Arthroscopy - Types, Advantages and Risk Factors

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 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 pain killers, 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.

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.