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Arthroscopic Procedures of the Shoulder and Knee

The total knee replacement procedure is performed in a hospital under spinal, or general anesthesia. During the procedure, an incision is made in the knee to access the joint so the damaged bone and cartilage can be removed. Once the damaged tissue is removed, the prosthetic device is inserted and is usually cemented into place with a bone cement. A plastic spaced is inserted between the femur and tibia components. The patella is usually resurfaced as well.

Recovery from Arthroscopic procedures of the shoulder and knee

A short hospital stay is likely, varying a bit depending on the type of procedure performed and the overall health of the patient. Patients usually experience immediate relief from the joint pain suffered before the replacement. However, there will be some post-operative discomfort that can be managed with prescribed pain medication.

Physical therapy starts in the hospital, as soon as possible after surgery, either the same day or next day, to ensure rapid healing and restoration of function. Most patients are discharged directly to home from the hospital with Visiting Nurses and Physical Therapy in their home. Occasionally, inpatient rehabilitation is needed before return to home.

Patients in physical therapy progress from taking steps with a walker or crutches to walking without assistive devices on stairs and slopes. Patients are also given exercises to perform at home to reinforce the rehabilitative process.

Risks of Arthroscopic procedures of the shoulder and knee

Although considered a safe procedure for most patients, there are certain risks associated with all surgery. These risks include: infection, excessive bleeding, blood clots, buildup of excessive scar tissue, limited range of motion, nerve damage, implant rejection, and death, to name a few. For the great majority of patients, total knee arthroplasty is successful and uneventful, providing effective pain relief and greatly improved quality of life.

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Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.