The patient, a male 54-year-old, complains of right knee pain that has been worse over the last three months. Without any triggering incident, such as a fall or accident, the discomfort first began a year ago. The right knee’s outside surface is where the discomfort, which has been described as acute, is located.
The pain is really intense and becomes worse when doing things like walking, turning, twisting, and climbing stairs. Over the past year, the patient attempted both physical therapy and medicine, but neither provided meaningful alleviation. The patient had smoked for 25 pack years in the past. The patient says they have never used illegal substances.
The patient’s medical history is noteworthy for osteoporosis and hypothyroidism. Levothyroxine, calcium, and vitamin D supplements are currently being taken by him. The patient is a business analyst who is presently unable to work due to pain. The patient has a decreased right stance phase and walks with an antalgic gait. In order to move around, the patient currently uses a cane as an aid.
Is knee arthroscopy successful for osteoarthritis patients?
Surgery for OA is intended to ease pain and increase mobility, but in reality, it does neither for the vast majority of those who undergo it. Knee arthroscopy has not been shown to reduce pain, and what little alleviation patients might get is likely to wear off quickly.
Rehabilitation after knee arthroscopy?
It will take you around six weeks to feel back to normal. If your doctor restores the injured tissue, your recovery time could be extended.
You might need to scale back on your routine until your knee feels stronger and can move more freely again. As an alternative, you might be participating in some sort of physical rehabilitation (rehab) plan.
On palpation of the lateral femoral condyle during a physical examination of the right knee, there is soreness. Flexion (150 degrees), extension (10 degrees), and discomfort were the only restrictions on the range of motion. The compression tests conducted by Mcmurray and Apley were successful.
A subchondral insufficiency trabecular microfracture may be indicated by substantial subchondral marrow edema at the lateral femoral condyle, according to an MRI of the right knee. The patient and various treatment choices were thoroughly addressed before the patient decided on surgical surgery.
Infection, bleeding, nonhealing, the need for repeat surgery, knee arthritis , the need for rehabilitation, and the potential need for knee replacement in the future, among other risks and advantages, were thoroughly reviewed with the patient. The patient read the consent carefully and signed it.
If you have severe knee discomfort, have had to limit your activities because of the pain, and have tried alternative non-surgical treatments without success, knee replacement surgery may be a possibility for you.
Mostly People use the Knee Society Score (KSS) and the Oxford Knee Score (OKS) to provide an objective evaluation of my patients’ levels of difficulty. This provides additional consideration when making decisions based on the patient’s preferences and the potential outcomes of various treatment options.
Chondroplasty of the Medial Femoral Condyle
- a lateral meniscus tear at the right knee’s posterior root.
- Subcondylar fractures and lateral femoral condyle microfracture.
- the medial aspect of the patella has osteochondral injury.
- the medial aspect of the patella has an old osteochondral lesion.
- The lateral femoral condyle has a microfracture and subcondylar fracture.
- Arthroscopic lateral meniscectomy on the right knee.
- The medial femoral condyle and medial patellar facet arthroscopic chondroplasty in the right knee.
- Using tricalcium phosphate, arthroscopically aided percutaneous fixation of the lateral femoral condyle (subchondroplasty).
The patient was moved into the operating room and put on a sturdy operating table. Anesthesia was induced throughout. He put a tourniquet on. They administered the preoperative antibiotic. The right lower extremity was prepared as normal and dressed aseptically.
The tourniquet was blown up. The medial facet of the patella was found to have osteoarthritic lesions in the PF compartment. A medial entry portal was created, and an arthroscope was inserted into the medial compartment.
When that medial compartment was examined, it revealed a stable, old-healed osteochondral lesion on the lateral surface of the medial femoral compartment. The medial meniscus was unharmed. The intercondylar notch examination revealed an undamaged ACL. A tear in the posterior horn of the lateral meniscus was visible upon examination of the lateral tibiofemoral compartment. Biters and shavers were used to remove the debris from the lateral meniscus posterior horn.
Once more, a shaver-debrided osteoarthritic lesion of the medial facet of the patella is seen upon examination of the patellofemoral compartment. Through the medial portal, the arthroscope was inserted, and the results were verified again before the final photos were stored.
The removal of the lateral femoral condyle was now the main concern. Then a fluoroscope entered the scene. A drill hole was drilled about 2.5 cm proximal and anterior to the inferior and posterior articular surfaces of the femoral condyle while being guided by fluoroscopy.
A second cannula was used to drill a hole in the lateral femoral condyle in the same orientation as the first, but 0.5 cm farther proximally and anteriorly. Both the AP and lateral views were captured successfully.
About 2.5 milliliters of tricalcium phosphate bone cement was administered through each cannula and trochar. C-arm imaging revealed that the cement only penetrated into the bone. After inserting an arthroscope into the femoral condyle and intercondylar notch, it was determined that no bone cement was extravasating into those areas.
The scope was taken out of the knee, and fluid was drained from the joint. We had to wait for the cement to dry. Cannula removal occurred after bone cement had been in place for longer than 12 minutes. The completed fluoroscope image was captured and stored. The wound on the knee was cleaned and drained carefully.