Moscow City Center for Bone and Joint Replacement

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Arthroscopy of the knee joint is the “gold standard” in the diagnosis and treatment of intra-articular pathology of the knee joint, allowing to obtain accurate data on the condition of the joint and carry out the necessary therapeutic manipulations.
Our clinic uses a method of treating knee joints developed by world-class experts, following the algorithms of surgical interventions according to the protocols of the best European medical centers. Thanks to this, there are no scars left on the knee, there is practically no pain syndrome, the rehabilitation period is reduced to a minimum and, most importantly, the patient receives complete restoration of the motor function of the knee.

For what diagnoses is surgery strictly necessary?

For a hip fracture, surgery is necessary the sooner the better, since this problem occurs in older people. If the operation is delayed, such patients are difficult to rehabilitate. With arthrosis, everything depends on how the patient assesses his condition, pain syndrome, and whether he is mentally ready to undergo surgery, regardless of what the doctor recommended. If you delay surgery for severe arthrosis, the remaining joints and spine suffer, and deformity appears. The sooner the patient undergoes surgery, the easier and faster the recovery.

Indications for knee arthroscopy:

• damage to the cruciate ligaments of the knee joint;
• meniscus damage;
• damage and/or disease of articular cartilage;
• damage and/or disease of the fat body;
• reduction of periods of incapacity to work to 2-3 weeks;
• excellent cosmetic effect, because After arthroscopy there are practically no scars left.
• inflammatory diseases of the synovial membrane;
• habitual luxation of the patella;
• deforming arthrosis of the knee joint;
• rheumatoid arthritis;
• the presence of undefined loose bodies in the joint cavity;
• intra-articular fractures;
• diagnosis and treatment of synovitis.

Advantages of the atroscopic method:

The use of the arthroscopic method makes it possible to examine in detail the muscles, ligaments, tendons, articular surfaces of bones, the articular labrum and the inside of the membrane of the knee joint.

Joint arthroscopy has a number of advantages compared to surgery through an open approach:

• Minimal invasiveness. The operation is performed through several small incisions, with minimal damage to the joint structures;
• Possibility of full diagnosis of knee joint pathology;
• Short rehabilitation period after knee arthroscopy;
• Reduced length of hospital stay after surgery;
• Reducing the period of incapacity to work to 2-3 weeks;
• Excellent cosmetic effect, because... After arthroscopy there are practically no scars left.

Knee replacement surgeries

Knee replacement can be done entirely (total) or partially. In the first case, the endoprosthesis replaces both parts of the joint, in the second - only one of its sides (less time in the hospital, better results in terms of restoring mobility, surgery is sufficient for approximately 25% of patients with osteoarthritis).

There are alternatives to arthroplasty, but practice shows that in the long term their results are inferior to knee replacement . Alternative treatments include:

• Osteotomy is an operation to straighten the leg bone so that the load shifts from the damaged part of the knee to the healthy one.
• Mosaicplasty is the transfer of healthy hard cartilage tissue along with the underlying bone (partially) from another part of the knee to the affected area in order to restore it.
• Arthroscopy - washing and treating the affected area to remove pathological formations from pieces of bone and cartilage.

Recovery

Rehabilitation measures for patients after knee replacement must be carried out under the supervision of a specialist, since excessive physical activity can lead to damage to the artificial structure.

In the first days after surgery, crutches or high walkers are used, later - a cane. It is important to try not to limp right away, because changing your gait may be difficult in the future. After knee replacement surgery, you will be able to walk without additional devices in 4-6 weeks, and after 2-3 months, the doctor may allow you to engage in relaxing sports.

For the rehabilitation of patients, therapeutic exercises, massage, and physiotherapeutic procedures are used. A set of exercises is developed individually.

After endoprosthetics, observation by a traumatologist is recommended - the required frequency of examinations is determined individually

You can make an appointment for a consultation about knee replacement by phone, through a mobile application or the patient’s personal account on the website

How is arthroscopy performed?

The procedure is performed under anesthesia. Several options are practiced depending on the age and condition of the patient: local anesthesia (pain relief covers only the knee), regional (to the waist) and general (medicated sleep). In the first two cases, the patient can watch the procedure on a monitor, but not everyone is ready for such an experience.

The surgeon makes several small incisions on the knee. Sterile salt water or saline solution is pumped into them to expand. An arthroscope with a built-in camera is inserted into the joint. The image from it is transmitted to the monitor in the operating room. The specialist examines the joint, twists and folds, detects a problem, then, if the clinical picture allows, inserts small instruments into the incisions and corrects the problem (for example, excises damaged areas of the meniscus).

At the end of the operation, saline solution is removed from the joint, and the incisions are sutured. The wounds are treated with antiseptics and a sterile bandage is applied. The procedure takes from 30 to 60 minutes.

This is what an arthroscope looks like

Indications

Endoprosthesis replacement is recommended for patients who, due to injuries or various diseases, have completely or partially lost the ability to bend the leg at the knee joint. Decreased range of motion is often a symptom of:

• degenerative processes in the joint;
• aseptic necrosis;
• systemic connective tissue diseases;
• congenital developmental anomalies;
• intra-articular fractures.

