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1. Preparation

WHAT IS A KNEE ARTHROSCOPY?

An arthroscopy is a surgical procedure in which a small telescope (arthroscope) is inserted into the joint. Fluid is inserted into the knee to create more space, and the pictures are sent via a fibreoptic cable to a video screen. Your surgeon is able to visualise the inside of your knee in minute detail. Additional small incisions can be made to allow the passage of other instruments, which may be used to remove damaged tissue.

Because the incisions are very small (the arthroscope is typically around 5mm in diameter), the procedure is much less invasive than open knee surgery, and therefore your recovery may be quicker and easier.

WHY IS IT DONE?

The knee is complex and as it is a weight-bearing joint, is prone to a variety of disorders affecting both structure and functioning of the knee. Arthroscopy is commonly used to assess and treat conditions such as:

• Cruciate ligament tears
• Meniscal tears
• Removal of loose fragments of bone or cartilage
• Removal of cysts
• Reconstruction of the Anterior Cruciate ligament
• Abnormal alignment or instability of the knee-cap

Persistent pain, swelling, catching or giving way may be some of the symptoms associated with the above conditions.

HOW DO I CHOOSE A SPECIALIST?

Your GP will be able to recommend and refer you to an orthopaedic surgeon. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. In Australia each medical specialty has a governing body to which the consultants belong. These organisations are often a good reference for information about what to expect from your medical specialist. You can access the Australian Orthopaedic Association via the website at http://www.aoa.org.au/. This site provides an overview of orthopaedic services and will allow you to search for surgeons in your area.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Orthopaedic Specialists who participate in HCF’s Medicover no gap arrangement:

1. Call HCF Member Services on 13 13 34
2. Visit one of HCF’s customer service branches
3. Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form, which you should fully understand
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent
• In addition to what the procedure entails, you should also ask about:
  • Preparation
  • What sort of results can you expect – can your doctor give you an idea of how much your mobility or discomfort will improve?
  • How long will you need to book off work (or perhaps you may need to arrange for extra help with childcare etc)?
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instructions:
  • Aspirin (or any related products),
  • Blood thinners (warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin.

WHERE IS IT DONE?

A knee arthroscopy can be done in either a day surgery or in a day facility within an overnight hospital.

HOW LONG IS THE PROCEDURE?

The time needed for a knee arthroscopy varies but on average takes anywhere from 30 minutes to 2 hours.

WHO IS INVOLVED?

The people involved in the procedure are:

• The Orthopaedic surgeon, your Specialist doctor
• Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
• Specialised nurses for the procedure and recovery
• Radiologist if any x-rays are necessary
• Pathologist if any blood tests are necessary

HOW DO I PREPARE FOR AN ARTHROSCOPY?

Under some circumstances, you may be able to enhance your recovery by strengthening the muscles that support your knee, such as your quadriceps (thigh muscles), before the procedure. Ask your doctor or physiotherapist for specific advice on exercising before your arthroscopy. If excess weight is an issue for you, this may also be a good time to try and address this – you can ask your doctor about healthy eating plans and / or a referral to a dietician if required. If you are a smoker and you can't give up completely, try to avoid smoking in the weeks before and immediately after the procedure to minimise after the risk of complications such as chest infection.

Because the arthroscopy will probably be done under a general anaesthetic (albeit a relatively short one), you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.

You will be given instructions on when to start fasting – normally at least 6 hours prior to the procedure. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated at a later date.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Do not bring any valuables with you (sometimes a plain band is acceptable)
• Leave all jewellery at home, except if you wear a wedding ring
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• You may also wish to bring something to read whilst you wait
• Remove all nail polish and do not wear any make-up

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Arthroscopic Knee Surgery admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 2,523 same day admissions in participating private hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 49560 and 49561.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. specialist consultations. Therefore, the total average

medical service charge ($1,730) differs from the sum of the individual average charges

as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out of

pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

arthroscopic knee surgery admissions. The percentages shown for each type of medical

service are much higher as they are calculated for those services only and not the entire

admission, which includes all medical services and the hospital services. In an admission

you may have one medical service with an out of pocket expense, which then excludes

the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive, the receptionist will do all the paperwork necessary for your admission. A nurse will perform some basic checks and physical observations and ask about any medication you are taking and allergies you may have. Remember to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

At some stage prior to theatre, your doctor will ask you to sign a consent form indicating that you give him/her permission to perform the procedure, and that you understand all the potential risks and complications involved.

