Pain and complications of knee arthroscopy: causes, symptoms and treatment

Among all orthopedic surgeries, arthroscopy is considered the least invasive. However, its implementation is associated with certain risks. According to statistics, arthroscopic interventions are accompanied by the development of complications in 0.6-1.7% of cases. The likelihood of undesirable consequences directly depends on the complexity of the operation. They occur most rarely during diagnostic arthroscopy, and most often during incomplete medial meniscectomy.

Soon after the operation.

Curious! The risk of complications does not depend on the experience of the surgeon or the gender of the patient. However, the age of the patient plays a certain role. It is known that in people over 50 years of age, undesirable consequences occur much more often than in younger people.

Table 1. Incidence of various complications of arthroscopy.

Fact! In terms of the development of complications, operations on the meniscus, synovium, and anterior and posterior cruciate ligaments are considered the most dangerous. During these surgical interventions, patients most often experience hemarthrosis, infectious and thrombotic complications.

Ligament damage

To gain access to the medial meniscus, surgeons artificially widen the joint space before arthroscopy. To do this, they use special leg holders and power traction. Carrying out such manipulations can lead to damage to the ligaments of the knee joint (0.04% of all arthroscopy). Note that most patients suffer from the medial collateral ligament, which is located on the inside of the knee.

Meniscus suturing.

Mild sprains or tears of the ligaments cause knee pain and may be accompanied by ligamentitis. Painkillers (Diclofenac, Ibuprofen) and temporary immobilization of the knee help get rid of unpleasant symptoms.

Treatment at home

Carrying out therapeutic measures at home is only possible if non-surgical treatment is prescribed. If there is a need for parenteral (intramuscular, subcutaneous or intravenous) administration of drugs, the patient receives treatment on an outpatient basis. To do this, he visits the manipulation room of a medical institution, where he undergoes the necessary manipulations.

An attempt to independently treat damage to the internal cartilage without undergoing the necessary set of diagnostic tests can cause the development of various complications, including pinching of part of the damaged meniscus with its wedging into the joint space. Such complications lead to the need for subsequent surgery.

Ischemia of the muscles of the lower limb

To prevent bleeding during arthroscopy, doctors apply a tourniquet to the patient's leg. Unfortunately, long-term exposure can cause temporary paralysis of the lower limb. The pathology is characterized by a short-term impairment of muscle contractility and motor functions of the leg.

The leg is bandaged.

Table 2. The risk of developing paresis depending on the age of the patients and the time of application of the tourniquet.

Thus, the likelihood of temporary paresis is much higher among older people. Those patients who have undergone complex long-term operations are also at greater risk. Undesirable complications can be avoided by reducing the time of application of the tourniquet.

Fact! Temporary paresis is usually harmless and responds well to treatment. To combat them, physical therapy, massage and physiotherapeutic procedures are used.

Features of knee surgery

Arthroscopy of the knee joint is performed in the presence of cysts, arthritis, arthrosis, intra-articular fractures or deformation of the articular cartilage. Before the operation, the patient will have to undergo a series of tests to ensure there are no contraindications. Surgery is performed under general anesthesia or conduction anesthesia. The uniqueness of arthroscopy lies in the fact that today it is the only option for minimally invasive intervention that allows you to diagnose and eliminate the pathological process simultaneously. In general, the operation lasts from 1 to 2 hours, depending on the severity of the diagnosis.

Compartment syndrome

Occurs due to leakage of irrigation fluid in the presence of a defect in the joint capsule. The development of pathology is facilitated by an increase in irrigation pressure and blockage of drainage. Compartment syndrome is accompanied by soft tissue swelling and a sharp increase in intrafascial pressure. As a rule, it leads to necrosis of muscle tissue and the appearance of contractures in the postoperative period.

Compartment syndrome is treated conservatively. Patients are prescribed analgesics (Tramadol, Ketorolac), decongestants (Furosemide) and anti-ischemic drugs. They are also administered drugs that improve the rheological properties of the blood and relieve vascular spasm. If conservative therapy is ineffective, patients undergo surgery - decompressive fasciotomy.

