ជង្គង់ Arthroscopy តម្លៃក្នុង ប្រទេសឥណ្ឌា

តើអ្វីជា Knee Arthroscopy ហើយហេតុអ្វីបានជាវាត្រូវបានអនុវត្ត?

Knee Arthroscopy គឺជាបច្ចេកទេសវះកាត់ដែលរាតត្បាតតិចតួចបំផុត ដែលអាចឱ្យគ្រូពេទ្យវះកាត់ឆ្អឹងមើលឃើញ ធ្វើរោគវិនិច្ឆ័យ និងកែតម្រូវបញ្ហានៅក្នុងសន្លាក់ជង្គង់ដោយប្រើកាមេរ៉ាតូចមួយហៅថាarthroscope. ឧបករណ៍នេះត្រូវបានបញ្ចូលតាមរយៈស្នាមវះតូចៗ ហើយវាបញ្ជូនរូបភាពតាមពេលវេលាជាក់ស្តែងទៅកាន់ម៉ូនីទ័រ ជួយឱ្យគ្រូពេទ្យវះកាត់រុករក និងធ្វើប្រតិបត្តិការនៅខាងក្នុងសន្លាក់ដោយភាពជាក់លាក់។

នីតិវិធីត្រូវបានគេប្រើយ៉ាងទូលំទូលាយកំណត់មូលហេតុពិតប្រាកដនៃការឈឺជង្គង់ជាប់លាប់,ការហើម ឬបញ្ហាមេកានិចដែលមិនឆ្លើយតបទៅនឹងការព្យាបាលបែបអភិរក្ស ដូចជាថ្នាំ ឬការព្យាបាលដោយចលនា។ វាអាចជារោគវិនិច្ឆ័យដែលជាកន្លែងដែលគ្រូពេទ្យវះកាត់ពិនិត្យជង្គង់សម្រាប់ស្ថានភាពដូចជាការរហែកសរសៃចង ឬការខូចខាតឆ្អឹងខ្ចី ឬព្យាបាលដែលជាកន្លែងដែលបញ្ហាមូលដ្ឋានត្រូវបានព្យាបាលក្នុងអំឡុងពេលនីតិវិធីដូចគ្នា។

Arthroscopy ត្រូវបានគេប្រើជាទូទៅដើម្បី៖

• ដោះ ឬជួសជុល meniscus ដែលរហែក ដែលជាឆ្អឹងខ្ចីដែលទ្រជង្គង់។
• កាត់​ឬ​កាត់​ឆ្អឹង​ខ្ចី​ដែល​ខូច ជាពិសេស​នៅ​ក្នុង​ករណី​មាន​ជំងឺ​រលាក​សន្លាក់​នៅ​ដំណាក់កាល​ដំបូង។
• បង្កើតឡើងវិញនូវសរសៃចងខាងមុខ (ACL) ដោយប្រើជាលិកាអញ្ចាញធ្មេញ។
• យកបំណែកឆ្អឹងរលុងឬជាលិកា synovial រលាក។
• ព្យាបាលបញ្ហាតាមដាន patellar ដែលប៉ះពាល់ដល់របៀបដែលជង្គង់ផ្លាស់ទី។
• បង្ហូរសារធាតុរាវ ឬយកដុំគីសនៅខាងក្នុងសន្លាក់។

ដោយសារតែវាត្រូវការតែការកាត់តូចប៉ុណ្ណោះ លទ្ធផលនៃការពិនិត្យជង្គង់ការជាសះស្បើយលឿនជាងមុន,តិចតួចបំផុត។ ស្លាកស្នាម, និងភាពមិនស្រួលក្រោយការវះកាត់តិចជាងបើប្រៀបធៀបទៅនឹងការវះកាត់បើកចំហ។

តើអ្នកណាត្រូវការកែឆ្អឹងជង្គង់?

