The following is a helpful timeline to help you understand and prepare for your experience at HSS. Although the following outline of a knee arthroscopy is a typical one, please keep in mind that your experience may differ.The Weeks and Days Before Your Surgery
When scheduling your knee arthroscopy with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Most likely, you will go home the same day; sometimes, however, you may be required to stay overnight.
Clearance: Your surgeon will refer you to an internal medicine specialist for a medical evaluation and clearance for surgery. This clearance includes a history and physical examination as well as some laboratory tests. If your particular medical condition requires it, additional tests such as an EKG or chest x-ray will be ordered at this time.
Medications: You may be instructed by your surgeon and/or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin) several days to a week before your surgery, depending on the medication. In addition, you may be instructed to take some of your medications the morning of surgery even though you will not be able to eat that morning. It is important to bring a list (or a bag of pill bottles) including all your medications to your medical clearance, including vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery.)
On the day before surgery, a nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, what medications to take, and by what time you should no longer have anything to eat or drink. This does not apply to medications that you have been instructed to take the morning of surgery with a small sip of water. Be sure to follow the nurse’s recommendations strictly, as your surgery might otherwise have to be re-scheduled.
On the morning of surgery, you will arrive several hours before your procedure is scheduled to begin.
The “Holding Area”: You will come to the preoperative “Holding Area”, where dedicated staff will help prepare you for surgery. A locker will be provided for your belongings, but please leave any valuables at home. This includes all jewelry, as you will be asked to remove it before entering the operating room. You will be asked to change into a hospital gown and will be assigned a bed in the Holding Area. A nurse will start an intravenous line (commonly referred to as an IV), to give you fluids, and if you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.
Preoperative Exam: A physician’s assistant will take your history and perform a physical examination. The main purpose of this examination is to see if anything has changed since you last saw your medical or surgical physicians. You will be asked to confirm what type of surgery you are having and asked to sign consent for that surgery if you have not already done so. Your surgeon or one of his or her assisting physicians will check your identification band, ask you to spell your name, and state your date of birth. They will then sign your surgical site. This is simply a safeguard to confirm you as the patient, and it also verifies where on your body the surgery will be performed. At this time, you will also meet your anesthesiologist, who will discuss what type of anesthesia you will receive.
Your anesthesiologist will review your medical history and chart while confirming the correct site of your surgery (right or left knee). He or she will then present you with the anesthetic plan and answer all of your questions. You will also sign your consent for anesthesia. Knee arthroscopy at HSS is usually performed with spinal anesthesia or a combined spinal epidural, depending on the anticipated length of surgery.
Anesthesia/Surgery: Once everything is ready, a nurse will take you to the operating room. Monitors will be placed, and your anesthesiologist will measure your blood pressure and heart rate and provide extra oxygen via a tiny tube under your nose. You will also receive intravenous sedation. Due to the sedation, you may not remember the placement of the spinal/epidural. For the placement of the anesthetic, your lower back will be sterilely cleaned and draped, and a local anesthetic will be used to numb the skin on the back. A very small needle will be placed into a specific space, and local anesthetic is injected. If an epidural is required, a small catheter will be left in the space through which additional local anesthetic can be administered.
By the time surgery is to begin, you will be numb from the waist down. This anesthetic technique allows for surgery to be performed on the knee without the need for general anesthesia and provides pain relief for several hours after the surgery.
Sedation will be given throughout the surgery in addition to the spinal or epidural, so you will be sleeping throughout the surgery. The level of sedation may be variable, but most people remember waking up in the recovery room after the operation is completed. Occasionally, some patients recall some events or perhaps the sound of the operation. Be assured that you will not feel any discomfort during surgery. When the surgery is complete, your surgeon will speak with your family and you will be transported to the recovery room.
Recovery Room: In the recovery room, you will gradually wake up from the sedation. Your vital signs will continually be monitored, as they have been in the operating room. You will initially be unable to feel or move your legs. The sensation and movement will gradually return and pain medication will be provided upon request. Your recovery room nurse will decide when you can have something to eat and drink, and when you can see your family members. Most patients go home the same day after their knee surgery. After postoperative instructions and prescriptions for pain are administered, you are discharged home.
You are recommended to start taking the pain medication as instructed. It is a good idea to be on top of the pain before it becomes severe. As soon as you feel your legs “waking up,” you may start to take your prescription pain pills.
Physical Therapy: The recovery process will be an active one. You will likely begin working with a physical therapist the day after your surgery. This is an important part of your recovery that will allow you to get back to your normal activities as soon as possible.
Pain Management: If post-operative pain control is an issue, your surgeon may request consultation from the Acute Pain Service (APS), an anesthesiologist from the APS will visit you to evaluate and treat your pain. Usually on the first day after surgery, you will be transitioned to oral pain medications.
Edited by Yi Lin, MD