In some cases you will be given a pre-medication that will make you drowsy and relaxed before being taken to the operating theatre. Although it is most common to have a general anaesthetic, in certain circumstances your anaesthetist or specialist may discuss the possibility of either a regional or local block.

WHAT CAN I EXPECT DURING A KNEE ARTHROSCOPY?

To reduce the possibility of infection, your knee will be shaved and washed with a surgical scrub, and the whole area covered in sterile drapes.

Your surgeon will make the first small incision, passing the arthroscope through the skin and into the joint. The arthroscope, a small soft tube that has a light and camera at the end, projects images of the inside of your knee onto a television-type screen. This guides your surgeon as he rotates the instrument inside your knee.

Another small incision is made on the opposite side of the knee to allow the inspection of all compartments. If a problem is detected, other incisions may be made to allow the surgeon to insert small instruments to correct the problem. Normally the incisions are less than one centimetre in length.

After the surgery is complete and the arthroscope is removed, your surgeon will either place small band-aids called steri-strips over the holes or stitch them closed with sutures. Padding and a bandage are then placed over the area. This provides pressure and support for your knee as well as protecting the area from infection.

3. Aftercare

WHAT HAPPENS AFTER A KNEE ARTHROSCOPY?

After the surgery you will be taken to the recovery room. Nursing staff will check on you regularly, taking your blood pressure, pulse and monitoring your breathing. You may be wearing an oxygen mask when you first wake up, and you may also be hooked up to an intravenous drip to replace the fluids lost during surgery. It will be removed once you are drinking fluids and have passed urine.

Once you have recovered, a physiotherapist will see you and show you a number of exercises to do. Prior to discharge, your surgeon may come and see you and explain what was done during the surgery and any findings.

You should be able to go home the same day providing the procedure was straightforward and you recover well from the anaesthetic. However, you will not be able to drive and should arrange for someone to drive or escort you home. If this presents a problem for you, please advise your doctor/hospital prior to admission. It is best to check with both your doctor and car insurance company before resuming driving. This is not only because you have had a general anaesthetic, but because your doctor may not wish you to sit for prolonged periods with your knee immobile in the flexed position. You may require crutches to keep the weight off of your knee until it heals.

Some swelling can be expected but should settle down within the first 3-4 days. Application of ice will help to reduce the swelling. It is best to elevate your leg while sitting or lying down. You will be given specific instructions about care of your knee, follow up appointments and any circumstances in which you should seek further medical attention.

1. Preparation

WHAT IS A KNEE ARTHROSCOPY?

An arthroscopy is a surgical procedure in which a small telescope (arthroscope) is inserted into the joint. Fluid is inserted into the knee to create more space, and the pictures are sent via a fibreoptic cable to a video screen. Your surgeon is able to visualise the inside of your knee in minute detail. Additional small incisions can be made to allow the passage of other instruments, which may be used to remove damaged tissue.

Because the incisions are very small (the arthroscope is typically around 5mm in diameter), the procedure is much less invasive than open knee surgery, and therefore your recovery may be quicker and easier.

WHY IS IT DONE?

The knee is complex and as it is a weight-bearing joint, is prone to a variety of disorders affecting both structure and functioning of the knee. Arthroscopy is commonly used to assess and treat conditions such as:

• Cruciate ligament tears
• Meniscal tears
• Removal of loose fragments of bone or cartilage
• Removal of cysts
• Reconstruction of the Anterior Cruciate ligament
• Abnormal alignment or instability of the knee-cap

Persistent pain, swelling, catching or giving way may be some of the symptoms associated with the above conditions.

