Arthroscopy

Definition

Arthroscopy (ahr-THROS-skuh-pe) is a procedure for diagnosing and treating joint problems. During arthroscopy, a surgeon examines and, in many cases, repairs your injured or diseased joint with the help of an optical instrument called an arthroscope. An arthroscope consists of a light source, a lens system, and bundled glass or plastic fibers (fiber optics) to carry light to the area being examined. These parts are encased in a tube, usually about one-eighth of an inch (4 mm) in diameter. A video camera attached to the arthroscope relays the view from within your joint to a video monitor. Because the arthroscope is so narrow, your surgeon needs only a small incision to place it in your joint.

Why it's done

Doctors use arthroscopy to help diagnose and treat a variety of joint conditions — most commonly those affecting the knee, shoulder, elbow, ankle, hip and wrist — in people of all ages.

In diagnosis, arthroscopy is the definitive examination, typically performed after X-rays and other imaging studies have left some diagnostic questions unanswered. Often, arthroscopy is also used to assess the results of earlier joint surgery, or to supplement some types of standard ("open") orthopedic surgery.

Conditions treated with arthroscopy include:

• Bone spurs or loose bone fragments
• Damaged or torn cartilage
• Inflamed joint linings
• Joint infections
• Torn ligaments
• Scarring or tissue overgrowth within joints

Risks

Arthroscopy is a low-risk procedure. Complications occur in 1 percent to 2 percent of arthroscopies. The risks include:

• Bone, cartilage or ligament damage from placing and movement of instruments within the tight space of the joint
• Blood vessel or nerve damage in the area around the joint
• Tendon or ligament damage
• Bleeding within the joint
• A blood clot in a leg vein, mainly a risk in procedures lasting over an hour
• Infection

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

• Tell your surgeon about all the medications you're taking, including over-the-counter drugs and dietary supplements. Find out which of your regular medications to discontinue before your procedure and how many days in advance to stop them.
• Stop eating and drink only clear liquids at least six hours before the procedure.
• Arrange for a ride home after the procedure.
• Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure.

What you can expect

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Ice compress

Although the experience varies depending on why you're having the procedure and on which joint is involved, some aspects of arthroscopy are fairly standard.

• You'll remove your street clothes and jewelry and put on a hospital gown or shorts.
• A nurse will place an intravenous catheter in your hand or arm and inject a mild sedative.

You'll receive general, regional or local anesthesia.

• General anesthesia is sometimes the best option for repairing acute injuries, or for procedures in which the surgeon has to reposition the arthroscope repeatedly. You receive general anesthesia by an intravenous injection. If you have general anesthesia, you'll be unconscious throughout the procedure.
• Regional anesthesia leaves you awake while blocking sensation in a large part of your body. The most common form of regional anesthesia is delivered through a small tube placed between two of your vertebrae, or spine bones. Another type — sometimes referred to as a nerve block — is injected in the vicinity of a nerve or group of nerves.
• Local anesthesia involves injecting numbing agents below the skin to block sensation in a limited area, such as your knee. With local anesthesia, you'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.

During the procedure

• You'll be placed in the best position for the procedure you're having. For knee arthroscopy, that's usually on your back on a short table with your knees bent and your feet hanging down. For shoulder arthroscopy, you may be on your side or in the "beach chair" position, with your chest and torso supported at an upright angle. You may be faceup or facedown for an elbow arthroscopy, depending on your surgeon's preference.
• The surgeon places your arm or leg in a positioning or traction device to isolate the joint and provide good access to the area from different angles. He or she may use a pressure band (tourniquet) to decrease blood loss and to see the joint better.
• A surgical assistant disinfects the area around the joint and applies sterile drapes to prevent infection.
• The surgeon makes a small incision in the skin over the surgical site and inserts a hollow tube through the underlying tissue and the membrane covering the joint. The arthroscope is inserted through the tube. To distend the joint for a better view, flexible tubing — attached to the arthroscope or part of a separate irrigation system — carries sterile fluid into the joint to fill it.
• Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.
• When the surgery is complete, your surgeon removes the arthroscope and other instruments and flushes the joint with sterile solution.
• The surgeon may also inject local anesthetics into the joint to reduce pain.
• The incisions may be closed with sterile adhesive tapes or stitches, as necessary.

After the procedure

• Arthroscopic surgery usually takes between 30 minutes and two hours, depending on the procedure performed. After that, you'll be taken to a separate room to recover for a few hours before going home.
• Your doctor may give you medication to relieve pain and inflammation.
• At home, you'll need to wrap, rest, ice and elevate the joint for several days to reduce swelling and pain.
• You may need to temporarily use splints, slings or crutches for comfort and protection.
• Your doctor may prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.
• In general, you should be able to resume desk work and light activity in a week, and more strenuous activity in two weeks. Remember, however, that your situation may dictate a longer recovery period, along with rehabilitation.

Results

Your surgeon will review the findings of the arthroscopy with you as soon as possible. You may also receive a written report, as may your primary physician.

After arthroscopic surgery to treat a joint injury or disease, healing may take several weeks. Your surgeon will monitor your progress in follow-up visits and address any problems that arise.