ការថតឆ្អឹងជង្គង់ត្រូវបានណែនាំសម្រាប់បុគ្គលដែលមានបទពិសោធន៍បញ្ហាជង្គង់រ៉ាំរ៉ៃ ឬកើតឡើងដដែលៗដែលមិនមានភាពប្រសើរឡើងជាមួយនឹងការព្យាបាលបែបអភិរក្ស ដូចជាថ្នាំ ការចាក់ថ្នាំ ឬការព្យាបាលដោយរាងកាយ។ វាមិនមែនជាជម្រើសដំបូងឡើយ ប៉ុន្តែវាចាំបាច់នៅពេលដែលអន្តរាគមន៍ដែលមិនវះកាត់មិនអាចដោះស្រាយរោគសញ្ញា ឬនៅពេលដែលការធ្វើរោគវិនិច្ឆ័យមិនច្បាស់លាស់។

ការថតឆ្អឹងជង្គង់ត្រូវបានណែនាំជាទូទៅសម្រាប់៖

• អត្តពលិកដែលមានរបួសសន្លាក់៖ទឹកភ្នែក Meniscus ការខូចខាតសរសៃចង (ដូចជារបួស ACL ឬ PCL) និងរបួសឆ្អឹងខ្ចីគឺកើតមានជាញឹកញាប់នៅក្នុងកីឡា។ Arthroscopy អនុញ្ញាតឱ្យមានការវាយតម្លៃត្រឹមត្រូវ និងការជួសជុលដោយមិនមានការរំខានដល់ជាលិកាជុំវិញ។
• អ្នកជំងឺដែលមានជំងឺសន្លាក់ Degenerative Joint Disorders៖ក្នុងករណីមានជំងឺរលាកសន្លាក់ឆ្អឹងដំបូង ឬ chondromalacia ដែលឆ្អឹងខ្ចីចាប់ផ្តើមចុះខ្សោយ ការវះកាត់ arthroscopy ជួយសម្អាតផ្ទៃសន្លាក់ និងកាត់បន្ថយការឈឺចាប់ដែលបណ្តាលមកពីជាលិការឬខូច។
• បុគ្គលដែលមានការឈឺចាប់ជង្គង់ ឬហើមដែលមិនអាចពន្យល់បាន៖នៅពេលដែល MRI ឬការពិនិត្យរាងកាយមិនផ្តល់ការធ្វើរោគវិនិច្ឆ័យច្បាស់លាស់ arthroscopy ផ្តល់នូវទិដ្ឋភាពផ្ទាល់នៅខាងក្នុងសន្លាក់ ដែលធ្វើឱ្យវាកាន់តែងាយស្រួលក្នុងការកំណត់អត្តសញ្ញាណការខូចខាត ឬការរលាកដែលលាក់កំបាំង។
• អ្នកជំងឺដែលមានរោគសញ្ញាជង្គង់មេកានិច៖បុគ្គលដែលជួបប្រទះការចាក់សោ ការចាប់ ឬចលនាកំហិតនៅក្នុងជង្គង់ អាចមានបំណែកនៃឆ្អឹងខ្ចី ឬឆ្អឹងដែលទាមទារការដកចេញតាមរយៈការវះកាត់ arthroscopic ។
• ករណីក្រោយការប៉ះទង្គិចផ្លូវចិត្ត៖បុគ្គលដែលជាសះស្បើយពីការបាក់ឆ្អឹង ឬរបួសជង្គង់ធ្ងន់ធ្ងរអាចត្រូវការអន្តរាគមន៍ arthroscopic ដើម្បីលុបស្លាកស្នាម ជួសជុលការខូចខាតជាលិកាទន់ ឬពង្រឹងយន្តការសន្លាក់។

ការវះកាត់រាតត្បាតតិចតួចនេះគឺស័ក្តិសមសម្រាប់មនុស្សពេញវ័យគ្រប់វ័យ ជាពិសេសអ្នកដែលមានការងារទាមទាររាងកាយ ដែលចូលចិត្តជៀសវាងការវះកាត់ធំ ហើយស្វែងរកចលនាធម្មតាវិញលឿនជាងមុន។

តើការថតឆ្អឹងសន្លាក់ជង្គង់ត្រូវបានអនុវត្តយ៉ាងដូចម្តេច?

