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Arthroscopy - Types, Advantages and Risk Factors

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Arthroscopy is a minimally invasive surgery for joint problems. This article discusses the need, types, and procedures involved in arthroscopy.

Written by

Dr. Deepiha. D

Medically reviewed by

Dr. Ranvir Sachin Tukaram

Published At May 20, 2022
Reviewed AtJune 10, 2024

What Is Arthroscopy?

Arthroscopy is a surgical procedure performed on joints to visualize inside the joints. Initially, the arthroscopic technique was developed to find the location of a problem and make a preliminary diagnosis. Later, arthroscopy was used as a therapeutic tool also. It is a minimally invasive surgery, also known as keyhole surgery. It is done on a routine outpatient basis.

What Are the Types of Arthroscopy?

Based on the location where arthroscopy is performed, the procedure can be named as follows:

  • Knee Arthroscopy:

Knee arthritis is a prevalent problem among adults. It is an inflammation of the joints causing pain and swelling. Knee arthroscopy uses an arthroscopic technique to look around the knee joints. The procedure is commonly used to diagnose and address many pathological conditions like knee arthritis, meniscus tears (torn or damaged meniscus), cartilage injuries, ligament repair, and reconstruction.

  • Shoulder Arthroscopy:

Shoulder arthroscopy is used to understand the damage to shoulder bones. In addition, this technique is used to diagnose and treat various shoulder diseases. Shoulder arthroscopy includes rotator cuff repair, SLAP (superior labral tear from anterior to posterior) repair, shoulder stability, partial clavicle excision, and synovectomy (surgical removal of the synovial membrane).

  • Hip Arthroscopy:

Hip arthroscopy is used to see inside the hip joint without extensively cutting muscles and ligaments. It is commonly indicated in the treatment of femur (thigh bone) and acetabulum (socket-like cavity in the pelvic bone) impingement and associated pathologies. Special instruments are used to aid entry into the hip joint.

  • Wrist Arthroscopy:

Wrist arthroscopy is a simple procedure to visualize, diagnose, and treat wrist joint problems. It is indicated in wrist bone fracture, ligament tear, stress injury, and wrist osteoarthritis (wear and tear of the joints and bones).

  • Spine Arthroscopy:

The spinal arthroscopy procedure treats degenerative disc disease, spinal injury, and spinal instability when the surrounding prominent structures have to be preserved. The mid-spine has to be accessed through ribs in some pathological cases. In such cases, spine arthroscopy is used as it is a less invasive technique.

  • Ankle Arthroscopy:

Ankle arthroscopy is a procedure to inspect all the tissues in and around the ankle. Any damaged ligaments, cartilage, bones, and tendons of the ankle are repaired by this technique.

  • Elbow Arthroscopy:

Elbow arthroscopy successfully treats bone or cartilage instability, cartilage tear, tendon damage, stress injuries, and inflammation of the elbow joints. In addition, elbow arthroscopy may relieve pain from many problems associated with soft-tissue damage surrounding the elbow.

  • Temporomandibular Joint Arthroscopy:

Temporomandibular joint arthroscopy is used to diagnose damage to the joint's surface. In addition, they are used to treat temporomandibular disorders and arthrocentesis (washing out the jaw joint space for diluting and flushing the inflammatory chemicals). Temporomandibular joint arthroscopy is a minor invasive type of temporomandibular joint surgery.

How Does the Person Prepare for an Arthroscopy Procedure?

The preparation of the person depends on the joint the surgeon is examining and repairing. In general

  • Avoid Some Medication:

The doctor advises to avoid some medications and supplements which can enhance the risk of bleeding.

  • Fast Beforehand:

Depending on the form of anesthesia, the doctor may suggest avoiding eating solid foods almost eight hours prior to the procedure.

  • Arrange for a Ride:

The person will not be able to get home on their own, so there should be some friend or family to take them back home.

  • Choose Loose Cloth:

Loose and comfortable clothing should be worn, especially in the case of knee arthroscopy.

How Is Arthroscopy Done?

Arthroscopic surgery takes less time compared to conventional ones. The protocol followed before surgery are:

  1. The patient is examined thoroughly before starting the procedure.

  2. A standard prophylactic regimen is recommended.

  3. The patient is placed in a convenient and best position for the procedure. Based on the procedure, the type of anesthesia is selected and delivered.

