Operative indications and cases to be wary of

The cases to expect to be difficult are :

large muscular males (large but potentially tight joints)

A stiff Osteoarthritic joint following a significant intra-articular fracture. Gross arthro-fibrosis may exist to the extent that the joint may be largely filled by fibrotic tissue. You may be warned of this possibility if the normal 10-20 mls cannot be injected into the joint. Perhaps only a few mls of fluid will get into the joint. You may need to carve the joint space out again by removing this tissue. Initially your only view may be a portion of the shaver blades. Hold position carefully and clear as much as possible before changing position or portals.

Haemophiliac arthropathy, due to gross arthro-fibrosis following multiple bleeds. The problems and solution are as above.

Cases of previous septic arthritis or multiple joint surgery. The problems and solution are as above.

Patients with fused hips or knees (see advanced arthroscopic fusion for technique with a fused hip).

Patients with small feet which will easily slip out of the Acuflex traction stirrup.