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FREQUENTLY ASKED QUESTIONS:-
If you are having an anaesthetic then it is extremely important that you follow appropriate advice with respect to when to stop eating/drinking prior to your operation. This advice should be given to you by your surgeon, your anaesthetist, by a nurse in a preadmission clinic or sometimes by the actual hospital itself. For general guidance, when having a general anaesthetic one should not eat anything for 6 hours prior to the time of the surgery. After that one can then continue to drink clear fluids (water, black tea/coffee) up until 2 hours before surgery, and then one should have nothing at all to drink from that point onwards. It is vital, however, that you specifically check the exact details of this yourself with your own doctors/nurses prior to your surgery. Failure to comply to the appropriate advice may mean that your surgery might need to be either delayed or potentially even cancelled, because of the risk of any stomach contents coming up during the anaesthetic, going down the windpipe into the lungs and causing a pneumonia.
The amount of time that you might require off work after your surgery will depend on what actual procedures you have done … remember, ‘an arthroscopy is not just an arthroscopy’ --- ‘arthroscopy’ simply means ‘looking inside a joint’ …. there is a very wide variety of actual procedures that can be undertaken inside a knee joint via arthroscopy, and these will dictate the speed of your recovery/rehab and the timing of you being able to return to work. Also, return to work will depend on what kind of job you do (manual vs office-based) and what your commute to work might be.
Your should always discuss this issue directly with your own surgeon. However, I normally advise my patients to take 1 week off work at least (although many of ‘The City Boys’ tend to ignore this!), regardless of what is actually done inside the knee, just to get over the whole ‘event’ … you should not underestimate how tired you are going to be from all the physical and mental stress of having an operation and an anaesthetic.
After some surgeries (eg delicate meniscal repairs, articular microfracture, meniscal scaffolds or meniscal transplantation) I might need to keep patients non- or partial-weight-bearing with 2 crutches and with their knee in a strap-on hinged knee brace to protect the joint for the first 6 weeks post-op. In these instances, I often advice people to take 1 week fully off after the surgery, followed by 1 week of working from home (if possible), returning to work after that by avoiding public transport and rush hour (working flexible hours if possible, and taking lifts from friends/family or using taxis). In particular, it is not safe using the tube or trains when on crutches.
In summary, however, there are so many variable factors involved in the timing of when to return to work that you really will need to discuss this in advance directly with your own consultant.
Again, this depends on what’s actually done inside the knee. After a simple straight forward arthroscopy, where for example a small meniscal tear has been trimmed with a partial meniscectomy, most patients are able to fully weight bear straight away. I do, however, give my patients crutches after every arthroscopy because initially the knee may be sore plus at the end of the operation I inject the knee with local anaesthetic, as a painkiller. However, this can potentially numb the reflexes in the knee temporarily, and so the crutches are there as a safeguard, to prevent patients’ knees from giving way if they think that they can fully weight bear ahead of when their muscles and reflexes might actually be able to cope with it.
Crutches are provided by the hospital (we use 2 crutches), and most patients after a simple arthroscopy are able to walk reasonably normally (with the crutches there for additional support/safety), and then get rid of the crutches after 24 to 48 hours).
If more involved/complicated surgery has been performed inside the knee via the arthroscopy (such as meniscal repair, articular cartilage microfracture or grafting, meniscal scaffold implantation or meniscal transplantation) then you might need to keep the crutches for a full 6 weeks post-op. The hospital physiotherapists will show you how to use your crutches and will make sure that you can use them safely and effectively before you are discharged from hospital after your surgery.
Once again, this depends on what you’ve had done. As a very rough guide only:-
- Meniscal trim (partial meniscectomy) = about 6 weeks
- Meniscal repair = 3 months
- Articular microfracture = 9 months
- Meniscal replacement surgery (scaffold or transplant) = 9 months
- ACL or PCL reconstruction = 9 months
Yes – your hospital will provide you with crutches prior to discharge, after your surgery.
When resting, e.g. sitting at home on a sofa, it is best to elevate your leg on a cushion or pillow. Some degree of swelling in the foot is common after any kind of knee surgery – when the foot is kept down gravity tends to pull tissue fluid (lymph) down towards the foot. Elevating the foot encourages the tissue fluid to flow back up towards the heart. Ideally, the foot should be elevated higher than the level of your heart, but the tends to be fairly impractical. The other thing that will help reduce swelling is to keep your foot/ankle moving regularly, as much as possible – when the calf muscles contract they pump venous blood back up towards the heart, which helps improve the peripheral circulation (which as well as reducing swelling also probably reduces the risk of blood clots in the veins – a DVT).
