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Arthroscopy

Arthroscopy is a minimally-invasive procedure used for the diagnosis and treatment of conditions affecting joints. The doctor can directly view the internal structures of a joint using an instrument called an arthroscope.

Orthopaedic surgeons use arthroscopy to diagnose and treat joint problems. An arthroscope is a small, tube shaped instrument that is used to look inside a joint.

It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.

The joint most frequently examined using arthroscopy is the knee. However, arthroscopy can be used to examine other joints, including the following:

  • Shoulder
  • Elbow
  • Ankle
  • Hip
  • Wrist
Hospital Stay: Hospital Stay: 3 days
Duration: Duration: 1 hr
Cost Estimate: Cost Estimate: 2500 USD - 6500 USD These are indicative prices in Indian Hospitals

Joints are formed where bones meet.  Most joints are mobile, allowing the bones to move.  Basically, the knee is two long leg bones held together by muscles, ligaments, and tendons.  Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.

There are two groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones.  Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

The knee consists of the following:

  • Tibia – This is the shin bone or larger bone of the lower leg.
  • Femur – This is the thighbone or upper leg bone.
  • Patella – This is the kneecap.
  • Cartilage – A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
  • Synovial membrane – A tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
  • Ligament – A type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint’s movement.
  • Tendon – A type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
  • Meniscus – A curved part of cartilage in the knees and other joints that acts as a shock absorber.

An arthroscopic procedure may be used to diagnose and assist in the treatment of the following conditions:

  • Inflammation in the knee, shoulder, elbow, wrist, or ankle
  • Injuries, such as shoulder rotator cuff tendon tears or impingement syndrome (pinching of tendons in the shoulder caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade)
  • Cartilage damage, such as tears, injury, or wear
  • Ligament tears with instability in the knee
  • Tendon damage
  • Carpal tunnel syndrome in the wrist
  • Loose bone and/or cartilage, particularly in the knee, shoulder, elbow, ankle,  wrist, or hip

Corrective surgery or a biopsy may be performed using arthroscopy.  For example, torn ligaments can be repaired or reconstructed. Arthroscopic surgery may eliminate the need for an open surgical procedure.

Before the surgery

  • In addition to taking a complete medical history, the doctor may perform a complete physical examination to ensure that the patient is in good health before undergoing the procedure.  The patient may undergo blood tests or other diagnostic tests.
  • Notify the doctor if the patient is sensitive to or is allergic to any medications, latex, tape, and anaesthetic agents (local and general).
  • Inform the doctor of all medications (prescribed and over-the-counter) and herbal supplements that the patient is taking.
  • Notify the doctor if the patient has a history of bleeding disorders or if he/she is taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.  It may be necessary for to stop these medications prior to the procedure.
  • If the patient is pregnant or suspect that she is pregnant, the doctor should be notified.
  • The patient will be asked to fast for eight hours before the procedure, generally after midnight.
  • A sedative is usually given prior to the procedure to help the patient relax.

During the procedure

Arthroscopy may be performed on an outpatient basis or as part of the stay in a hospital. Arthroscopy may be performed under general anaesthesia, or while under localized anaesthesia. The type of anaesthesia will depend upon the specific procedure being performed. The anaesthesiologist will discuss this with the patient in advance.

Generally, an arthroscopic procedure follows this process:

  • The patient will be asked to remove clothing and will be given a gown to wear.
  • An intravenous (IV) line may be started in the arm or hand.
  • The patient will be positioned on the operating table.
  • A urinary catheter may be inserted.
  • If there is excessive hair at the surgical site, it may be clipped off.
  • The anaesthesiologist will continuously monitor heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  • The skin over the surgical site will be cleansed with an antiseptic solution.
  • The doctor may drain blood from the surgical area by elevating the extremity and/or applying an elastic wrap to the extremity. The doctor may instill a fluid solution (generally a saline solution) before the arthroscope is inserted to help distend the joint and reduce swelling.
  • The doctor will make an incision in the joint area.
  • The arthroscope will be inserted through the incision, into the joint.
  • Other incisions may be made to introduce other small grasping, probing, or cutting tools.
  • Corrective surgery, if necessary, may be performed.
  • The incision will be closed with stitches or adhesive strips.
  • A sterile bandage or dressing will be applied.

After the procedure

After surgery, the patient will be taken to the recovery room for observation. The recovery process will vary depending on the type of anaesthesia that is given. The circulation and sensation of the affected extremity will be monitored. Once blood pressure, pulse, and breathing are stable and the patient is alert, he/she will be taken to the hospital room or discharged  home. Arthroscopic surgery is usually done on an outpatient basis.

Rehabilitation

Once the patient is at home, it is important to keep the incision site clean and dry.  Specific bathing instructions will be given. If stitches are used, they will be removed during a follow-up visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

The patient can take a pain reliever for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.

Activity and the use of the joint may be limited for 24 to 48 hours after a diagnostic arthroscopy. If other procedures are performed, such as a ligament repair, activity and use of the joint may be limited for a longer period of time. For knee surgery, the patient may be given an immobilizer to wear. The doctor may also instruct the patient to apply ice to the surgical site and to elevate the knee when sitting. Specific instructions will depend on the exact procedure performed.

The doctor should be notified to report any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the incision site
  • Increased pain around the incision site
  • Numbness and/or tingling in the affected extremity

Normal diet can be resumed unless the doctor advises differently.

Risks / Complications

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bleeding
  • Infection
  • Blood clots in the legs or lungs

There may be other risks depending on the patient’s specific medical condition.

Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize, diagnose, and treat problems inside of a joint. The word arthroscopy comes from the Greek words, “arthro” (joint) and “skopein” (to look). The term literally means to look within the joint. During the knee arthroscopy, the surgeon will make 2-3 tiny incisions to insert the pencil-sized instruments. These instruments contain a small lens and lighting system to magnify and illuminate the structures inside the joint. By attaching the arthroscope to a miniature camera, the surgeon can visualize and examine the inside the joint. They can examine the bones, cartilage, and ligaments of the knee and repair or correct various problems or injuries.

Diagnosing a joint injury will always begin with a thorough medical history, physical examination, and radiographic studies (x-rays, MRI, CT scan, etc.). Through the arthrosocope, a final diagnosis is made which is often more accurate than through traditional “open” surgery, x-ray studies, or MRI alone.

Some of the more common reasons that knee arthroscopy is done in orthopaedics include:

  • Torn meniscus (cartilage inside your knee)
  • Discoid lateral mensicus (abnormally formed mensicus)
  • Loose bodies in knee joint
  • Fractures in or near knee joint (although these will often require an “open” approach)
  • Repair of torn ligaments (can require open surgery)
  • Persistent knee pain with failure of conservative therapy (diagnostic knee arthroscopy)
  • Removal of inflamed lining (synovium) in the knee

Arthroscopic surgery is done in the operating room or surgical suite under a general anaesthetic or under a local block (regional anaesthesia). A small incision (about the size of a buttonhole) will be made to insert the arthroscope into the knee joint. 2-3 additional buttonhole incisions are often needed to examine other parts of the joint or to insert other instruments. When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through the accessory incisions. Many common knee injuries can now be treated arthroscopically.

After arthroscopic surgery, the small incisions will be covered with a bulky dressing and knee immobilizer. The patient will be moved from the operating room into the recovery room. Some patients will need little or no pain medication, although it is not uncommon to have pain if an injury was treated.  Pain medication should be used as needed for the first few days after surgery.

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