Contraindications

Knee replacement is not performed in the presence of absolute and relative contraindications.

Absolute contraindications:

• decompensated pathology of internal organs;
• acute infectious diseases;
• mental health disorders;
• infectious arthritis;
• vascular pathology of the lower extremities in the acute stage;
• allergic reactions to anesthesia components, artificial joint materials.

Relative contraindications:

• oncological pathology;
• chronic diseases of internal organs;
• disruption of bone mineralization due to changes in hormonal levels;
• excess body weight.

Complications after meniscus removal

Meniscus removal

incomplete and total can have consequences, like any surgical intervention, although the likelihood of negative reactions is low. According to statistics, about 90% of operations to remove the menisci of the knee joints predict a successful outcome without postoperative problems. Of course, with high precision of manipulation, compliance with asepsis and antisepsis during the procedure and proper postoperative care. But still, let’s announce possible complications:

• thrombotic formations in the operated limb;
• bleeding due to damage to blood vessels;
• injury to the nerve bundle;
• pathogenic infection inside a joint or in a surgical wound.

There is an opinion that it is common after removal of the meniscus

the consequence is arthrosis. We do not argue, but it is also important to take into account the fact that total surgery, namely, it threatens the appearance of degenerative pathogenesis in 15 years, is a rarely used tactic, used exclusively in particularly difficult cases, as a last resort. For example, if the scale and severity of the lesion are not subject to corrective plastic surgery or partial resection of the meniscus of the knee joint, which is very rare.

Specialists always try to leave as much of a functional unit as possible, understanding that the biomechanics of the bone joint of the knee rests on it. Therefore, being guided by the fact that removal of the meniscus will provoke consequences in the form of gonarthrosis of the knee joint, and not going to the doctor, is a huge mistake. Serious osteochondral degenerations, plus atrophy of the thigh muscles, will definitely not take long to occur. And even simple defects in the collagen structures of cartilage left to chance, which at one time could have been completely cured conservatively, promise a similar outcome.

Valuable information! First of all, the operation saves the meniscus, which means that the pathological source that interferes with the normal interaction of the articular bones will no longer act on the knee. By eliminating the damaging factor, the likelihood of the formation of a degenerative-dystrophic focus in the structures of the bone joint is also reduced.

rehabilitation

rehabilitation
A fairly important stage in the treatment of traumatic injuries to the structures of the knee, on the correct implementation of which the prognosis depends, is rehabilitation after surgery on the meniscus. It includes a number of measures that are aimed at preventing complications (secondary infection, bleeding), as well as the gradual restoration of joint function.

For this, various medications, physiotherapy (magnetic therapy, mud baths, electrophoresis), as well as therapeutic exercises with a gradual increase in the load on the knee are used.

After the meniscus has been removed, rehabilitation is longer and lasts at least six months. If there is a minor injury affecting the meniscus or ligaments, the operation was performed using arthroscopy, then the recovery period will be shorter.

Surgery for old meniscus tear

The lack of timely provision of specialized medical care after a knee injury leads to the formation of calluses in the area of ​​rupture of cartilage structures, which prevent the regeneration of the cartilage tissue that makes up the meniscus. The operation and restoration in this case have certain difficulties associated with the need for preliminary excision of calluses in order to allow their subsequent full regeneration with the restoration of anatomical integrity.

Surgery for minor injuries is performed primarily using arthroscopy.

Stages of implementation

As a rule, the duration of arthroscopy does not exceed 1 hour, but it all depends on the purpose of the procedure. All surgical procedures are carried out in a special sterile operating room, which is equipped with all the necessary equipment, including medical monitors for image display. Then they begin anesthesia, the types of which vary. This or that type of anesthesia is selected strictly individually and depends on the purpose of arthroscopy, the duration of the operation, the wishes of the patient and the preferences of the surgeon.

Then the arthroscopist performs an antiseptic treatment of the surgical field and makes three small incisions (3-5 mm) in the projection of the knee, through which arthroscopic instruments are introduced into the joint cavity - a camera with a light source, a tube for filling the joint with a special liquid, which allows you to enlarge and straighten the joint cavity and main working tool. Then the operation itself is performed. After completing all the necessary manipulations in the joint cavity, the fluid is pumped back and the instruments are removed.

Recommended behavior after knee arthroscopy

Preparation for endoprosthetics

Before the operation, the patient undergoes a comprehensive medical examination, including:

• laboratory tests
  - blood tests (general, biochemical, for HIV infections, syphilis, hepatitis B and C, for coagulation) and urine (general only);
• instrumental studies
  - fluorography, ECG, Doppler ultrasound scanning (USDG) of the veins of the lower extremities, endoscopy of the gastrointestinal tract, radiography of the damaged joint;
• consultations with specialists
  - therapist, anesthesiologist, dentist, gynecologist, and in the presence of any diseases, also examinations with an infectious disease specialist, neurologist, ophthalmologist, etc.