HOW DO I CHOOSE A SPECIALIST?

Your GP will be able to recommend and refer you to an orthopaedic surgeon. You may be happy to accept their advice and recommendation, or you may like to investigate your choices; either option is safe and valid. In Australia each medical specialty has a governing body to which the consultants belong. These organisations are often a good reference for information about what to expect from your medical specialist. You can access the Australian Orthopaedic Association via the website at http://www.aoa.org.au/. This site provides an overview of orthopaedic services and will allow you to search for surgeons in your area.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website)

To access a list of Orthopaedic Specialists who participate in HCF’s Medicover no gap arrangement:

1. Call HCF Member Services on 13 13 34
2. Visit one of HCF’s customer service branches
3. Access HCF’s website at www.hcf.com.au / members / find a health professional / find a doctor

WHAT SHOULD I ASK MY SPECIALIST?

• Make sure you fully understand the procedure that is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form, which you should fully understand.
• What are your likely out of pocket medical expenses? Your doctor should be able to give you a breakdown of any costs you will incur - this is known as informed financial consent
• In addition to what the procedure entails, you should also ask about:
  • Preparation
  • What sort of results can you expect – can your doctor give you an idea of how much your mobility or discomfort will improve?
  • How long will you need to book off work (or perhaps you may need to arrange for extra help with childcare etc)?
  • Follow up appointments - jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
• Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instructions:
  • Aspirin (or any related products),
  • Blood thinners (warfarin, heparin.),
  • Arthritis medication,
  • Pain medication,
  • Insulin.

WHERE IS IT DONE?

A knee arthroscopy can be done in either a day surgery or in a day facility within an overnight hospital.

HOW LONG IS THE PROCEDURE?

The time needed for a knee arthroscopy varies but on average takes anywhere from 30 minutes to 2 hours.

WHO IS INVOLVED?

The people involved in the procedure are:

• The Orthopaedic surgeon, your Specialist doctor
• Anaesthetist: they give you medication that make you relaxed and sleepy and look after you whilst the procedure is being carried out
• Specialised nurses for the procedure and recovery
• Radiologist if any x-rays are necessary
• Pathologist if any blood tests are necessary

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Arthroscopic Knee Surgery admissions for the financial year 06/07 are provided below:

Points to Note:

• Charges are based on HCF claims for a sample size of 2,523 same day admissions in participating private hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 49560 and 49561.
• As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).
• There is no excess payable for same day admissions.

¹ These medical services are in-patient services only.

² The medical charges are based on averages and each episode of care is different, i.e.

you may not have all of these medical services, and/or you may also have other medical

services not indicated here e.g. specialist consultations. Therefore, the total average

medical service charge ($1,730) differs from the sum of the individual average charges

as shown.

³ Doctors who do not use the HCF no-gap arrangement have a higher average out of

pocket charge, as their charges are higher than those doctors who use the no-gap

arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the

average benefits plus the average out of pocket charge you pay will not equate to the

charge as shown in the table.

⁴ Doctors’ charges vary so always ask your doctor whether he/she will participate in

HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the

Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered

under the HCF Medicover No Gap arrangement will receive as full payment for

services provided. This also applies to unregistered providers should they charge within

the schedule of benefit listed. This arrangement ensures that our members incur no out

of pocket expense.

⁵ This percentage indicates the total coverage of hospital and medical services for all

arthroscopic knee surgery admissions. The percentages shown for each type of medical

service are much higher as they are calculated for those services only and not the entire

admission, which includes all medical services and the hospital services. In an admission

you may have one medical service with an out of pocket expense, which then excludes

the whole admission from being fully covered. Hence the significant difference in

percentage for individual types of medical services as compared to the total admission

fully covered.

