looking in any dictionary of medical terms, you will read that anesthesia is a deliberate inhibition of the central nervous system (CNS), the purpose of which is to “disconnect” the patient from the feeling and awareness of pain impulses. That is, for example, the effect on the patient’s brain with special drugs. In this case, an artificial coma occurs, muscles relax, some reflexes turn off and pain sensitivity disappears.
Anesthesia involves completely putting a person to sleep in order to turn off the central nervous system. However, not every patient is put to sleep during arthroscopy. Anesthesia is used only in special cases. And most arthroscopic interventions are performed under local, spinal and conduction anesthesia. These types of pain relief do not require “switching off consciousness”, so they frighten patients less.
“Walking.” Fell... Woke up - plaster"
None of us are immune from injury. And not only in the movies there are situations: “Walk. Fell. Lost consciousness. I woke up - there was a cast." Active and extreme sports that are popular today have added more work to orthopedic traumatologists. Falls on a snowboard, skiing, or rollerblading often lead to joint injuries. And what suffers the most is the knee joint, which already bears a huge load. Ligament and meniscus tears, problems with articular cartilage - all this requires surgical help.
Don't bend your knees!
The main symptoms of knee injuries are pain and limited mobility in the knee joint. If a person bends and straightens his leg and feels that he has pain on the outside or inside of the knee, then first of all one can think about damage to the meniscus. If some kind of mechanical obstruction appears when flexing or extending the leg, this indicates a “blockage” of the joint as a result of a meniscal tear or detachment of the articular cartilage. Unsteadiness when walking indicates a ligament rupture. It is more difficult for one person to climb up the stairs, for another it is more difficult to go down, pain may occur when moving, when getting up from a squat - all these are specific symptoms of various damage to the structures of the knee joint, so consultation with a doctor is necessary.
Rh, ultrasound, arthroscopy...
In case of knee injuries, first of all, it is necessary to take an x-ray of the joint. Although x-rays will not show damage to the meniscus and articular cartilage, they must be taken to rule out a fracture of the bones that form the joint in the first place. If an x-ray shows an intra-articular fracture, it makes sense to do a computed tomography study, which significantly complements and details the clinical picture. It allows you to clarify the nature of the displacement of fragments, the location and depth of the bone defect. In some cases, cartilage detachment occurs along with the bone plate - this can be seen on x-rays. Ultrasound of the knee joint is not very informative; its reliability is about 20–25%. Another diagnostic method - magnetic resonance imaging - allows you to see the condition of the ligament apparatus, menisci, cartilage layer by layer, which helps to identify pathology in a particular area of the joint. This study is prescribed mainly when the clinical picture is not clear enough. But only arthroscopy can provide 100% accuracy. Any intervention using arthroscopy always begins with an examination of all joint structures and an accurate diagnosis to decide on the necessary treatment.
Preparation for arthroscopy
Preparing for arthroscopy involves taking the necessary measures and having the results of a number of examinations in the patient’s hands.
Examinations that must be completed before surgery:
Analyzes:
- Complete blood count (valid for 2 weeks).
- General urine test (valid for 2 weeks).
- RW, HIV, HBS, HCV (valid for 1 month).
- Blood type, Rh factor (valid for 3 months).
- Biochemical blood test from a vein: total protein, ALAT, ASAT, LDH, CPK, bilirubin, urea, creatinine, glucose (good for 2 weeks).
- Coagulogram: PTI, APTT, fibrinogen, prothrombin (valid for 2 weeks).
- Covid-19 (SARS-CoV2) - swab (good for 3 days).
X-rays and studies:
- Fluorography – chest x-ray (valid for 6 months).
- Ultrasound of the vessels of the lower extremities.
- ECG (valid for 2 weeks).
Other:
- Statement of health from a general practitioner with a description of concomitant diseases and recommendations for therapy, continuous use of medications and surgical history.
- Passport.
- Anti-embolic stockings.
Report about the joint
The essence of arthroscopy is that two small incisions measuring 5–6 mm are made in the area of the knee joint. Through an incision, a tube is inserted into the joint cavity - an arthroscope - this is a television camera lens, the diameter of which is 3-4 mm. Inserted into the joint, it illuminates and, thanks to the attached video camera, allows you to see all intra-articular structures on the monitor screen. And not just see, but examine with a magnification of 40-60 times! That is why during arthroscopy the doctor can detect and accurately evaluate all, even the smallest, damage to the joint and correctly eliminate them. Using arthroscopy, you can remove the damaged part of the meniscus, repair ligaments, “patch” damaged cartilage, and perform many other complex surgical procedures. In addition, arthroscopic surgery is indicated for people with advanced osteoarthritis. Such patients can undergo in our clinic not only a detailed examination with the participation of a rheumatologist, traumatologist-orthopedist, but also receive both medical and surgical treatment. Orthopedists prescribe arthroscopy not only for therapeutic purposes, but also for diagnostic purposes: if, after a joint injury, the patient’s pain does not go away for more than a month, and its cause cannot be determined using even magnetic resonance imaging.
Consequences and prognosis
Minimal punctures after arthroscopy usually disappear within 3-4 weeks after surgery. This is very small compared to scars from full-scale operations: the marks remain with the patient for life or for many years.