Arthroscopic technique

Arthroscopic technique

Thanks to the introduction of arthroscopic surgery into clinical practice, it was possible to achieve a significant reduction in the morbidity of surgical treatment and reduce the length of time required for:

• tissue regeneration and restoration of mobility;
• the entire course of treatment and a person’s stay in a medical institution.

Postoperative recovery

After surgical procedures, regardless of the method of their implementation, the patient remains in the hospital of a medical institution for a certain period of time. A set of measures is prescribed aimed at speedy tissue regeneration of the postoperative wound area and prevention of complications:

• Limitation of leg mobility.
• Periodic treatment of surgical suture materials with special antiseptics, which are usually used in the form of a solution.
• Prescribing antibacterial agents to prevent infection.
• The use of hemostatic medications to prevent bleeding, especially after open surgery.

The average postoperative period is determined by the method of performing the operation. It varies from 3-5 to 10 days.

Damage to intra-articular structures

During arthroscopic surgery, the surgeon can damage any structure of the knee joint. Most often this occurs when a sharp trocar is used, insufficient expansion of the joint space, poor visibility, or the doctor attempts to perform “blind” manipulations.

During arthroscopy the following may be affected:

• menisci;
• articular cartilage;
• cruciate ligaments;
• joint capsule.

Damage to intrasynovial structures is very dangerous and can have serious consequences. It can provoke leakage of irrigation fluid, deformation of the menisci or intra-articular ligaments, the development of deforming osteoarthritis in the postoperative period, etc. Naturally, in the future all this will lead to impairment of the functions of the knee joint.

If the surgeon notices an injury to the ligaments, menisci or joint capsule in time, he can immediately eliminate it. Unfortunately, this is not always possible.

Exercises after hip replacement

In a rehabilitative exercise program, daily workouts involve different muscle groups. Loads are increased gradually, taking into account the general health and age of the person. Tasks must be performed strictly according to the instructions to prevent dislocation of the artificial joint.

In the first postoperative week, gentle activity is useful: breathing exercises, Thomas testing technique. At the later stage of treatment of the hip joint, classes are carried out in various states: lying down, sitting, with a transition to verticalization of the body with additional support.

Exercise No. 1

1. Lie on your back.
2. Tighten your buttocks and bring them together, as if holding a pencil between them.
3. Stay in this state for 6 seconds.
4. Relax for 5 seconds.
5. Repeat the task.

Exercise No. 2

1. Sit up in bed.
2. Pull in your stomach.
3. Straighten your shin.
4. Bend and pull the toe towards you.
5. Stay in this state.
6. Slowly lower your shin.

To stretch muscles and develop a new joint, each task should be performed 6-8 times. The lesson consists of a series of similar training tasks.

Tool failure

In recent years, it has become less common due to the improvement of arthroscopic equipment. If an instrument breaks down, doctors immediately stop irrigation and aspiration. They then carefully remove the broken fragment using special equipment. If the piece is small and difficult to access, it may be left in the synovial cavity.

Tools.

Damage to nerves and blood vessels

They occur very rarely, in only 0.06-0.08% of cases. Neurological disorders may develop due to the use of a tourniquet or against the background of compartment syndrome. The cause of vascular damage is most often the careless handling of instruments by the surgeon. As you know, the popliteal artery is located very close to the posterior capsule of the knee joint. Consequently, dissection of the latter is often accompanied by a violation of the integrity of the vessel.

The structure of damage to various nerves during arthroscopy:

• subcutaneous – 84%;
• fibular – 10%;
• femoral – 6%;
• sciatic – 6%.

Fact! Ischemic and traction nerve injuries respond well to treatment. But if their anatomical integrity is violated, it is almost impossible to eliminate neurological disorders.

Pain after knee arthroscopy

A pronounced pain syndrome occurs after synovectomy, intra-articular ligament reconstruction and meniscal surgery. In the early postoperative period, pain is relieved with opioid analgesics or intramuscular injections of nonsteroidal anti-inflammatory drugs (Ketorolac, Diclofenac). In the future, NSAIDs may be prescribed in tablet form.

3rd day after surgery.

Some patients may experience knee pain several days after arthroscopy. This symptom often indicates the development of deforming osteoarthritis. The reason for this is intraoperative damage to the articular cartilage.