HOW DO I PREPARE FOR AN ARTHROSCOPY?

Under some circumstances, you may be able to enhance your recovery by strengthening the muscles that support your knee, such as your quadriceps (thigh muscles), before the procedure. Ask your doctor or physiotherapist for specific advice on exercising before your arthroscopy. If excess weight is an issue for you, this may also be a good time to try and address this – you can ask your doctor about healthy eating plans and/or a referral to a dietician if required. If you are a smoker and you can't give up completely, try to avoid smoking in the weeks before and immediately after the procedure to minimise the risk of complications such as chest infection.

Because the arthroscopy will probably be done under a general anaesthetic (albeit a relatively short one), you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.

You will be given instructions on when to start fasting – normally at least 6 hours prior to the procedure. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated at a later date.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

• Take any recent, relevant x-rays or scans
• Do not bring any valuables with you
• Leave all jewellery at home (sometimes a plain band is acceptable)
• Wear comfortable clothing
• Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
• You may also wish to bring something to read whilst you wait
• Remove all nail polish and do not wear any make-up

2. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive, the receptionist will do all the paperwork necessary for your admission. A nurse will perform some basic checks and physical observations and ask about any medication you are taking and allergies you may have. Remember to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

At some stage prior to theatre, your doctor will ask you to sign a consent form indicating that you give him/her permission to perform the procedure, and that you understand all the potential risks and complications involved.

In some cases you will be given a pre-medication that will make you drowsy and relaxed before being taken to the operating theatre. Although it is most common to have a general anaesthetic, in certain circumstances your anaesthetist or specialist may discuss the possibility of either a regional or local block

WHAT CAN I EXPECT DURING A KNEE ARTHROSCOPY?

To reduce the possibility of infection, your knee will be shaved and washed with a surgical scrub, and the whole area covered in sterile drapes.

Your surgeon will make the first small incision, passing the arthroscope through the skin and into the joint. The arthroscope, a small soft tube that has a light and camera at the end, projects images of the inside of your knee onto a television type screen. This guides your surgeon as he rotates the instrument inside your knee.

Another small incision is made on the opposite side of the knee to allow the inspection of all compartments. If a problem is detected, other incisions may be made to allow the surgeon to insert small instruments to correct the problem. Normally the incisions are less than one centimetre in length.

After the surgery is complete and the arthroscope is removed, your surgeon will either place small bandaids called steri-strips over the holes or stitch them closed with sutures. Padding and a bandage are then placed over the area. This provides pressure and support for your knee as well as protecting the area from infection.

2. Aftercare

WHAT HAPPENS AFTER A KNEE ARTHROSCOPY?

After the surgery you will be taken to the recovery room. Nursing staff will check on you regularly, taking your blood pressure, pulse and monitoring your breathing. You may be wearing an oxygen mask when you first wake up, and you may also be hooked up to an intravenous drip to replace the fluids lost during surgery. It will be removed once you are drinking fluids and have passed urine.

Once you have recovered, a physiotherapist will see you and show you a number of exercises to do. Prior to discharge, your surgeon may come and see you and explain what was done during the surgery and any findings.

You should be able to go home the same day providing the procedure was straightforward and you recover well from the anaesthetic. However, you will not be able to drive and should arrange for someone to drive or escort you home. If this presents a problem for you, please advise your doctor/hospital prior to admission. It is best to check with both your doctor and car insurance company before resuming driving. This is not only because you have had a general anaesthetic, but because your doctor may not wish you to sit for prolonged periods with your knee immobile in the flexed position. You may require crutches to keep the weight off of your knee until it heals.

Some swelling can be expected but should settle down within the first 3-4 days. Application of ice will help to reduce the swelling. It is best to elevate your leg while sitting or lying down. You will be given specific instructions about care of your knee, follow up appointments, and any circumstances in which you should seek further medical attention.