Keyhole knee surgery (Arthroscopy)

An arthroscopy is a type of keyhole surgery. It uses a medical instrument called an arthroscope, which is a thin, flexible tube with bundles of fibre-optic cables inside that act as both a light source and camera. A small incision is made on the front of your knee and the arthroscope inserted. Its role in treating arthritis is in the assessment of the joint surfaces (and is superior to MRI) and removal of torn cartilage. As with all types of keyhole surgery there is less pain, faster recovery and less risk of infection when compared with open surgery.

At arthroscopy, loose and damaged pieces of joint can be removed, and if the main symptom is acute sharp pains with catching and locking, then an arthroscopy may well provide lasting relief. Arthroscopy cannot repair a worn out joint, so if there is already bone rubbing on bone because a part of the joint has worn out, causing pain and aching after exercise an arthroscopy may not help at all.

Overall, keyhole knee surgery is very safe and has one of the highest satisfaction rates of any surgical procedure. The possible complications of any operation include reactions to anaesthetic drugs (these often cause nausea and sickness), excessive bleeding or developing a blood clot, usually in a vein in the leg (a Deep Venous Thrombosis, DVT).

Who is suitable for keyhole surgery?

We will assess whether your knee will benefit from keyhole knee surgery. We may use plain X-rays and an MRI scan to help with this assessment. The most common reasons to recommend keyhole surgery are:

• torn meniscal cartilage
• damaged joint surface cartilage
• torn anterior cruciate ligament
• loose bodies

Is it too soon?

Rule one is ‘keep away from doctors, and surgeons in particular’, so it is almost never wrong to postpone surgery. What we do know, is that to keep feeling well, everyone needs to take a reasonable amount of exercise. If you can no longer walk for pleasure, or play the ‘age-appropriate’ sport that you really enjoy because of a simply rightable wrong, then there is no harm in getting an opinion.

Is it too late?

Only rarely will we ever say, ‘I wish you had come sooner’, because the wearing out process usually takes a long time, even though a joint may hurt a lot.

Here are a few of the exceptions:

• when a small problem can be sorted out by a small operation, but it is left too long, so a big operation is needed instead. The commonest example of this in the knee: a sore knee that is left too long can become unstable. One can manage to limp around, albeit rather slowly, and fear keeps you away until it is unbearable, by which time a total knee replacement has to be performed, instead of the smaller unicompartmental replacement, which usually prevents a total knee ever being needed.
• when a simple ligament rupture leaves the knee unstable and consequently serious meniscal damage occurs.

Is my condition bad enough for an operation?

We measure how bad things by asking questions such as:

• On a 0-10 scale, how much pain are you in?
• Is it steadily getting worse?
• How much trouble do you get in everyday life and doing the things you enjoy?

Before your operation you will be ‘scored’ using a variety of functional scores. These are principally questionnaire based, and help put your problems in perspective. They also give a helpful comparison for your progress following surgery. The Oxford knee score is an example of such a questionnaire.