Arthrotomy of the knee joint is an surgical intervention in which exposure of the joint is performed. During the operation, the doctor gains access to the joint with the ability to remove intra-articular contents. It can be blood, a foreign body, purulent contents, resection of surrounding tissues, the introduction of medications, etc.
Arthrotomy of the knee joint is rare 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 do an excellent job with most surgical tasks. If necessary, carry out the removal of the joint, the installation of the prosthesis is prescribed an arthrotomy.
Indications for surgery
Surgery arthrotomy of the knee joint is prescribed in the following cases:
- post-traumatic hemarthrosis;
- intraarticular suppuration with arthritis, local tuberculosis;
- articular malformations;
- joint fractures;
- wounds penetrating the joint;
- neoplasms;
- ankylosis, gonarthrosis.
Surgical intervention is prescribed for separation, fragmentation of the meniscus, knee injuries.
For each patient, the question of whether an arthrotomy of the knee joint is necessary is decided individually. In some cases, they try to conservatively treat a joint. For example, when fluid accumulates, a puncture is performed, then drugs of metabolic, aseptic action are injected into the joint. If the non-surgical method is ineffective, and it is impossible to perform arthroscopy, 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 from the pulmonary, cardiac systems;
- acute infectious diseases (SARS, flu, etc.).
In other cases, doctors perform an operation.
Types of Arthrotomy
Meniscus surgery can be of several types. It varies in execution technique.
- Cross access on the Textor.
- The front external or internal parapatellar type of operation performed according to Olha, Langenbek.
- Posterolateral in the War of Yasenetsky.
A correctly selected technique of knee arthrotomy allows doctors to get maximum access to the problem area. Because of this, during some operations, doctors combine various techniques, or rather, their advantages. This technique is called Kornev's paracondial arthrotomy, during which deep lateral incisions are made on both sides of the knee joint. This section provides access to all potentially dangerous areas where pathological contents are often delayed.
Preparation
Arthrotomy is performed under general anesthesia. In cases where this type of anesthesia is contraindicated, the possibility of an epidural or spinal anesthesia is considered.
In the preoperative period, the patient is prescribed the following types of tests:
- blood biochemistry;
- blood test for syphilis;
- blood for HIV, AIDS;
- Analysis of urine;
- coagulogram;
- hepatitis.
Before a planned operation, a five-day preparation is always carried out, involving multiple surface treatments of the knee joint. To do this, use soap solutions, ammonia. The doctor prescribes aseptic dressings applied at night.
With intraarticular purulent numbness, the operation is performed in conjunction with the prescribed course of antibiotics.
In the preparatory phase, the patient is recommended to consult with other specialists: a cardiologist, therapist, TB specialist, etc. According to the indications, the patient may be prescribed consultations of other doctors, for example, an endocrinologist, nephrologist, etc.
Technique
The technique for exposing the joint capsule is of several types. Each of them has its own performance features.
- Anterior parapatellar surgery. A skin incision is made over the patella, a few centimeters from it at the junction of the external muscle of the thigh and quadriceps. From this place, 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, an autopsy of the fibrous layer and synovial capsule is performed. Then all the necessary manipulations are carried out.
- Textor operation. The incision is made in the shape of a horseshoe with the capture of both sides of the joint. During implementation, a ligament of the patella is dissected, ligaments are dissected on the sides.
- Arthrotomy of the knee according to Voyno-Yasenetsky. This type of intervention is most often used for purulent lesions of the joint. During the procedure, the cartilaginous joint is revealed using four incisions. First, make two front cuts, parallel to both sides of the knee. After this, an autopsy of the posterior inversion is performed with a pair of longitudinal-side sections. Then purulent contents are removed, drainage systems are removed.
Arthrotomy operation is completed by a thorough stop of bleeding. 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 ligation of the joint.
Complications
Regardless of the technique, arthrotomy can cause complications. These include:
- the development of infectious processes in the operating area;
- blood clot formation;
- trauma to neurovascular formations;
- hemorrhage in the knee joint;
- allergic reaction to anesthesia.
Rehabilitation
Rehabilitation after arthrotomy is a long process that lasts up to six months. In the early stages, patients receive intensive medication with antibiotics, anti-inflammatory drugs, painkillers. Vascular therapy is prescribed to prevent thrombosis.
Immobilization of the limb is carried out as much time as is required in a particular case.
During the rehabilitation period, exercise therapy is prescribed to accelerate the restoration of joint function and prevent muscle atrophy. First, passive exercises performed in bed are applied. Then the complex of exercises is supplemented by simple but effective exercises that allow you to quickly develop a 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.