New Technique Allows Patients To Observe Their Own Knee Surgery

Disability from disorders of the knee is caused by injuries and arthritic degeneration. Knee disorders are common, requiring over 500,000 surgical procedures a year in the United States. Roughly one-third of these procedures require open surgical techniques using incisions while the remainder utilize the microsurgical techniques of arthroscopic surgery through small puncture wounds. Repairing knee damage through microsurgical techniques has dramatically improved the results of knee surgery while at the same time reducing the recovery time and the cost of the procedure.

While knee arthroscopy is an outpatient surgical procedure requiring only 2 or 3 puncture holes in the knee, 90% of the time it is performed using general or spinal anesthetic techniques. These anesthetic techniques, while effective, can be uncomfortable, risky, and costly for patients. Several arthroscopic centers around the country, including Duke University and the University of Pennsylvania, have developed techniques for performing knee arthroscopic surgery using local anesthetic agents similar to novocaine. The method involves injecting the knee with anesthetic medication and using surgical equipment and techniques that minimize pain and operating time, which is typically about 30 minutes. Using these techniques patients can enjoy watching their own knee surgery on the TV monitor with excellent comfort without the risks, inconvenience, and expense of general anesthesia or spinal anesthesia.

When Dr. Boyd Haynes joined Dr. Helmuth Trieshmann at the Orthopaedic Surgery and Sports Medicine Center in Newport News in 1992, he brought with him local anesthetic techniques for knee arthroscopy which he learned during his Sports Medicine Fellowship at the University of Pennsylvania from Dr. Joseph Torg, the Team Physician for the Philadelphia Eagles. Dr. Haynes and Dr. Trieshmann have adapted these techniques to the operating rooms at Mary Immaculate Hospital and Riverside Hospital in Newport News. Since 1992, Dr. Haynes and Dr. Trieshmann have performed more than 300 knee arthroscopies using the local anesthetic technique. Procedures include repair and removal of torn cartilage, loose bodies, arthritis, kneecap abnormalities, fractures and ligament injuries. The surgical results are every bit as good as those achieved with general or spinal anesthetic techniques and the patients have a safer and much more enjoyable experience.

Dr. Trieshmann presented the results of a cost analysis of general and local knee arthroscopy at the Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando, Florida, February, 1995. His study demonstrated a savings of $600 in hospital costs associated with the local anesthetic technique ($2,300 versus $2,600). Another benefit of the local anesthetic technique is that patients are generally comfortable for 24 hours following the surgical procedure, which greatly facilitates recovery. Furthermore, this procedure is performed without the use of a tourniquet on the upper thigh which can cause weakness, pain and nerve injury. Another important aspect of local knee arthroscopy is the fact that a comfortable, awake and alert patient can observe and actively participate in his or her own surgical procedure.

Dr. Robert Snyder joined Dr. Trieshmann and Dr. Haynes in September 1994 and has performed knee arthroscopic procedures using local anesthetic techniques as the Team Physician for the United States Military Academy at West Point. Drs. Trieshmann, Haynes, Snyder, Carlson, Coleman, and McFarland are the only orthopaedic surgeons in the Hampton Roads metropolitan area including Williamsburg, Newport News, Hampton, Norfolk, Virginia Beach, Portsmouth and Chesapeake who perform arthroscopic knee surgery using local anesthesia. Surgeons from as far away as Charlottesville have come to Newport News to observe and learn these techniques.