Knee arthrotomy is a surgical procedure in which the joint is exposed. During the operation, the doctor gets access to the joint with the ability to remove the intra-articular contents. This may be blood, a foreign body, purulent contents, resection of surrounding tissues, administration of medications, etc.
Knee arthrotomy is rarely performed and only in emergency cases. This is due to the aggression of the operation. In addition, minimally invasive modern methods of treatment in the form of arthroscopy are excellent for most surgical tasks. If necessary, remove the joint, install the prosthesis, an arthrotomy is prescribed.
Indications for surgery
Knee arthrotomy surgery is prescribed in the following cases:
- post-traumatic hemarthroses;
- intra-articular suppuration in arthritis, local tuberculosis;
- articular malformations;
- articular fractures;
- penetrating wounds into the joint;
- new growths;
- ankylosis, gonarthrosis.
Surgical intervention is prescribed for detachment, meniscus fragmentation, knee injuries.
For each patient, the question of the need for knee arthrotomy is decided individually. In some cases, conservative treatment of the joint is tried. For example, when fluid accumulates, a puncture is performed, then metabolic, aseptic drugs are injected into the joint. If the non-surgical method is ineffective, and arthroscopy is not possible, an arthrotomy is prescribed.
Contraindications
Knee surgery has a number of absolute contraindications. These include:
- chronic ailments in the acute phase;
- thrombophlebitis of the lower extremities;
- pathological conditions of the pulmonary, cardiac systems;
- acute infectious diseases (SARS, influenza, etc.).
In other cases, doctors perform surgery.
Types of arthrotomy
There are several types of meniscus surgery. It differs in technique.
- Textor transverse access.
- Anterior external or internal parapatellar type of operation performed according to Olya, Langenbeck.
- Posterior-lateral according to Voyno-Yasenetsky.
Properly chosen technique of knee arthrotomy allows doctors to get maximum access to the problem area. Because of thisduring some operations, doctors combine various techniques, or rather, their advantages. This technique is called paracondylar arthrotomy according to Kornev, during which deep lateral incisions are made on both sides of the knee joint. This incision provides access to all potentially dangerous areas where pathological contents often linger.
Preparation
Arthrotomy is performed under general anesthesia. In cases where this type of anesthesia is contraindicated, an epidural or spinal anesthesia is considered.
In the preoperative period, the patient is scheduled for the following types of tests:
- blood biochemistry;
- blood test for syphilis;
- blood for HIV, AIDS;
- urinalysis;
- coagulogram;
- hepatitis.
Before a planned operation, a five-day preparation is always carried out, involving multiple treatments of the surface of the knee joint. To do this, use soap solutions, ammonia. The doctor prescribes aseptic dressings applied at night.
In case of intra-articular purulent swelling, the operation is performed in conjunction with the prescribed course of antibiotics.
In the preparatory stage, the patient is advised to consult with other specialists: a cardiologist, a therapist, a phthisiatrician, etc. According to indications, the patient may be assigned consultations of other doctors, for example, an endocrinologist, a nephrologist, etc.
Technique
Method of exposing the joint capsulethere are several types. Each of them has its own performance characteristics.
- Anterior parapatellar surgery. A skin incision is made above the patella, a few centimeters from it, at the junction of the extrinsic thigh muscle and quadriceps. From this point, the skin is cut down along the outer line of the patella. The incision ends two centimeters below the tibial tuberosity. After dissection of the hypodermis and fascia, the fibrous layer and synovial capsule are opened. Then all the necessary manipulations are carried out.
- Operation on Textor. The incision is made in the shape of a horseshoe with the capture of both sides of the joint. During the implementation, the ligament of the patella is dissected, the ligaments are dissected on the sides.
- Arthrotomy of the knee joint according to Voyno-Yasenetsky. This type of intervention is most often used for purulent lesions of the joint. During the procedure, the cartilage joint is opened with four incisions. First, two anterior incisions are made, parallel on both sides of the knee. After that, the posterior inversions are opened with a pair of longitudinal-lateral incisions. Then the purulent contents are removed, the drainage systems are removed.
The operation of arthrotomy is completed by a thorough stop of bleeding. The dissected tissue is sutured in layers. At the end, the leg is immobilized with plaster. A window is made in it, through which the treatment will be carried out, the dressing of the joint.
Complications
Regardless of the technique used, arthrotomy can cause complications. These include:
- development of infectious processes in the operating area;
- clot formation;
- injury to neurovascular formations;
- hemorrhage in the knee joint;
- allergic reaction to anesthesia.
Rehab
Rehabilitation after arthrotomy is a lengthy process, lasting up to six months. In the early stages, patients receive intensive medical treatment with the use of antibiotics, anti-inflammatory drugs, and painkillers. Vascular therapy is prescribed to prevent thrombosis.
Immobilization of the limb is carried out for as long as necessary in a particular case.
During the rehabilitation period, exercise therapy is prescribed to accelerate the recovery of joint function and prevent muscle atrophy. First, passive exercises performed in bed are applied. Then the complex of classes is supplemented with simple but effective exercises that allow you to quickly develop the leg. Gradually, mechanotherapy, physiotherapy, therapeutic baths, applications and other techniques are connected to exercise therapy. Compliance with all recommendations allows you to return to normal life in a short time.
