Dr. Berman’s Knee Arthroscopy Consent
Possible Complications
We have listed complications/problems, which have been reported with arthroscopic
knee surgery.
IN GENERAL, KNEE ARTHROSCOPY IS EXTREMELY SAFE, HIGHLY SUCCESSFUL,
AND HAS MINIMAL COMPLICATIONS ASSOCIATED WITH THE PROCEDURE. Certain risks
maybe increased or decreased depending upon the types of arthroscopic surgery
and the extent of the injury thatyou have. It is critical for you to have realistic expectations regarding
your surgery and expected outcome.
1. Postoperative bleeding within the knee joint. This may require
aspiration (removal) in the office
postoperatively.
2. Persistent swelling (fluid on the knee). This may occur in arthritic
knees possibly requiring periodic aspiration or injection with cortisone
(an anti-inflammatory medication).
3. Postoperative infection. Superficial (skin) or deep (within
the joint) may occur. The incidence is reported at <1% (1/250). A skin
infection generally is treated with oral antibiotics. If you developed
a deep infection, you would require readmission to the hospital, re-arthroscopy
or an open procedure to wash out the infection, and a variable period
of intravenous antibiotics.
4. Phlebitis (blood clots). Deep vein thrombosis or blood clots
are unusual in arthroscopic knee surgery but can occur, as in any other
surgery involving the lower extremity. A blood clot would require a readmission
to the hospital and a treatment with a blood thinner (Heparin/Coumadin)
for several days followed by a 3-month period of oral anticoagulants (Coumadin).
5. Pulmonary embolus. When a blood clot becomes dislodged it may
travel to the lungs resulting in acute shortness of breath, rapid heartbeat,
and in rare situations result in sudden death.
6. Knee ligament injury. Under anesthesia to allow visualization
we have to stress the knee. If too much force is applied one of the side
ligaments could be stretched. This is a nonsurgical problem that heals
uneventfully and occurs rarely.
7. Broken instruments. The instruments that are used to perform
your surgery may potentially break within your joint. This is a rare complication.
If this occurred, the piece almost always could be uneventfully removed
arthroscopically. However, if this was not possible, your knee may need
to be opened surgically to extract the broken instrument.
8. Synovial fistula. This rare complication results when the skin
incompletely heals and knee fluid leaks out through the joint to the skin.
9. Nerve injury. Partial or complete injury to the major nerve
to the limb has rarely been reported in the literature. Complete recovery,
partial and complete permanent injuries have resulted from these rare,
but serious, complications. This rare complication has occurred in patients
requiring meniscal repair (meniscal suturing), and for this reason we
make an accessory surgical incision and place a protective retractor to
protect the nerve and vessels. The saphenous nerve runs along the inner
aspect of the knee. Permanent injury would result in numbness along the
side of the lower leg into the foot area. The common peroneal nerve courses
around the outside of the knee, providing protective sensation and enabling
us to raise our foot and ankle. If this nerve is injured a foot drop occurs
and would require a brace and/or surgery.
10. Vessel injury. Rarely the major artery/vein in the lower extremity
is injured. If this occurs it is generally quickly detected. In a major
injury to these vessels, which course through the back of the knee, immediate
vascular repair by a vascular surgeon is required with a subsequent hospitalization.
Very rarely, vascular injuries have resulted in an amputation of the extremity.
11. Tourniquet palsy. We often have to inflate your tourniquet
on your thigh during surgery to maximize our visualization. If this were
to exceed 2 hours you would notice some numbness and tingling on the foot
for the first 24 hours and then resolution.
12. Reflex sympathetic dystrophy. This rare entity is characterized
by pain out of proportion. If this occurred postoperatively it would require
referral to a pain clinic, prolonged rehabilitation, and epidural spinal
pain blocks.
13. Compartment syndrome. This rare complication occurs when fluid
leads out of the knee into the muscle compartments. Massive swelling could
result in compromise of the neurovascular structures with a potential
complication resulting. If this were suspected or detected, emergency
surgical decompression of the muscular compartments is required.
14. Meniscal retear. Occasionally the meniscus retears during a
twisting mechanism. This may result in recurrence of symptoms similar
to preoperative symptoms requiring a re-arthroscopy. The healing rate
of meniscal repairs is approximately 90% in patients whose anterior cruciate
ligament is intact (60% in those whose anterior cruciate ligament is torn/absent).
A retear of a meniscal repair would require re-arthroscopy and possible
repair or excision.
15. Equipment failure. Arthroscopic surgery is “high tech”
and extremely demanding. The surgery is performed while observing the
magnified images of the knee joint structures on a television screen.
Motorized equipment (cameras, light sources, videorecorders, etc.) could
possibly malfunction resulting in the inability to complete your surgery.
In our operating room we have back up systems should this occur.
Common Occurrences
1. Some patients will note bruising around the knee. Occasionally
this will be noted on the back of the leg, lower leg, or even into thigh.
This is not a complication.
2. Anterior knee pain (“Patellar pain syndrome”). Some
patients may develop new symptoms or exaggerated current symptoms during
the course of their rehabilitation.
3. Persistence of arthritic symptoms. In patients who have arthritis
the results of arthroscopic surgery are more variable. Some patients significantly
benefit from surgery, others do not. In the patient who has arthritis
it is difficult to predict preoperatively to what extent the patient will
benefit.
4. Portal discomfort. The small arthroscopic skin incisions as
they heal may feel nodular. This generally resolves over time.
5. Swelling. It is common and in fact expected to have swelling
about your knee after surgery. Icing your knee is extremely helpful.