Advice! If after arthroscopy you have been bothered by knee pain for a long time, do an ultrasound or MRI. The study will help identify pathological changes in the knee joint and make a diagnosis.

Recovery at home

It may take up to 3 months to fully recover from knee replacement surgery. Most people can return to normal activities within 6 weeks after surgery, but there may be some pain and swelling for up to 3 months, and scar tissue and muscle will still be healing over the next 2 years. Patients following knee replacement surgery can expect to engage in moderate exercise such as walking, swimming and cycling, but they should avoid extreme sports.

Hemarthrosis - accumulation of blood in the knee

Usually develops due to damage to the ascending lateral femoral circumflex artery. Hemarthrosis is treated by arthroscopic lavage of the synovial cavity and intra-articular injection of a local anesthetic (Lidocaine, Novocaine) with adrenaline. After this, a pressure bandage must be applied to the patient’s knee.

Accumulation of blood in the capsule.

Infection

Infectious complications are rare, occurring in only 0.1-0.42% of patients. The causative agent of septic arthritis is most often Staphylococcus aureus. The disease is acute and usually does not cause difficulties in diagnosis. In rare cases, it may have a subacute, more “insidious” course.

Classic signs of septic arthritis:

• acute pain;
• severe swelling;
• skin redness;
• fever;
• increased ESR and neutrophilic leukocytosis in the blood.

Infectious inflammation.

Note that the absence of typical symptoms of arthritis does not mean the patient is completely healthy. Infection can be excluded only through bacteriological examination of the synovial fluid. The analysis should be done at the slightest suspicion of septic arthritis.

During arthroscopic procedures, doctors may not prescribe prophylactic antibiotics to patients. This, like intra-articular corticosteroids during arthroscopy, increases the risk of infectious complications.

Treatment for septic arthritis can take anywhere from a few days to 6 weeks. In some cases, parenteral administration of antibiotics is sufficient for patients. Sometimes patients require lavage and drainage of the joint cavity. The choice of treatment usually depends on the severity of the arthritis.

Complex regional pain syndrome

It can occur with any injury to the knee, including after arthroscopic surgery. It is assumed that the syndrome is of a reflex nature and occurs due to damage to the autonomic nerve fibers of the saphenous nerve. The syndrome can develop at any age in both sexes, but most often it affects women over 40 years of age.

The clinical manifestations of this pathology are very variable. Most often, the syndrome goes through three phases of development (vasodilation, vasoconstriction, atrophy) and leads to arthromatic changes in the skin, muscles, and periarticular tissues. Almost all patients with CRPS eventually develop knee contractures. Note that X-ray changes in patients are detected 2-8 weeks after the onset of the first symptoms.

The leg does not fully extend.

Signs of CRPS:

• chronic pain in the lower limb;
• pronounced swelling of soft tissues;
• change in skin color;
• increased sensitivity of the skin in the knee area;
• osteoporosis, which is detected using radiography.

Complex regional pain syndrome is treated conservatively with psychotherapy and medications. Patients are prescribed anticonvulsants, antidepressants, muscle relaxants, NSAIDs, bisphosphonates, calcitonin, B vitamins and drugs that improve venous outflow. Patients often undergo a stellate ganglion block or lumbar sympathetic block.

Treatment for CRPS is only effective if it is started within the first 3 months after the first symptoms appear. If this does not happen, the patient experiences irreversible changes in nerves, muscles and bones.

Possible complications after surgery

The risk of complications after this operation is low.

Serious complications, such as infection of the operated joint, occur in less than two percent of cases. Such serious complications as myocardial infarction or stroke are even less common. However, chronic diseases can increase the risk of complications. Although they are rare, these complications may prolong your recovery period.

Vein thrombosis of the femur or pelvis is the most common complication of total hip arthroplasty. Your podiatrist will take steps to prevent blood clots from forming in the veins of your legs and pelvis. These measures include special elastic bandages or stockings, exercises and anticoagulants.

Despite the fact that the biocompatibility of implants and surgical techniques are constantly progressing, over time the endoprosthesis may wear out or its fixation in the bone may weaken. In rare cases, important vessels or nerves in the knee joint may be damaged during surgery.