ការវះកាត់ជង្គង់ត្រូវបានអនុវត្តនៅក្រោមការប្រើថ្នាំសន្លប់ទូទៅ ឆ្អឹងខ្នង ឬការប្រើថ្នាំសន្លប់តាមតំបន់អាស្រ័យលើស្ថានភាពសុខភាពរបស់អ្នកជំងឺ និងភាពស្មុគស្មាញនៃនីតិវិធី។ ការវះកាត់ទាំងមូលមានរយៈពេលជាធម្មតា៣០ ទៅ ៩០ នាទី។ហើយអ្នកជំងឺភាគច្រើនត្រូវបានរំសាយចេញនៅថ្ងៃតែមួយ លុះត្រាតែត្រូវការការព្យាបាលបន្ថែម។

ខាងក្រោម​នេះ​ជា​ដំណើរការ​មួយ​ជំហាន​ម្តងៗ​នៃ​របៀប​ដែល​ការ​វះកាត់​ជង្គង់​ត្រូវ​បាន​អនុវត្ត៖

• ការរៀបចំអ្នកជំងឺ៖ក្រុមវះកាត់ដាក់អ្នកជំងឺនៅលើតុប្រតិបត្តិការ ដោយជង្គង់ដែលរងផលប៉ះពាល់ត្រូវពត់បន្តិច។ តំបន់នេះត្រូវបានក្រៀវយ៉ាងហ្មត់ចត់ ហើយថ្នាំ tourniquet ត្រូវបានអនុវត្តដើម្បីកាត់បន្ថយលំហូរឈាម ដោយហេតុនេះធ្វើអោយប្រសើរឡើងនូវភាពមើលឃើញនៅខាងក្នុងសន្លាក់។
• ការ​បញ្ចូល​រន្ធ​គូថ និង​ការ​បញ្ចូល​សរសៃ​ពួរ៖គ្រូពេទ្យវះកាត់ធ្វើការវះកាត់តូចៗពីរឬបី (នីមួយៗប្រហែល 5-10 មម) នៅជិតសន្លាក់ជង្គង់។ តាមរយៈស្នាមវះមួយ ​​ពួកគេបញ្ចូល arthroscope ដែលជាកាមេរ៉ាស្តើងខ្មៅដៃភ្ជាប់ទៅនឹងម៉ូនីទ័រនិយមន័យខ្ពស់។ វាអនុញ្ញាតឱ្យគ្រូពេទ្យវះកាត់មើលរូបភាពលម្អិតនៃសន្លាក់ក្នុងពេលជាក់ស្តែង។
• ការពិនិត្យ និងធ្វើរោគវិនិច្ឆ័យរួមគ្នា៖គ្រូពេទ្យ​ពិនិត្យ​មើល​ឆ្អឹងខ្ចី, meniscus, ligaments, និង synovium សម្រាប់​ការខូចខាត ឬ​រលាក។ ពួកគេអាចពត់ និងបង្វិលជើង ដើម្បីពិនិត្យមើលសន្លាក់ពីមុំច្រើន។ ជំហាននេះបញ្ជាក់ ឬបញ្ជាក់ការធ្វើរោគវិនិច្ឆ័យ។
• នីតិវិធីព្យាបាល (បើចាំបាច់)៖ប្រសិនបើរកឃើញបញ្ហា គ្រូពេទ្យវះកាត់បញ្ចូលឧបករណ៍ឯកទេសតាមរយៈស្នាមវះផ្សេងទៀត ដើម្បីធ្វើការជួសជុល។ ទាំងនេះអាចរួមបញ្ចូលៈ
  • កាត់ឬជួសជុល meniscus ដែលរហែក
  • ធ្វើឱ្យឆ្អឹងខ្ចីដែលខូចរលោង (chondroplasty)
  • យកសាកសពរលុង ឬជាលិការលាកចេញ
  • ការបង្កើតឡើងវិញនូវសរសៃចងដែលរហែកដូចជា ACL ដោយប្រើការផ្សាំ
• ប្រព័ន្ធធារាសាស្រ្ត និងការបិទ៖គ្រូពេទ្យ​វះកាត់​លាង​សម្អាត​សន្លាក់​ដោយ​ទឹកអំបិល​មាប់មគ ដើម្បី​យក​កំទេចកំទី​ចេញ និង​ធានា​ឱ្យ​ឃើញ​ច្បាស់​។ បន្ទាប់ពីបញ្ចប់នីតិវិធី ពួកគេបានដកឧបករណ៍ និង arthroscope ចេញ បន្ទាប់មកបិទស្នាមវះដោយប្រើស្តេរីស្ទ្រី ឬថ្នេរតូចៗ។
• ការថែទាំក្រោយការវះកាត់៖ក្រុមការងារអនុវត្តការស្លៀកពាក់ដែលគ្មានមេរោគ ហើយក្នុងករណីខ្លះ បង់រុំបង្ហាប់។ អ្នកជំងឺ​ត្រូវ​បាន​ប្តូរ​ទៅ​ជា​សះស្បើយ និង​តាមដាន​រយៈពេល​ពីរ​បី​ម៉ោង​។ ភាគច្រើនត្រូវបានអនុញ្ញាតឱ្យត្រឡប់ទៅផ្ទះវិញក្នុងថ្ងៃតែមួយជាមួយនឹងការណែនាំសម្រាប់ការសម្រាក ការលាបទឹកកក ការគ្រប់គ្រងការឈឺចាប់ និងដំណាក់កាលដំបូងនៃការព្យាបាលដោយចលនា។

