Arthroscopy: Keyhole Knee Surgery Explained

The survivorship of newer implants, taking an average value, is more than 20 to 25 years, though there's a range. To measure success there's a prerequisite: we presume the patient has taken care of the joint, followed the precautions, physical therapies and exercises they've been told — the value I've mentioned is the average assuming that's been taken care of.

It's a permanent, non-removable procedure — it doesn't need to be removed. The follow-ups: the first milestone is at two weeks, to remove the stitches, then six weeks post-surgery, then three months, six months, and then annually.

In athletes the demand of activity is much more than the normal population — jumping, contact sports — and there's wear and tear involved in the artificial joint over time. We generally tell patients not to jump or run, for the sake of the longevity of the implant — the more activity, the more wear, and the more chance of needing revision surgery. First we tell them to change their activity level if possible; if that's not possible, there are certain implant variations available, like hip resurfacing or metal-on-metal implants, which can be offered if it's mandatory for the athlete to continue their sport — though ceramic implants are not good for them because of a higher chance of breakage.

For infection: understand the kind and duration of it. If it's acute, be very aggressive — antibiotics alone won't suffice, don't hesitate to go inside and clean the joint, with multiple debridements till it feels clean; antibiotics work as an adjuvant, not the primary therapy. In the knee you can also change the polyethylene component, put a drain for three to five days, give antibiotics. But if it's longstanding — more than a month — you may need staged revision surgery: stage one, remove the implant and put an antibiotic spacer, monitor for six weeks until infection markers are normal and skin has healed, then stage two, the revision total replacement. On MRI: all joint replacements can have an MRI done, provided the implant is well fixed — if it's unstable, MRI may not be a good idea, but if the joint is stable, MRI can be done using implant-specific coils that neutralise the implant artefact.

This is a common perception, actually — in the first six to eight weeks we don't want the patient to bend beyond 90 degrees, talking about hip replacements, to reduce the chances of dislocation so the capsule heals well. That's the 90 degree rule for hip replacement.

The surgeon performs a joint washout, removes loose bodies floating within the joint, trims torn sections of the meniscus, and can address a cartilage defect during the same keyhole procedure.

Arthroscopy is a daycare procedure requiring only a single day in hospital, with most patients recovering within two to three weeks.

Arthroscopy suits patients with mechanical symptoms such as loose bodies, meniscus tears or localised cartilage defects, rather than widespread joint space loss.

Once arthritis has progressed to involve a whole compartment or the entire joint, arthroscopy alone is no longer effective, and options such as osteotomy or joint replacement become more appropriate.