Arthroscopy - Everything you need to know

Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s with the advent of fiberoptic technologies and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home on the same day the procedure is completed.

The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.

If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

What is done in preparation for arthroscopy?

Arthroscopy is essentially a procedure during which no blood loss is expected and generally has few complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most importantly, the patient should be able tolerate the anesthetic that is used during the procedure. A person's heart, kidney, liver, and lung function should be adequate. If there are existing problems such as heart failure or emphysema, these should be optimized as possible prior to surgery. Patients who are on anticoagulants (blood thinners) should have these medications carefully adjusted prior to surgery. Other medical problems should also be controlled prior to surgery, such as diabetes and high blood pressure.

Preoperative evaluation of a patient's health will generally include a physical examination, blood tests, and a urinalysis. Patients who have a history of heart or lung problems and generally anyone over the age of 50 will usually be asked to obtain an electrocardiogram (EKG) and a chest X-ray. Any signs of ongoing infection in the body usually postpones arthroscopy, unless it is being done for possible infection of the joint in question.

What Happens During the Procedure?

Your doctor will perform arthroscopic surgery in a hospital or outpatient operating room. That means you can go home the same day. The type of anesthesia you’ll receive depends on the joint and what your surgeon suspects is the problem. It may be general anesthesia (you’ll be asleep during surgery), or your doctor will give it to you through your spine. He might also numb the area he’s doing the surgery on.

Your doctor will insert special pencil-thin instruments through a small cut (incision) the size of a buttonhole. He’ll use a tool called an arthroscope that has a camera lens and a light. It allows him to see inside the joint. The camera projects an image of the joint onto a screen. The surgeon will fill the joint with sterile fluid to widen it so it’s easier to see.

He’ll look inside the joint, diagnose the problem, and decide what type of surgery you need, if any. If you do need surgery, your surgeon will insert special tools through other small incisions called portals. He’ll use them to cut, shave, grasp, and anchor stitches into bone.

If your surgeon decides you need traditional, “open” surgery to fix the problem, he may do it at the same time as your arthroscopic surgery.

Afterward, he’ll remove the arthroscope and any attachments. He’ll close the wound with special tape or stitches.

 

How long is the recovery time after arthroscopy?

Immediately after arthroscopic surgery, patients may be sleepy, especially if a general anesthetic or sedation has been used. Medications are administered to control pain if needed. If a local anesthetic has been used, there may be no pain at all immediately after the procedure. If a spinal or regional anesthetic has been used, there can be numbness and weakness of the extremity that gradually resolves before the patient is sent home.

The surgical incisions from arthroscopy are small. They usually consist of one or more 5 mm (1/4 inch) incisions on either side of the joint, which are bandaged after surgery. The bandage may absorb some of the tissue drainage from these wound sites. The bandage should only be removed under the advice of the treating surgeon or nurse. It should otherwise be kept as dry as possible during the first few days after surgery. Patients should notify their physician's office immediately if they develop unusual joint pain, swelling, redness or warmth, or if they injure the involved joint.

For several days after arthroscopy, patients will generally be asked to rest and elevate the joint while applying ice packs to minimize pain and swelling. After surgery, an exercise program is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues. The goal is to recover stability, range of motion, and strength of the joint rapidly and safely, while preventing the build-up of scar tissue. This program is an essential part of the recovery process for an optimal outcome of this procedure.

Over the years, higher quality fiberoptic equipment has allowed the development of miniature arthroscopes. This has allowed the examination of smaller joints with arthroscopy. Arthroscopy has become an integral tool for orthopedic surgery and its role will continue to expand as further improvement in arthroscopes and arthroscopic instruments continues.

What About Recovery?

You may have some pain in the joint after surgery. Your doctor may prescribe pain medication. He might also prescribe aspirin or other medication to prevent blood clots.

You may need crutches, a splint, or a sling for support as you recover.

Arthroscopic surgery usually results in less joint pain and stiffness than open surgery. Recovery also generally takes less time.

You’ll have small puncture wounds where the arthroscopic tools went into your body. The day after surgery, you may be able to remove the surgical bandages and replace them with small strips to cover the incisions. Your doctor will remove non-dissolvable stitches after a week or 2.

While your wounds heal, you’ll have to keep the site as dry as possible. This means covering them with a plastic bag when you shower.

Your doctor will tell you what activities to avoid when you go home. You can often go back to work or school within a few days of surgery. Full joint recovery typically takes several weeks. It may take several months to be back to normal.

Rehabilitation or specific exercises can help speed your recovery. Your doctor will tell you which ones are safe to do.