Knee arthroscopy is a procedure done to investigate knee problems using insertion of a tiny camera into the knee joint. Other instruments may also be inserted into the knee during the procedure to attempt repair of any problems that are visualized. However, like all medical interventions, arthroscopy carries its own risk of complications that must be weighed before the patient undergoes treatment.
Inadvertent Damage
One of the more common complications of knee arthroscopy is inadvertent damage to knee joint structures or tissues. This risk is mostly related to the experience the surgeon has with the procedure and the care with which the procedure is performed, according to the "DeLee and Drez's Orthopaedic Sports Medicine" textbook. Structures damaged can include the joint capsule, nerves, blood vessels, and cartilage.
Tourniquet Paresis
Tourniquet paresis is a result of the tourniquet used during knee arthroscopy. Due to the large amount of blood infusing the knee, a tourniquet is applied to decrease the blood flow and make insertion of the camera, visualization and closure of the entry wound easier. If the tourniquet is left on long enough, however, it can press on nerves or blood vessels that supply the joint and the patient can suffer from decreased joint mobility upon awakening. Decreased tourniquet time is the best way to prevent this side effect, and the effects are usually mild and resolve on their own.
Infection
Infection is a risk of any surgical procedure and knee arthroscopy is no exception. It tends to be rare and is usually due to a break in sterile technique. When it does occur, the knee joint is irrigated and debrided of any infected tissue and intravenous antibiotic therapy is utilized, as outlined in the textbook "Campbell's Operative Orthopaedics."
Reflex Sympathetic Dystrophy
This is also known as complex regional pain syndrome (CRPS) and involves pain that affects the joint or leg after surgery. Other associated symptoms include changes in color and temperature of the skin over the affected area, increased sensitivity, sweating and swelling. The condition is poorly understood and methods of prevention are aimed at decreased surgery time and early physical therapy.
Clot Formation
Occasionaly, a patient can develop a blood clot in the deep veins of the legs; this is known as deep vein thrombosis (DVT). It can result in localized symptoms such as pain, swelling, and redness. Occasionally, the clots can dislodge from the leg veins and travel all the way to the blood vessels of the lung and block the circulation there. When this occurs it is known as a pulmonary embolism (PE) and can be life-threatening. Patients suffering from pulmonary embolism can present with increased heart rate, rapid breathing, decreased oxygen levels, chest pain and blood expectoration. Risk factors for this complication include increased body mass, family history of clotting disorders, advanced age, and history of malignancy. Prophylactic use of blood thinning medications is used in patients at increased risk to prevent this complication.
Synovial Fistula Formation
This refers to an external leak of the joint fluid due to the formation of a communication between the joint and the external skin. This is rare, and treated with seven to 10 days of knee immobilization and antibiotic therapy to prevent any infection. Resolution occurs rapidly with treatment, as noted in "Campbell's Operative Orthopaedics."
References
- "Campbell's Operative Orthopaedics, 11th Edition;" Canale & Beaty; 2007
- "DeLee and Drez's Orthopaedic Sports Medicine, 3rd Edition;" DeLee; 2009
