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Knee Arthroscopy

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Guidelines for Patients Having Knee Arthroscopy INDIVIDUAL PATIENT NOTES Consultant Name Date of procedure Weight Bearing Status Walking Device Date for Removal of Sutures Stitches or Staples Clips Other Recommendations Contents Introduction 4 About the Procedure Infection Nerve Injury Wound Healing 4 6 6 7 Before Your Procedure On arrival 7 7 8 After Your Procedure Recovery 8 8 9 Dressing Wound Care Swelling Bruising Pain 9 9 10 10 Physiotherapy Exercise Programme Activity Advice Stairs Technique Follow Up Physiotherapy 11 11 13 13 13 14 14 At Home Showering Driving Return to Work Recognise the Signs of Infection 15 15 15 16 Post Discharge Contact Details 17 Exercise Diary 16 18 19

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Guidelines for Patients Having Knee Arthroscopy Guidelines for Patients Having Knee Arthroscopy During the surgery two or three small incisions are made in the knee through which the surgeon can insert instruments First your knee is filled with sterile fluid The fluid expands the knee joint to make more room inside for the surgeon to see and work Next a tube that has a small light and camera is inserted into the knee The tube is called an arthroscope The camera sends an image of your knee to a TV monitor The surgeon can view the inside of your knee on the monitor Instruments are inserted into the knee joint and damaged tissues are repaired Irrigating Instrument Introduction This information booklet has been written to give you and your family a basic understanding of what is involved when you require a Knee Arthroscopy About The Procedure Knee arthroscopy surgery provides a view of the inside of your knee and allows the surgeon to see if there is any knee injury or abnormality An arthroscopy can detect knee problems such as Tears in ligaments or tendons Pain and swelling inflammation Fractures Loose pieces of bone or cartilage Joint wear and tear An arthroscopy can treat knee problems such as Tears in meniscus cartilage Wear and tear of other cartilage Tears in ligaments Other knee problems 4 Viewing Scope Trimming Instrument When possible the doctor uses special surgical instruments to correct the injury or abnormality Then the joint is washed out with a stream of sterile fluid and the instruments are removed The incisions are closed with stitches staples or Steri strips Lastly dressings are put on the incisions 5

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Guidelines for Patients Having Knee Arthroscopy Guidelines for Patients Having Wound Healing Femur Posterior Cruciate Ligament PCL Lateral Collateral Ligament Anterior Cruciate Ligament ACL Medial Meniscus Knee Arthroscopy Although arthroscopy is performed through Key Hole incisions there is still a possibility of delayed wound healing This may result in a serous discharge from the wounds for a short period after surgery and usually settles spontaneously Occasionally the arthroscopy portals can produce a small local hernia of fatty tissue from within the knee This rarely causes any clinical problems Before Your Procedure You will be contacted by the scheduling department the day before your procedure with an admission time You need to be fasting for at least 6 hours before surgery This includes ALL food AND drinks including water and chewing gum If your procedure is in the morning please fast from midnight If you have an afternoon slot please fast for at least 6 hours prior to your admission It is advised to shower the morning of surgery or the night before if you have an early admission time Please bring a list of your medications with you when you come in You may be advised to take some of your regular medication the morning of your procedure If so please do so with only a small sip of water Please remove all nail polish makeup Superficial usually settles with antibiotics Deep involving the joint This can require further surgery to wash out the joint as well as intravenous antibiotics The only jewellery allowed is a wedding band Please leave valuables at home Nerve Injury On Arrival Medial Collateral Ligament Tibial Plateau Tibia Fibula While complications in knee arthroscopy are not common all surgery has associated risks The following is a list of some of the problems that could potentially occur Infection Infection is a potential complication of all operations Post operative infection may be Small areas of numbness may be associated with the operative incision The numbness is usually temporary Occasionally wounds can become painfully sensitive although this normally settles with time 6 Please check in at the Day Unit Reception on the 1st floor where you will be registered and then escorted to your cubicle A nurse will take your medical history and your blood pressure 7