ការថតឆ្អឹងជង្គង់ត្រូវបានចាត់ទុកថាជានីតិវិធីដែលមានហានិភ័យទាប ជាមួយនឹងរបួសតិចតួចបំផុតចំពោះជាលិកាជុំវិញ។ ដោយសារតែធម្មជាតិនៃការរាតត្បាតតិចតួចបំផុតនៃ arthroscopy ជង្គង់ អ្នកជំងឺជាធម្មតាអាចចាប់ផ្តើមដើរ (ជួនកាលដោយមានការគាំទ្រ) ក្នុងរយៈពេល 24 ទៅ 48 ម៉ោងបន្ទាប់ពីការវះកាត់។

What is the Cost of Knee Arthroscopy in India?

The cost of knee arthroscopy in India generally ranges from $1,800 to $3,200. The price depends on the hospital, the surgeon's expertise, and whether the procedure is diagnostic or therapeutic. The pricing is significantly lower than in countries like the USA, UK, or UAE, without compromising on medical standards, technology, or outcomes.

Most hospitals in India offer comprehensive surgical packages that are transparent, fixed, and inclusive of key medical services. These treatment packages are designed to provide international patients with a smooth and predictable treatment journey from admission to recovery.

The cost of knee arthroscopy in India typically includes:

• Pre-operative consultation and evaluation: This covers the initial orthopedic assessment, physical examination, and planning for the arthroscopy based on your symptoms and imaging studies.
• Diagnostic imaging and blood tests: Required investigations, such as X-rays, MRIs, ECGs, and lab tests, are part of the pre-surgical workup.
• Surgeon's and anesthetist's fees:
• These are bundled into the overall surgical charges and reflect the expertise of the operating team.
• Operation theatre charges and surgical equipment use: Includes sterilization, arthroscopic tower rental, and use of high-definition imaging systems and instruments.
• Hospital stay (1–2 days): While most arthroscopies are day-care procedures, a one-night stay may be recommended based on your recovery. Standard or private room charges are usually included.
• Medications and consumables during hospitalization: This covers pain relievers, antibiotics, IV fluids, sterile dressings, and other surgical disposables.
• Postoperative review and initial physiotherapy session: Most hospitals include at least one post-surgery consultation and a basic physio session before discharge.

Breakdown of Knee Arthroscopy Cost in India

The total cost of knee arthroscopy in India typically ranges from ₹1,50,000 to ₹2,70,000, depending on whether the surgery is diagnostic or therapeutic, as well as the hospital or city where it is performed. 

• The pre-operative investigations for knee arthroscopy in India, including X-rays, MRI scans, ECGs, and blood tests, typically cost between $100 and $200. These are essential for evaluating the joint and confirming the surgical plan.
• The actual arthroscopic procedure, which involves inserting a camera and instruments to treat internal joint issues, usually costs between $1,200 and $2,000. It includes the use of an arthroscopy tower, high-definition imaging, and disposable surgical kits.
• Surgeon and operation theatre fees typically range from $300 to $500, depending on the surgeon's expertise, hospital infrastructure, and duration of the procedure.
• The hospital stay charges for knee arthroscopy in India are relatively low, typically ranging from $100 to $200, especially if the patient is discharged within 24 hours.
• Postoperative medications, dressings, and supportive aids (such as knee braces or ice packs) may incur an additional cost of $100 to $300, depending on the patient's individual recovery needs.

Note: This cost structure applies to a standard single-knee arthroscopy. Suppose you require bilateral (both knees) or complex repairs, such as ACL reconstruction or meniscus suturing. In that case, the cost may be slightly higher due to the additional materials and time required for surgery.