  4. A tourniquet (a device placed around the arm or leg to arrest the blood flow temporarily) is applied and kept in position during the procedure.

Procedure:

  1. Two small incisions are made.

  2. An arthroscope (a small camera) is inserted through a narrow tube in one incision, and working instruments are inserted through the other incision. Those tiny instruments are used to hold, debride, and repair the structures.

  3. Sterile liquid or normal saline is infused to distend the joint area and make working space.

  4. The physician moves the camera while looking at the monitor, and it helps reduce the risk of injury to the nerves and blood vessels.

  5. Sometimes an additional incision can be made to perform the procedure effectively.

  6. After surgery, small stitches or patches are placed over the opening, and an external soft dressing is given to avoid movements.

How Long Is the Recovery After Arthroscopy?

The recovery time depends upon the procedure and the surgery site. Once the effect of anesthesia wanes, the patient will start feeling pain in the surgical site. After the procedure, the surgeons prescribe medications like painkillers, antibiotics, and anti-inflammatory drugs. In addition, they may suggest a few tips like RICE (rest, ice, compress, elevate the joints) for faster recovery. Surgeons may also suggest avoiding strenuous physical activities.

What Are the Advantages of Arthroscopy?

  • Arthroscopy is minimally invasive and does not require opening up completely.

  • It is technically possible to use this procedure in almost all joints.

  • Since small incisions are made, the healing and recovery phase is fast.

  • The injury to the connective tissue and surrounding structures is less than in traditional surgeries.

  • A small stitch or special tape is sufficient to patch up the surgical opening.

  • Pain, discomfort, and stiffness are less in the arthroscopic technique.

  • The formation of scars is negligible.

  • Complications are rare.

What Are the Risk Factors Associated With Arthroscopy?

Complications are infrequent in arthroscopy. Possible reasons to visit the surgeon immediately are fever, chronic pain, discharge, excess swelling, and numbness. Commonly found risks related to arthroscopy are:

  • Nerve and Vessel Damage: Improper handling of instruments may damage the adjacent nerves and blood vessels, leading to numbness and bleeding.

  • Edema: Irrigation fluid may leak into surrounding soft tissue and cause swelling. The swelling will usually subside by itself in a week.

  • Blood Clot: A blood clot is common in any surgery. The collagen and the debris, along with the blood, get thickened and stick together. Although blood clots are rare in arthroscopy, they can be fatal. Hence anticoagulants (drugs that prevent blood clots) are prescribed if necessary.

  • Infection: Antibiotic prophylaxis is used to prevent infections.

What to Expect After Arthroscopy?

Even though the arthroscopy may be performed on different joints and the person may have different experiences, some of the aspects of arthroscopy are the same, these are

  • The clothes and jewelry should be removed and the gown and the shorts provided by the hospital should be worn.

  • A small intravenous catheter will be placed by the nurse a mild sedative will be injected.

What Are the Final Results?

The person should be able to return to the desk job and mild activities within a few days. The person can resume driving within one to three weeks. They can be involved in more intense activity in some days after the initial phase after surgery. But this might not be the case for all the patients, some people's recovery time can vary.

Conclusion:

Arthroscopy is a preferred surgery in many conditions since it is less invasive and has a rapid recovery phase. In addition, arthroscopy is considered a safe and often successful procedure to eliminate pain caused by cartilage and soft tissue damage. Orthopedic surgeons (bone surgeons) perform arthroscopy. They are trained in the diagnosis and treatment of spine and bone disorders.

Frequently Asked Questions

1.

What Is Knee Arthroscopy?

Knee arthroscopy is a minimally invasive procedure done to diagnose and treat various pathological conditions affecting the knee joint. Osteoarthritis is the most common ailment of the knee joint. Arthroscopy uses a small camera and fine instruments to look at and perform the procedure effectively.

2.

What Is Shoulder Arthroscopy?

The shoulder is a versatile joint and much prone to injury. Shoulder arthroscopy helps to delineate the amount of damage to the shoulder bones. In addition, arthroscopy can be used as a treatment tool for minor surgeries which require only minimal opening, like rotator cuff repair, bony excisions, and removal of the joint membrane.

3.

What Is Hip Arthroscopy?