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Guidelines for Patients Having Knee Arthroscopy temperature and pulse If you are feeling unwell it is important to mention this to the nurse You will need to put on a gown and disposable underwear Two hospital bands will be applied containing your name date of birth and hospital number These will be confirmed with you on arriving at each different department Ladies under 55 will need to provide a urine sample and a specimen pot will be given on admission Men over 50 and Women over 40 years of age will routinely have a tracing of their heart ECG taken before surgery This is a standard procedure and the tracing will be assessed by your anaesthetist Your belongings will be locked away on the ward in the lockers provided including dentures and glasses You will be brought to the holding bay in theatre to sign your consent form with the consultant and meet the anaesthetist Please note that at times some delays can occur in the department and we ask for your patience at such times Guidelines for Patients Having The nurse will go through after care and pain relief instructions your follow up appointments and or prescription with you prior to your discharge You may need to speak with your Consultant before you go home or follow up with them in rooms Dressing and Wound Care You will have a pressure dressing on your knee Underneath you will have some small dressings covering steri strips and sutures closing the incision site You will be advised as to if and when these need to be removed It is advised to leave the dressing alone as much as possible and you do not need to change your dressing unless it falls off or becomes contaminated Spares will be provided Most people will have sutures stitches or staples that will need to be removed approximately 10 14 days after surgery This may be done by the GP Centre for Orthopaedics or consultant Swelling and Bruising Expect to experience bruising and swelling in the knee after surgery This is a normal part of the recovery phase after a knee arthroscopy Bruising can occur to the whole operated leg and may last a number of weeks The swelling can cause pain in your knee and may restrict the amount of movement you have in the joint To reduce this take the medications that are prescribed for you and ice your knee The swelling can persist for 2 to 3 weeks and sometimes longer Swelling can be minimised by doing the following Compressive Bandage Make certain your Compressive bandage Tubigrip is not too tight and regularly elevate your leg so it is above the level of your heart if you are sitting prop your ankle up on several pillows Keep your ankle higher than your knee and your knee higher than your hip This will help reduce swelling and relieve pain Ensure to remove the Tubigrip at night it should be worn during the day only for up to two weeks until swelling improves After Your Procedure Recovery You will wake up in the Recovery room where the nurses will monitor you until you can return to the day unit or inpatient bed Please use the call bell if you need to use the bathroom or get out of bed You may experience pain at this time please alert your nurse who will take measures to relieve this Light refreshments will be provided You will need to pass urine before you go home The nurses will contact your next of kin to come and collect you 8 Knee Arthroscopy 9

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Guidelines for Patients Having Knee Arthroscopy Guidelines for Patients Having Ice Ice packs may help to relieve pain Place crushed ice in sealable freezer bag and then into a clean pillow slip or else wrap some frozen peas in a clean pillow slip and apply to the knee and surrounding areas for 10 mins on and then 10 mins off Repeat x 3 4 times daily Pain Pain is a common occurrence following any surgical procedure It can be well managed with medications special pain management devices and ice The pain will naturally reduce as your wound heals and with regular use of analgesics pain killers It is imperative to keep your pain well controlled so you can mobilise comfortably perform your physiotherapy exercises and resume normal activities after your surgery Knee Arthroscopy Physiotherapy Weight bearing and Walking Full weight bearing is permitted as tolerated unless you are otherwise informed Crutches are generally but not always prescribed post knee Arthroscopy This depends on your Consultants preference If prescribed your Physiotherapist will advise you on the length of time for crutches This can range from up to 5 days or in some cases until you are reviewed by your consultant at your post op clinic review The Physiotherapist will guide you on all the above You will be asked to rate or score your pain regularly after your surgery You will be asked to give a number between 0 and 10 where 0 represents no pain and 10 represents the worst pain you can imagine Your score will depend on how intense your pain is 0 No pain 10 Worst pain imaginable 0 no pain 1 2 mild pain 3 4 5 moderate pain 6 severe pain 7 8 very severe pain 9 10 worst pain imaginable Exercise Programme Pain Medication On discharge from hospital you will be prescribed some medications some of which will be for pain Part of the prescription will include pain medication Plan to do your exercises 30 minutes after taking pain medication as preventing pain is easier than chasing pain If these medications are not relieving your pain or you cannot take the medications due to side effects or you require a repeat prescription contact your local GP 10 Exercise is very important following a knee arthroscopy Please be sure to read the exercises carefully and ask your physiotherapist any questions that you may have before you leave the hospital These exercises should be carried out 3 times a day morning afternoon and evening If you experience any pain with any of these exercises cease the exercise immediately 11

