Nemanja is 27 years old and he came to Atlas General Hospital for an intervention – ankle joint arthroscopy. Before this non-invasive surgery, he told us how long he had the issues and in what ways he was trying to solve them.
Nemanja: “For seven years now, I have been feeling some minor pain in my ankle, which has been increasing considerably in the last two years. I went to various physical therapies, magnet therapies and currents but nothing gave the desired result. That’s why I decided for this type of surgery. ”
How was the arthroscopy procedure indicated and suggested?
Nemanja: ” After a while, when the physical therapy did not give any results, I realized that I needed surgical help. That was about a year ago. I realized I was going to have surgery. I went to various doctors and asked for various opinions, and in the end I came here to Atlas General Hospital. ”
Do you know what arthroscopy is?
Nemanja: ” I read on the Internet that it is not even a surgical procedure, if I read it well. During the procedure it is made five-millimeter small incisions on the joint. Then it is entered with a mini camera and the problematic part is cleaned. I haven’t read or learned how this cleaning of the ankle goes yet. ”
All that matters to you is to be pain-free afterwards
Nemanja: ” Yes, that’s all that matters.”
While they were preparing Nemanja in the operating room for the procedure and general anesthesia, Assistant Dr. Vladan Stevanović, a surgeon who will operate him arthroscopically, explained what the specific procedure means, what he will do and how he will operate.
Assistant Dr. Vladan Stevanović: “Arthroscopy of the ankle joint means that we will either remove or preserve the damaged part of the cartilage. We will fill the damaged part of the bone with artificial bone and restore its part of the cartilage. If this is not possible, something called a micro fracture will be made at the site of the damaged bone. We will make something that looks like the cartilage that the patient had before. That cartilage is no longer of the same quality, but it will have a function that will enable a normal and quality life after several months of rehabilitation”.
The patient needs physical therapy after the operation.
Assistant Dr. Vladan Stevanović: “ Absolutely. The entire protocol will be applied there and the patient will be informed what awaits him. Avoiding weight on the ankle with certain movements, and it also takes a certain amount of time. In orthopedics, that means several weeks in order for some things to heal, and biology simply has its own way.
It is important that the patient is pain-free after arthroscopy.
Assistant Dr. Vladan Stevanović: ” He will certainly be painless and return to normal life. That is what is very important for his 27 years. ”
Dr. Vladan Stevanović, who specializes in arthroscopic surgery of the joints of the upper and lower extremities, told us what arthroscopy means and when patients can be operated in this way.
Assistant Dr. Vladan Stevanović: “ This is a minimally invasive procedure that can be used to examine all large and small joints with the help of a camera. Arthroscopy is used for both therapeutic and diagnostic purposes. Whether it is the shoulder, elbow, wrist, hip, knee or ankle, everything is available to us with the appropriate tools and modern technology at our disposal.
What is the difference between arthroscopy and classic surgery and how much it is a benefit for the patient and for you as well as for your profession.
Assistant Dr. Vladan Stevanović: “ You said it right, it is a benefit for everyone. Minimally invasive procedure means that the incision is no longer such that it implies that all tissues should be removed in order to reach the desired goal. We can do this through small openings, at least one centimeter in size. There can be at least two or more of them, depending on the joint we use.
Therefore, the damage to the patient’s tissue is much less. His rehabilitation is much faster. A lot can be achieved with the surgical technique. Some things are even more accessible and visible than with the naked eye, because it is done with a magnifying camera. We observe everything on the monitor and modern instruments enable many surgical techniques. That’s how we can do everything, from removing bad parts of bones or tissues to suturing, repairing them, reconstructing them, changing new ones, and that list is not final. ”
In general, this procedure is applied to younger patients and athletes when it comes to orthopedics. Assistant Dr Vladan Stevanović confirmed to us that medicine is advancing and that modern trends and achievements are being applied in Serbia as well, and said that older patients are now also candidates for this non-invasive surgical method.
Procedure for older patients
Assistant Dr. Vladan Stevanović: ” It has significantly expanded, especially in shoulder surgery, where now in older people there is damage to the muscles of the rotator cuff with limited function. Their shoulder is damaged and we can suture their muscles or put some so-called patches that can replace their muscles and restore them to function properly. I’m talking about people 60 and 70 plus years and older. As far as the knee is concerned, when there are degenerative conditions and they have not yet been indicated for the procedure of an endoprosthesis (total endoprosthesis) for various reasons, we also decide for this type of surgery. ”
Beside the state-of-the-art equipment possessed by Atlas General Hospital, the surgeon’s experience is very important for this procedure to be performed successfully. The intervention was attended by an orthopedic specialist when Dr. Vladan Stevanović introduced him to the skills of arthroscopy.
There are not many experienced surgeons who do this kind of procedure in Serbia, so it is necessary to constantly educate and master this skill.
Assistant Dr. Vladan Stevanović: “ I have been operating for almost twenty years, to say exactly 18, all with constant education, permanent travelling abroad or with the coming of colleagues here. In this way we exchange information. This is truly modern medicine because everything can be recorded, sent or followed live. We often comment on an operation live with colleagues abroad because it is very easy solved with TV medicine. Indeed, this is a group, especially a group of surgeons that are involved in this kind of procedures. These are surgeons who accept modern techniques and enable them to develop more and more. ”
That is exactly what you said, you are also an educator. Here, it is necessary for as many people as possible to master that technique in Serbia, because in addition to the equipment, skill is also needed.
Assistant Dr. Vladan Stevanović: “ Absolutely. Skill is of the utmost importance here.
For the arthroscopy it’s necessary:
- to set the indication first
- to perform a good clinical examination
- to get to know the patient
- to get to know the pathology
- to perform all diagnostic procedures
- to opt for one of these procedures
What does arthroscopic surgery require?
Arthroscopic surgery requires constant work, constant exercise, investment in yourself and the equipment, as well as in your associates. I have the opportunity to be an educator for this type of surgery on behalf of the European Association. ESSKA (European Society for Sports Traumatology, Knee Surgery and Arthroscopy) – is a European association for sports traumatology, knee surgery and arthroscopy. We have formed a kind of the Center, where this type of surgery can be practiced on certain models. This is good because the surgeon is prepared in advance, so that the patient will not be the first to be tested on, so to say, for a certain surgeon. ”
The operation was successfully completed, Nemanja is waiting for a period of rehabilitation, and as Assistant Dr. Vladan Stevanović said, he will no longer have pain because his joint has been healed.