Immediately after the intervention, the patient will feel some discomfort; it is advisable to completely eliminate any stress on the operated joint. If arthroscopy was performed on the leg joints, the patient is advised to use crutches for 2-4 weeks.
A week or two after the intervention, the person can return to their normal activities. Until this point, it is recommended to reduce the load on the joint to a minimum, and also to follow the doctor’s recommendations for restoring the body after surgery.
The prognosis is favorable. Almost all patients, with the help of this operation, got rid of their joint problems, successfully recovered and returned to their normal lives. No significant negative reactions were recorded. If the intervention is performed correctly, the patient does not have to worry about the result.
Local or general?
Arthroscopy can be performed under local anesthesia, general anesthesia or spinal anesthesia. The choice of anesthesia method depends on the scope of the intended intervention. Abroad, mostly minor arthroscopic operations are performed in a clinic on an outpatient basis under local anesthesia. In our clinic, diagnostic and therapeutic knee arthroscopy is performed as part of a “one-day hospital stay.” In this case, the task of anesthesiologists is to provide a sufficient depth of pain relief in combination with a short recovery time for the patient. Therefore, when performing interventions on one knee joint, conduction anesthesia is used, which allows the operation to be performed with a sufficient level of pain relief and rapid (after 2-3 hours) restoration of motor activity. During the operation, the patient is conscious and, if desired, can watch its progress on the monitor.
Prices
Treatment of Hallus Valgus (“bones” on the leg). One leg - 70,000 rub. Two legs - 120,000 rub.
Arthroscopy of the knee joint—from 35,000 to 150,000 (excluding anesthesia, hospitalization and consumables) depending on the volume of the operation. Consultation with a GarantKlinik specialist is required.
Arthroscopy of the shoulder joint - from 30,000 to 65,000 rubles (excluding anesthesia, hospitalization and consumables) depending on the volume of the operation. Consultation with a GarantKlinik specialist is required.
GarantKlinik is the base of the Sechenov Moscow State Medical University, so our prices are similar to the state ones.
A fairy tale in reality
The main advantage of arthroscopic operations is minimal tissue damage; therefore, the recovery period takes much less time than after traditional open surgery. The results of endoscopic operations are like a fairy tale. For example, after arthroscopic resection of part of the meniscus, the patient is allowed to walk in the evening on the day of surgery, and after two weeks he can return to his usual activities. Of course, if the patient is indicated for complex reconstructive arthroscopic surgery, then the rehabilitation period will be longer, and he may have to move around with crutches for some time. But compared to the fact that after a regular, open operation he will be forced to walk on crutches for a month, this already seems like a “trifle.” Of course, there are some contraindications for arthroscopy: - impossibility of performing anesthesia; - acute and chronic infectious diseases, as well as previously suffered infectious diseases of the joint; - exacerbation of rheumatoid arthritis.
Contraindications
The greatest number of contraindications exist for general anesthesia. When administered systemically, anesthetic drugs can negatively affect internal organs. Therefore, anesthesia is contraindicated for arrhythmias, heart defects, bronchial asthma, bleeding disorders, renal, hepatic and cardiovascular failure.
Contraindications to spinal and epidural anesthesia may include infection at the injection site and allergy to anesthetics. These types of pain relief will not be used even if there are no contraindications. This is possible if the patient himself refuses them.
Is there a risk?
As with any surgical intervention, when performing arthroscopy there is a certain risk of complications, the main of which are inflammatory postoperative processes. To avoid possible complications, it is best to trust those doctors who have experience in performing arthroscopic operations. In our clinic, such interventions have been “on stream” since 1996, so we can safely say that our specialists have the necessary qualifications and experience.
Recovery
Complete rehabilitation occurs 4-5 weeks after surgery.
Since in the case of arthroscopy, tissue damage is minimal, the rehabilitation period is short.
As a rule, after the intervention, a person is allowed to get out of bed on the second day. Movement during the period of hospitalization is not prohibited. Already on the 2nd day, the patient can be discharged and continue recovery at home. The doctor gives each patient a list of necessary procedures that speed up healing and develop the joint.
On days 7-12, the doctor examines the healing site and removes the sutures. After 2-3 weeks a person can already put on his usual shoes
When carrying out rehabilitation, the following methods are used to accelerate healing and restore the functionality of joints:
- Physiotherapy. Exercises aimed at developing the operated joint. A set of exercises is selected individually by an orthopedic surgeon.
- Careful hygiene, especially if the operation is performed on the joint of the lower extremities. The rate of healing of postoperative sutures directly depends on maintaining cleanliness.
- Wearing special orthopedic shoes with soft insoles. In some cases (if the operation was performed to eliminate valgus bursitis), structures are used to separate the toes or additional devices that hold the operated area in its natural position.
- Physiotherapeutic procedures: massage, magnetic therapy, laser therapy. Physiotherapy is prescribed by a physiotherapist and only after a personal examination of the patient.
Arthroscopy does not require long-term wearing of correction devices. Most rehabilitation techniques can be used at home by the patient after consultation with the attending physician.