Before the operation, the doctor may recommend limiting the intake of certain types of medications, taking a weight loss course to reduce the load on the joint, recovering from certain diseases that are contraindications to endoprosthetics, etc. The patient should also do the following:

• provide for the presence of handrails at home (especially along the stairs), comfortable benches and chairs with footrests and other devices that facilitate movement during the rehabilitation period;
• find a person in advance (relative, friend, social worker, etc.) who will help you do your daily work (cooking, cleaning) during the first time after surgery.

The purpose of preparation is to provide the most suitable conditions both for the operation itself and for a speedy recovery after it. The orthopedist will tell you more about the necessary measures during your consultation.

In what cases is endoprosthetics required?

Clear indications for knee replacement are the consequences of problems such as:

• post-traumatic arthrosis;
• rheumatoid polyarthritis;
• degenerative-dystrophic diseases;
• pathologically fused bones;
• tumor formations that interfere with the normal functioning of the joint;
• damaged ligaments of the knee joint with pronounced changes in the articular ends of the bones.

Often problems in the functioning of joints arise as a result of arthrosis, arthritis, gout, and frequent injuries. In these cases, the surgeon’s recommendation for endoprosthetics is also objective.

Advantages of endoprosthetics

Knee replacement surgery is considered technically complex. To carry out the intervention, you need a surgeon with a narrow specialization - a professional who specializes in endoprosthetics.

There are two main options for the operation:

• Unipolar prosthetics This is the name for installing an implant in only one damaged area. It often happens that the pathology does not affect the entire joint and unipolar prosthetics are enough to restore functional mobility.
• Total arthroplasty is the replacement of a complete joint.

The prosthesis is developed after an X-ray examination, taking into account the patient's anatomy. The essence of the operation is that the surgeon removes the damaged fragments and instead installs a biocompatible endoprosthesis that takes over the functions of the removed tissue. After completing the main part of the operation, drainage is installed on the wound. This is necessary in order to avoid blood accumulation in the joint area. In addition, they prevent infections and, if necessary, replace blood loss.

The operation is complex, but safe when performed in a modern clinic. And an endoprosthesis allows you to live an active and fulfilling life, forgetting about joint pain.

Why is arthroscopy needed?

Local anesthesia is usually used for arthroscopic surgery.

It is prescribed for accurate diagnosis of the location and extent of the lesion, as well as treatment, for example, suturing the edges of the tear or resection (partial removal) of damaged cartilage tissue. Thanks to the high level of development of medicine and the professionalism of doctors, even with extensive ruptures, it has become possible to fully preserve the functionality of the knee joint. But only with timely access to specialists and not delayed arthroscopic diagnosis. Taking into account the implementation of recommendations in the postoperative period and completion of the necessary rehabilitation measures, after a couple of months the patient returns to his previous active lifestyle and training.

Meniscus treatment - stages

Meniscus treatment - stages

• Carrying out diagnostics, during which the doctor finds out the cause of the violation of integrity, pays attention to the main symptoms of the pathological process, and also prescribes additional research methods with visualization of the knee structures (radiography, ultrasound, computed tomography or magnetic resonance imaging, arthroscopy).
• After analyzing the results of the study, with the help of which the meniscus of the knee is visualized, the operation is selected individually, taking into account a number of factors (the nature and duration of the injury, the anatomical individual characteristics of the patient, his age, the presence of concomitant pathology).
• The preparatory stage before surgery that affects the meniscus of the knee. Treatment is carried out using drugs of various pharmacological groups in order to reduce the severity of the inflammatory reaction, suppress the infectious process, normalize the general condition and adaptive capabilities of the patient's body.
• The main stage of therapeutic measures in which meniscus damage is restored. The operation is performed using various techniques (arthroscopic plastic surgery, open surgery).
• Recovery stage. After knee (meniscus) surgery has been performed, rehabilitation is an important stage that determines the complete restoration of functional activity. Its duration depends on the method of surgical intervention.

In most cases, all stages of therapeutic measures if the meniscus is damaged (surgery, treatment, recovery) are alternated sequentially. Each subsequent stage begins after the previous one has been completed.

Meniscus damaged

The meniscus is damaged.
In most cases, surgery is the only method of radical treatment. The exception is minor damage to the connective tissue fibers of the ligaments without disturbing the general anatomical structure. In this case, conservative therapeutic measures are prescribed, including the use of medications and physiotherapy techniques.

In case of severe violations of integrity, surgery is prescribed to restore the meniscus, its partial (resection) or complete removal. The method of surgical intervention and its volume are determined depending on the nature and location of the injury or pathological process in which the meniscus was damaged. The operation is selected by the doctor individually.

Surgery to remove part of the meniscus

Removing part of the cartilage structure of the knee is called resection. This is a necessary measure. It is carried out in cases of significant damage in which normal restoration of the anatomical relationship and integrity is impossible. Meniscus resection surgery is usually performed using an arthroscope.

Further therapeutic tactics depend on the volume of tissue removed. It may include a recovery period or replacing the area of ​​removed tissue with special implants. If partial removal was carried out due to an injury such as a torn meniscus, surgery, rehabilitation, and physiotherapeutic procedures are carried out over a sufficiently long period of time.