Left Knee Arthroscopic Debridement / Meniscectomy

This shows the insides of the left knee of a 68 year old patient with osteoarthritis (lateral compartment more affected than the medial compartment). Patient's symptoms include impingement & foreign body sensations, pain (especially on weight-bearing & ambulation), joint effusion/swelling, reduced range of motion.

Just looking at the X-ray images alone, it's clear that the patient is a candidate for total knee joint arthroplasty. However, the patient is still not ready for such a procedure; and the patient DOES have mechanical signs -- (+) McMurray & (+) jointline tenderness, in particular. This arthroscopic debridement serves as a stop-gap measure, something that will buy the patient more time until the patient is ready for that joint replacement surgery.

Arthroscopic findings:
hypertrophic fat pad & medial plica
lots of inflammed synovial tissue (not surprisingly)
Grade 2-3 cartilage lesions of the medial, lateral & patellofemoral joints
no Grade 4 lesions thus far (exposed subchondral bone)
no free cartilage fragments floating about
degenerative tears of the lateral meniscus free border (which I trimmed off)
what appears to be a "lateral hypertrophic plica" (which I chompped & trimmed off)

I scoped both left & right knees; but the right knee was a lot less inflammed, and had no meniscal tears, so it was a breeze to do compared to the left knee.

About 36 hours after surgery, I was with the patient and patient's next of kin (I happen to be a family friend); we had lunch, went shopping at the local mall, and enjoyed the rest of the afternoon prior to their flight back to Manila. By the time they reached Manila, patient was already striding faster & more confidently, with significantly improved range of motion -- but most importantly, patient was walking PAIN-FREE.

Yes, they flew here to Cebu just to have this procedure done -- they wanted me to do it, and they wanted to avoid the huge expense which they would've otherwise incurred in the process, had they done this procedure in a big private hospital in Manila.

Cost of having the procedure done here was around P45k, the sum total of O.R. charge, plus O.R. surcharge, plus confinement of one day, plus medications. O.R. fee got a 35% surcharge because we extended past 5pm (patient's flight to Cebu got delayed by over an hour, so the procedure got started around 4pm instead of 3pm). But that total hopital bill is still without the senior citizen & PhilHealth discounts!

Anesthesiologist charged P15k net professional fee, but I of course didn't charge (since I consider the patient & next of kin like extended family anyways). Although, even if I was to post my own fee, the total expense still comes out cheaper than if they had the procedure done in Manila. This way, they managed to save a considerable amount, and even got a chance to vacation a bit in sunny Cebu for a couple of days.

Oh yeah, they say that if they ever have that joint replacement, they'll most probably fly back here and have it done by me. Wise choice -- save about 40% to 50% on total hospital & doctor expense if they have it here in Cebu versus there in Manila; same quality of services anyway.

^_^