If the knee is swollen then icing it generally helps to reduce the swelling and reduce any pain. This can be done however frequently feels necessary. However, it is vital that you should avoid direct contact of ice with your skin, as this can actually cause nasty cold-burns to the skin.
In my practice, for those patients having anything bigger than just a simple arthroscopy, I often recommend the use of the Game Ready system. This is a portable device that attaches to a cuff that is strapped on around the knee, and which applies cooling plus intermittent compression to the knee. The Game Ready system reduces swelling, reduces pain and speeds up early recovery/rehab. Our patients have given us excellent feedback about this system, and it can be rented directly from the Game Ready company who will deliver it to your home and then pick it up afterwards (normally 1 month later), when it is no longer needed. CLICK HERE for further information.
At the end of every knee arthroscopy I tend to cover the wounds with waterproof dressings and then cover the dressings with a layer of wool bandage and then a layer of crepe bandage. If the patient is staying in hospital overnight, then our nurses on the ward will remove the bandaging and instead apply a TED (anti-DVT) stocking the following morning after the surgery, prior to discharge.
If a patient is having a simple arthroscopy as a day case (ie going home the same day), which is the case for most knee arthroscopies, then they are generally advised to remove the bandaging themselves 48 hours after their surgery, and then apply a TED stocking over their dressings, leaving their dressings alone intact.
The dressings that we use are very sticky waterproof dressings. Personally, I like my patients to leave these dressings on until I see them myself in clinic at about 10 days post-op, when I remove them myself in clinic. However, if at any stage these dressings fall off in the meantime, then the incisions (which are either closed with steristrips (sticky paper strips) or stitches) should be cleaned with antiseptic and then covered back over with a simple dressing or elastoplast.
The dressings that we generally use tend to be waterproof. However, they can come off. We therefore generally advise patients to avoid baths until their dressings/stitches have been removed by their surgeon/nurse. Showers tend to be OK as long as any dressings are covered over. This can be achieved by either wrapping the knee in clingfilm (which works OK but not brilliantly) or, ideally, with the use of a plastic Cast Protector sheath.
Your can drive whenever you are strong enough to stamp hard and fast on the ground with your right leg (for an automatic) or with both legs (for a manual). Therefore, how soon you might be ready to do this will depend entirely on which knee is being operated on and what is actually done to your knee during the actual surgery. After a simple arthroscopy, this can be as soon as just 2 or so weeks after your surgery. After more complicated/involved surgery, this could be anything up to 3 months. It is therefore important that you discuss this directly with your surgeon ahead of your actual surgery.
There is no specific formal medical guidance with respect to how long after surgery it might be before you are safe to fly. The concerns are that A) after any kind of knee surgery mobility is going to be impaired for a period, which makes travel awkward, and B) the potential increased risk of DVT (blood clots).
After kind of surgery the body releases stress hormones that prepare you for fight/flight/healing. One of the things that happens is that the blood clots more easily (becomes hypercoagulable). In addition, after knee surgery people tend to be less mobile, and immobility also increases the risk of blood clots forming in the veins of the leg. No-one is quite sure of the exact reason why flying might increase the risk of DVTs. It might be the immobility of being cramped in a seat for a long period or it could be related to the pressure changes from flying. However, the reason that the British Orthopaedic Association has not issued any formal guidelines is that the scientific research/evidence in this area is relatively lacking, and there is little objective data on which one could actually base formal advice.
Therefore, most people tend to generally agree with the following:-
- Short haul flights (less than 4 hours) are probably OK after knee surgery, as soon as the patient is actually mobile enough to get on/off the plane
- Long haul flights (more than 4 hours) should probably be avoided until 6+ weeks after surgery and until you are properly mobile.
- In addition, the general advice for reducing the risk of DVT when flying should be followed strictly, i.e. perform regular calf exercises, get up and walk up and down regularly and drink plenty of water.
Most patients are able to cope with stairs pretty much straight away once they get home after surgery. However, until you get your movement (flexion/bend) back in your knee (which could take just a couple of days, or it could take 6+ weeks, depending on what’s actually done inside your knee) then you may need to go up stairs slowly, 1 step at a time, and possibly even come down initially on your bottom. However, one way or another, most patients are actually able to cope with stairs after their knee surgery.
Pretty much whenever you like, as long as you’re not on antibiotics or any other specific medications where alcohol is specifically not recommended.