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Guidelines for Patients Having Knee Arthroscopy Guidelines for Patients Having Knee Arthroscopy Early Post operative Period 1 2 Weeks Perform the following exercises 3 times daily 12 1 Static Quadriceps Tighten muscles of your thigh on the operated leg pushing the back of your knee into the bed Hold for 5 seconds then relax Repeat 10 15 times 2 Straight Leg Raises Tighten muscles of the top of your operated leg Keeping your operated knee straight raise the leg about 6 to 10 inches off the bed Hold for 5 seconds Slowly lower your leg back to the bed Repeat 10 15 times 3 Knee Flexion Lying on your back bend your operated knee as much as possible by sliding the heel up and down in a controlled manner 4 Inner Range Quadriceps Place a pillow or rolled towel under the knee foam roller used in the picture Push the knee straight into the towel pillow hinging the heel off the bed trying the straighten the leg fully Hold for 5 seconds then slowly lower Repeat 10 times Activity advice You should start walking full weight bearing immediately unless informed otherwise by your physiotherapist You should begin prescribed Physiotherapy exercises as soon as is permittedusually immediately post surgery three times daily Stairs Technique Going Upstairs Going Upstairs Maintain crutches walking stick on the step below Step up with the un operated leg up onto the step above by pushing on crutches walking stick and banister Keep your kneecap pointed up toward the ceiling Step up the operated leg onto the same step Repeat 10 15 times Follow with the crutch walking stick onto the same step 13

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Guidelines for Patients Having Knee Arthroscopy Guidelines for Patients Having Knee Arthroscopy At Home Going Downstairs Showering Keep the dressing on your knee dry and intact for 48 hours After this time you may recommence showering A shower usually has a small step in and care should be taken getting in and out You may remove the tubigrip bandage before you shower and also to clean the tubigrip itself Going Downstairs Put crutch walking stick down onto the step below Step down onto the step with the operated leg Take weight onto the operated leg using the crutches and banister for support Follow with the un operated leg onto the same step If you only have a bath then it is not recommenced to use same until a safe period after the removal of the stitches staples Do not swim until advised by your consultant Hint The good leg goes up the stairs first and bad leg goes down the stairs first Follow up physiotherapy You will be advised to attend outpatient Physiotherapy within two weeks of discharge You may either attend a private physiotherapist in the hospital or a physiotherapist more local to your home Beacon Hospital physiotherapy department number is 01 2936692 Driving You must be able to comfortably use the brake and accelerator and be finished all pain medication before you are cleared to drive If in any doubt check with your consultant 14 15

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Guidelines for Patients Having Knee Arthroscopy Return to work Plan to take 2 3 days off work following your surgery If your job requires a lot of walking or manual labour contact your consultant for appropriate work restrictions Recognise the signs of infection Infection may occur despite your best efforts If any of the symptoms below occur then you will need to see your GP or liaise with the centre for orthopaedics for advice and possible antibiotics The signs of infection include Redness around the wound site Increased pain in the wound Swelling around the wound Heat at the wound site Discharge of fluid may be green or yellow Odour or smell from the wound Feeling of being generally unwell Fever or temperature 16 Please do not hesitate to contact us if any problems or questions arise once discharged Day Unit 01 293 7588 Orthopaedic Centre 01 293 7575 Out of hours 01 293 6600 Nursing Supervisor for urgent queries 01 293 7535 Physiotherapy Department 01 293 6692 01 293 6692

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Exercise Diary Following a Knee Arthroscopy Procedure Instructions The exercise programme will begin the first day after your surgery and the physiotherapist will teach you the exercises the first time you perform them DAY POST OPERATION Time of Day DAY 1 Morning Afternoon DAY 3 DAY 2 Evening Morning Afternoon Evening Morning Afternoon DAY 4 Evening Morning Afternoon DAY 5 Evening Morning Afternoon Evening Target Volume Repetitions x Sets 1 Static Quadriceps 2 Straight Leg Raises 3 Knee Flexions 4 Inner Range Quadriceps Following this you should record the number of repetitions of each exercise that you complete in the boxes in the table above The aim is to perform three exercise sets per day morning afternoon and evening 18 19

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Beacon Centre for Orthopaedics Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 7575 Mon Fri 9am 5pm Email orthoclinic beaconhospital ie www orthopaedics ie Beacon Physiotherapy Department Tel 01 293 6692 Email physiotherapy beaconhospital ie www beaconhospital ie Version 1 1 22

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