Hip arthroscopy is the most common procedure to visualize the contents of the hip joint since it does not require the opening of the muscles and ligaments. Traction and specialized instruments are used under the guidance of the camera to cut, shave, trim, grasp, and suture after the procedure.

4.

How Long Does the Pain Last After Hip Arthroscopy?

Usually, the procedure is not painful as it is done under anesthesia. And post-surgically, analgesics (painkillers) and anti-inflammatories are given, which will alleviate the pain. And as it is a minimally invasive procedure, the healing time is quick and can be free of pain in sex to eight weeks.

5.

How to Sleep After Hip Arthroscopy?

After hip arthroplasty, it is advisable to sleep on the side of the non-operative side. Comfort by placing a pillow between the knees. Generally, do not lie on the stomach or keep the legs in abnormal positions (like elevated, twisted, or crossed positions) while sleeping after hip arthroplasty.

6.

How Long Does Ankle Arthroscopy Surgery Take?

Most arthroscopy procedures are performed within one hour for diagnostic purposes. If the arthroscopy has opted for a therapeutic purpose like repairing the damaged ligaments, cartilage, bones, and tendons in the ankle, the time taken for the procedure depends on the severity of the damage and instrumentation skill.

7.

How Long Does it Take To Recover From an Arthroscopy?

Arthroscopy will have a quick recovery time compared to open surgery since the damage to the overlying and neighboring tissues of the joints is very minimal. The procedure can be performed on an outpatient basis, and the patients are discharged on the same day. Healing of the inner wounds occurs in one or two months. However, it may take up to six months to regain the complete joint range of motion.

8.

Can Able To walk After Arthroscopic Knee Surgery?

The ability to walk after arthroscopic knee surgery depends on the purpose of the arthroscopy. Usually, one can start walking within a day after arthroscopy and may need the help of crutches for a week or so. If the tissue damage is severe to carry out an extensive arthroscopic approach, then the person may need to rest for two weeks before any weight-wearing activities.

9.

What Type of Surgery Is an Arthroscopy?

Arthroscopy is a minimally invasive surgery where small incisions are made at the surgical site. One incision is used to insert the camera, and the other for performing the task. If needed, another incision can be made for the ease of instrumentation. The purpose of the procedure is to diagnose and treat joint problems.

10.

What to Wear After Hip Arthroscopy?

Braces can be used to support the joint after hip arthroscopy. The main purpose is to reduce the load on the joint while walking or bending. Thephysiciammay advises wearing braces for two weeks and then changing to crutches for another week. This period will give time for the hip joint to initial healing.

11.

What If Knee Arthroscopy Does Not Work?

Knee arthroscopy is not recommended for all patients. Although studies show a 90 % success rate for arthroscopy, there are also a few risk factors and failure outcomes. The physician may decide on whether to go on a second arthroscopic procedure or open surgery.

12.

How Soon Can One Exercise After Knee Arthroscopy?

One can resume daily activities after two weeks of limited motion. Physiotherapy and a rigorous rehabilitation program right after the surgery is recommended. Braces for supporting the knee joint for a few days, followed by crutches, can make the patient walk normally by the end of two months.

13.

How Long to Wear Compression Stockings After Knee Arthroscopy?

Compression stockings after knee arthroscopy should be worn for two weeks. It can significantly reduce the swelling and pain at the site of surgery. Studies have shown a better outcome of treatment with compression stockings during the post-operative phase of knee arthroscopy.

14.

How Long Does Shoulder Arthroscopy Take?

The entire process of shoulder arthroscopy takes place within an hour. It is an outpatient procedure, and the patients are discharged on the same day. Antibiotics and NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed to ease pain and prevent infection. The recovery phase is quick.

15.

How Long to Take Aspirin After Knee Arthroscopy?

Although rare, the collagen and the debris collection during arthroscopy may form a blood clot that could be serious. Hence anticoagulants like Aspirin may be prescribed to prevent blood clots. The tablet is usually taken for five days.

16.

What Kind of Anesthesia Is Used for Hip Arthroscopy?

General anesthesia (complete unconsciousness) is the most common and preferred choice for any arthroscopy. But sometimes regional anesthesias like spinal or epidural injection (a nerve block causing localized numbness) can be used depending on the purpose of the hip arthroscopy.
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Dr. Ranvir Sachin Tukaram
Dr. Ranvir Sachin Tukaram

Orthopedician and Traumatology

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