All our patients are seen in hospital by the hospital’s inpatient physiotherapists prior to discharge home, to ensure that they are able to cope (with crutches etc) safely. We tend to advise most patients to then just take it easy for the first week or so. I like to see my patients back in clinic at approximately 10 days post-op, and then I tend to advise most patients to commence their outpatient physio treatments ASAP after that.
Knee arthroscopy is performed through tiny incisions at the front of the knee. These are normally about 5mm in size, and either 2 or sometimes three incisions are needed. If any more major procedures such as ACL reconstruction or meniscal replacement are also performed then additional incisions will be required (although these too tend to be fairly small).
Some degree of swelling after knee surgery is inevitable. With knee arthroscopy the knee is pumped up with pressurized water (saline), and not all of this can be removed at the end of the op. In addition, at the end of the operation I inject the joint with local anaesthetic (a liquid) for pain relief, which also adds to the amount of fluid left inside the knee at the end of the procedure. Furthermore, it is not uncommon for there to be a small amount of bleeding into the knee joint after knee surgery, plus any period of immobility will also add to the general swelling.
The best way to deal with knee swelling is to get moving nice and quickly after your surgery, to ice the knee intermittently and/or to use the Game Ready system.
It should be noted that large swelling with pain in the knee, swelling with heat and tenderness, leaking of pus from the knee or a feeling of general malaise can all be signs of something more serious going on, such as a possible infection in the joint or a haemarthrosis (build up of blood inside the knee), and if you have any concerns at all regarding your knee then you must contact your surgeon/hospital straight away for their specific advice, as you may need to be seen for an urgent check-up.
Some degree of pain, swelling and warmth in a knee is inevitable after any kind of knee surgery. The more is actually done to/inside the knee, the more painful the joint will be in the initial post-op period, and the longer this is likely to take to settle. However, severe pain or pain that is getting worse with time rather than better is a potential sign of something being ‘wrong’.
Knee joints often feel a bit warm after surgery, probably due to an increased blood flow to the area. However, if a joint feels ‘hot’ or if you are feeling hot in yourself, sweaty or generally unwell then these can be potential signs of an infection, and you should seek urgent advice from your surgeon.
When a knee arthroscopy is performed the joint is pumped full of fluid to allow us to see clearly. Not all of this fluid can be fully emptied out of the knee at the end of the operation. Then, in addition, we also inject some liquid local anaesthetic into the joint at the end of the procedure, for pain relief. Therefore, it is fairly normal for the knee to feel a bit swollen after a knee arthroscopy, and for there even to be a bit of a ‘squelching’ sensation inside the joint. Sometimes, some amount of blood-stained fluid can leak out of the arthroscopy incisions, which should not be a worry. However, persistent or large amounts of leaking from a wound or any signs of pus coming out from the incisions are signs of a potential problem (such as potential infection), in which case you should contact your surgeon urgently for further advice.
Yes – to both – you certainly should. I always see my patients on the ward on the day of the surgery, prior to the actual operation. This is so that we can chat about the surgery, so that I can answer any further questions that you might have, and so that we can complete the consent form for the operation and draw an arrow on the appropriate leg (we always mark the side of the operation, to avoid any risk of potential confusion or error). Then I always see my patients post-operatively, on the day of their surgery, to check that they are OK, to explain to them exactly what was found inside their knee, to run through the details of what was actually done inside the knee, and to explain what rehab/physio is going to be needed.
Yes, it is always a good idea to bring with you whatever copies you might have of any X-rays and/or scans. If your imaging was performed in the same hospital where you are having your surgery then this is not so important, as the imaging will be available in theatre via the hospital’s computer system. However, images taken elsewhere at other hospitals will not be available, and your surgeon should be given access to all relevant imaging at the time of your actual operation.
Yes. After you’ve had an anaesthetic you will not be safe to drive yourself home and you will not feel good enough to travel on public transport. Therefore you will need someone to come and pick you up from hospital and take you home after your operation, and ideally you should have someone stay with you for the first night as well, just in case you need any assistance.
When you have an operation the anaesthetist will use a ‘blood saturation’ probe that checks the amount of oxygen in your blood via an optical sensor that has to look through a nail into the nailbed. Therefore, you should remove nail polish prior to your surgery.
All rings that can be removed should be removed. For rings such as wedding rings that might not actually come off, these can be left on but the nurses on the ward prior to you having surgery will tape up any rings to cover them over. It should, however, be noted that if at any time for any reason you were to develop swelling in a finger where you have a ring that won’t come off, then it could potentially be necessary to cut the ring off if at any stage it looks like it might threaten the circulation to your finger.