Knee Arthroscopy Cost Comparison: India vs Other Countries

International patients often choose India for knee arthroscopy because of its exceptional balance of low cost and high-quality care. The savings can be as high as 70–80% compared to hospitals in the US, UK, or Australia.

Choosing knee arthroscopy in India can save patients over $10,000 in some cases, while still receiving world-class orthopedic care from internationally trained surgeons and personalized recovery support.

What Factors Influence Knee Arthroscopy Cost in India?

Several important factors influence the cost of knee arthroscopy in India. These variables can affect your total expense depending on the type of treatment you require, the hospital you choose, and the complexity of your knee condition. The main cost-determining factors are:

• Type of Arthroscopy (Diagnostic vs Therapeutic): A purely diagnostic arthroscopy is less expensive than a therapeutic one, which involves repairing or removing damaged tissue (like meniscus trimming or ligament reconstruction). 
• Extent of Joint Damage: The more severe the damage inside the knee joint, the longer the surgical duration and the more advanced tools required. Procedures involving cartilage restoration, ligament grafting, or removal of large bone fragments will naturally increase costs.
• Surgeon's Experience and Team Expertise: Highly skilled orthopedic surgeons with global training and extensive arthroscopy experience may charge higher professional fees. However, their precision often leads to faster recovery and fewer complications.
• Hospital Category and City Location: Premium hospitals in major metropolitan cities, such as Delhi, Mumbai, or Bangalore, may have slightly higher rates due to their advanced infrastructure, robotic systems, and international patient services. 
• Anesthesia Type and Monitoring Requirements: The choice between spinal, general, or local anesthesia influences the overall surgical setup and anesthetist's fees. Complex therapeutic procedures may also require extended operating time and post-anesthesia monitoring.
• Postoperative Support and Rehabilitation Services: If your package includes physiotherapy sessions, mobility aids, or joint supports, such as braces, the cost may increase slightly. However, these services play a vital role in optimizing recovery.
• Use of Surgical Implants or Sutures: While most knee arthroscopies do not require implants, procedures involving ligament repair or meniscus fixation may involve high-quality sutures or anchors, which can add to the total expense.
• Insurance or Self-Pay Mode: For domestic patients, partial insurance coverage may apply. International patients typically opt for self-pay packages, which are transparently priced and often discounted for overseas travelers.

Why Is Knee Arthroscopy More Affordable in India?

India has some of the most competitive rates in the world for orthopedic procedures, such as knee arthroscopy, without compromising surgical outcomes, safety standards, or patient care. Several factors contribute to the affordability of knee arthroscopy in India, making it an ideal destination for medical tourists.

• Lower Operational and Facility Costs: Indian hospitals operate at lower infrastructure and staffing costs compared to Western countries. These savings are passed on to patients in the form of cost-effective treatment packages.
• Competitive Surgeon Fees Without Compromising Expertise: Orthopedic surgeons in India are often internationally trained and highly experienced, yet their consultation and surgical fees remain significantly lower than their counterparts in the US or UK.
• Availability of In-House Diagnostic and Surgical Facilities: Most multi-specialty hospitals in India offer in-house radiology, laboratory services, and operating theaters. It eliminates the need for third-party outsourcing, thereby reducing the overall treatment cost.
• Efficient Healthcare Delivery Models: Indian hospitals are optimized for high patient volumes. As a result, they are able to streamline surgical scheduling, reduce hospital stay durations, and avoid administrative overheads—contributing to lower overall pricing.
• Cost-Effective Medications and Surgical Supplies: India is a global leader in the production of generic pharmaceuticals and medical consumables. Everything, from anesthesia to postoperative antibiotics, is available at a fraction of the global price, directly lowering your hospital bill.
• Favorable Currency Exchange for Foreign Patients: For international travelers from Africa, the UK, CIS countries, or the Middle East, the exchange rate makes Indian medical care substantially more affordable, even when including flights and accommodations.
• Bundled All-Inclusive Packages for Medical Tourists: Most hospitals offer fixed-price arthroscopy packages that cover everything from consultations and surgery to hospital stay and follow-up.

International Patient Services for Knee Arthroscopy in India

Reputable orthopedic hospitals and surgical centers offer a range of dedicated services to ensure a stress-free experience from arrival to recovery.

