Arthrotomy of the knee, shoulder and other joints: implementation and rehabilitation after the procedure
Who is appointed and how is arthrotomy of large joints?
Arthrotomy is a procedure in which the opening of the joint cavity.
It is performed to treat suppurative process, or removal of foreign bodies from the joint cavity. Due to the fact that these pathologies are common, this type of operation is widespread in medical practice.
Arthrotomy refers to surgical procedures of medium complexity. It can be conducted as a separate operation or as the first stage of a more complex procedure.
Access to the articular cavity is carried out through incisions of various shapes and lengths. Most often the operation is performed on large joints.
Indications for use
The intervention is assigned in the following cases:
- removal of foreign objects, joint «mice» shifted to the meniscus;
- reduction of congenital dislocation;
- the use of arthroplasty in ankylosis of the;
- surgical treatment of wounds;
- removing the joints affected by tuberculosis or cancer;
- removing the pus or blood clots;
- closed intra-articular fractures;
- deforming arthrosis;
- avascular necrosis or aseptic necrosis.
This is just the most common pathology, which is performed under arthrotomy. In some cases, the decision to undergo a surgical operation is accepted when conservative treatment does not give results.
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There are absolute and relative contraindications to arthrotomy. Relative contraindications allow the operation, but retain certain risks.
These include mental disorders, neurological disorders, obesity of the third degree, and cancers of other organs, psychological unreadiness for surgery.
Absolute contraindications include:
- the immaturity of bone and cartilage;
- the presence of bacterial infection in other organs of the patient;
- chronic diseases of the cardiovascular and respiratory systems;
- thrombophlebitis or thromboembolism in the acute stage;
- infectious diseases in the acute stage.
Theoretically the procedure can be performed on different joints, but as a rule, conduct arthrotomy:
- Of the shoulder joint. Front method Langenbach. The patient lies on back with cushion under the joint that will be operated on. First incision is made 10 cm from the beginning of the acromial process of the scapula down along the deltoid muscle. Then the muscles are divided in the joint capsule anatomist along the tendon.
- Elbow. The patient flexes the elbow at an angle of 135º to the inner side of the forearm touching the table. Then is S-shaped incision: 2-3 cm above the lateral epicondyle, descending to the radial bone with the transition to the elbow. After dissection, the muscles spread, and the joint capsule is cut.
- Wrist. The Method Of Langenbeck. The incision originates from the middle of the ulnar edge of the metacarpal 2 and continues through the wrist joint on the forearm.
- Hip. From verhnebureinski iliac spine incision is made 5-6 cm down along the muscle that strains broad fascia of the thigh. Then cut the fascia Lata, gluteus Maximus divert ago, and the one that keeps a straight and Sartorius muscles of the thigh, sticking her forward. The result of the articular capsule exposed.
- Knee. The patient lies on her back, leg bent at the knee angle of 135º. An incision is made on one or both sides, 1-2 cm away from the patella. The back incision is made 0.5 cm from the point of intersection of the horizontal and vertical of the fibula.
- Ankle. The incision starts at 5-6 cm above the level of the ankle and carried on the surface of the tibia to the back side of the foot. Soft tissues are dissected and the tendons and the extensor of the thumb is put aside. This allows you to expose the joint space.
Preparing for surgery
Arthrotomy is performed under regional, local or General anesthesia. The type of anesthesia depends on the extent of surgery, the psychological state of the patient or existing chronic diseases.
Local anesthesia involves injecting pain medication directly into the incision. It relieves the pain but does not eliminate the unpleasant feeling which occurs due to touching the tissue. Therefore, under local anesthesia, a man may feel discomfort.
Regional or epidural anesthesia involves the introduction of anesthetics into the spinal canal. The patient is awake but feels no pain nor discomfort. Epidural anesthesia is okay to use when performing hip surgery, ankle and knee.
When anesthesia or General anesthesia the patient is unconscious, so completely unaware of what was happening. Most often anesthesia is used for prolonged or complex operations.
The methodology of the
The essence of the intervention consists in the exposure of the joint to further manipulation. During surgery, incisions are made in the typical direction.
The only exceptions are those cases where surgical treatment is performed for the first time. Then the wound is excised, the articular cavity is cut and the necessary treatments are: remove foreign bodies and blood clots, remove unwanted tissue.
If the primary arthrotomy performed before infection, wound infection, synovial membrane suture, pre — processing the joint cavity antibacterial agents.
Muscle tissue and the skin is not sutured, and a plaster cast applied to the case of the formation of ankylosis.
With the development of purulent inflammation of the joint, do a secondary operation.
The joint cavity widely open and insert a thin tube for the introduction of antibiotics.
When suppuration in the ankle or hip joints secondary arthrotomy ineffective, so resect.
This technique is used for injuries, severe bruises, wounds and other injuries of the joint.
Procedure that is done if you suspect any disease has its nuances, but its essence does not change. In each case, is a long incision of soft tissue to penetrate into the joint cavity.
Possible difficulties and problems
In contrast to the modern methods of operating, when performing the arthrotomy for possible complications. And though they occur infrequently, but can cause harm to the body.
Such complications include:
- infectious-inflammatory process;
- damage to the joint of the surgical tools;
- nerve damage;
- reflex dystrophy.
Among all complications, the most frequent infection and violation of the anatomical structures of the joint. For the treatment of infection antibiotics are used different forces.
As for the physical joint damage surgical instruments, as a rule, it does not have any clinical significance. The only negative consequence is a significant increase in the period of rehabilitation.
Those who had to go through arthrotomy, leave such comments.
I was in the hospital with a serious knee injury. Something needed to be urgently addressed, and I agreed to an arthrotomy. The operation went smoothly, but the next day the leg began to swell. Rehabilitation was long. A month later I started to bend the leg at the knee.
Oleg, 38 years
After I was diagnosed with «deforming arthrosis of the hip joint», I was ready for surgery.
Said arthrotomy painless, and indeed it is. The big drawback, of course, is a long rehabilitation period, but it’s nothing compared to the pain I had experienced before.
Maria, 45 years
I did arthrotomy after he detected inflammation in the joint. The procedure is completely painless. After a week I was perfectly healthy.
Svetlana, 40 years
Given the long-standing practice of doctors and patient feedback, we can conclude that this technique is an effective method of treatment of articular pathologies.
The disadvantages of this procedure – the likelihood of complications and long rehabilitation period. In addition, the procedure does not apply to quick operations, so its implementation may require a lot of time.
However, the intervention is completely painless and well tolerated by all patients. In contrast to innovative methods of surgery, this is a proven method that is effective in all pathologies of joints. In skilled hands it is not inferior to the latest techniques of treatment.