• Medical Visa Assistance: Hospitals provide a formal medical invitation letter that facilitates the quick issuance of medical visas for patients and their caregivers. Visa coordinators assist with document preparation, embassy requirements, and extensions if needed.
• Airport Pickup and Drop-Off: A representative from the hospital or medical tourism department arranges airport pickup in a private vehicle and ensures that patients are safely transported to their accommodation or the hospital.
• Language Interpretation Services: To eliminate communication barriers, hospitals offer interpreters for Arabic, French, Russian, Spanish, Swahili, and more. Medical forms, reports, and discharge summaries can also be translated.
• Dedicated International Patient Coordinators: Each patient is assigned a multilingual care coordinator who assists with scheduling consultations, managing hospital logistics, ensuring billing transparency, and organizing follow-up appointments and rehabilitation sessions.
• Help with Local Accommodations and Meals: Whether you prefer a hotel, serviced apartment, or guesthouse, the hospital can assist in booking safe and hygienic accommodations near the facility. Dietary preferences, including halal, vegetarian, or diabetic-friendly meals, are accommodated.
• Pre-Treatment Online Consultations: Before traveling, patients can consult with orthopedic surgeons virtually. These consultations provide clarity on diagnosis, estimated costs, length of stay, and treatment expectations.
• Post-Surgery Rehabilitation Planning: Hospitals offer customized rehabilitation plans that include physiotherapy sessions, home exercises, and follow-up consultations to support patients' recovery. For longer stays, patients can undergo extended rehab at discounted rates.
• FRRO and Legal Registration Support: Foreigners undergoing treatment for more than 180 days in India are required to register with the Foreigners Regional Registration Office (FRRO). Hospitals assist in completing this process.

What is the Success Rate and Recovery Timeline After Knee Arthroscopy?

Knee arthroscopy is considered one of the most reliable and low-risk orthopedic procedures worldwide, and India maintains a success rate of approximately 90% to 95% for both diagnostic and therapeutic arthroscopies. With the use of advanced arthroscopic systems, minimally invasive techniques, and postoperative rehabilitation protocols, patients typically achieve excellent pain relief and restoration of joint function.

Success Rate of Knee Arthroscopy in India

• The high success rate is attributed to experienced orthopedic surgeons, most of whom are trained in the latest arthroscopic techniques from the US, UK, or Germany.
• The resolution of pain, improved joint mobility, restoration of function, and a return to regular activity within the expected timeframe define success.
• Complications, such as infection, blood clots, or poor healing, are rare and typically occur in fewer than 3–5% of patients.
• Therapeutic outcomes are best for meniscal tears, cartilage smoothing, ligament injuries, and loose body removal, especially when paired with guided physiotherapy.

Recovery Timeline After Knee Arthroscopy

Recovery from knee arthroscopy is faster compared to open knee surgery due to minimal tissue damage, smaller incisions, and reduced blood loss. 

• First 24-48 Hours: Patients are monitored for a few hours post-surgery and are usually discharged on the same day or the day after. Cold therapy and leg elevation are recommended to reduce swelling. Walking with support (walker or crutches) is often permitted within 24 hours.
• Weeks 1-2: The dressing is removed, and the incision sites are cleaned and monitored for healing. Swelling and stiffness reduce significantly with rest and light activity. Basic physiotherapy begins, focusing on gentle range-of-motion exercises to improve mobility.
• Weeks 3-4: Strength-building exercises and quadriceps activation begin under physiotherapy supervision. Most patients return to desk work or light activity within 2 to 3 weeks. Pain is minimal and manageable with oral medications.
• Weeks 5 to 8: More dynamic activities like cycling, squats, or swimming are gradually introduced. Patients typically regain 70–80% of their joint function and can walk unassisted for longer periods.
• Month 3 and Beyond: Full recovery is generally achieved within 8 to 12 weeks, depending on the procedure performed. Athletes and physically active individuals may require 3 to 4 months before returning to sports or activities. Long-term outcomes are excellent when patients adhere to rehab and post-op guidelines.

Recovery Tip:

Success after knee arthroscopy depends as much on postoperative rehabilitation as on surgical technique. Patients are encouraged to attend all physiotherapy sessions, follow activity restrictions, and avoid high-impact movements until cleared by their surgeon.