Arthroscopy: Purpose, Procedure, Risk Factors

What is Arthroscopy?

Arthroscopy is a minimally invasive surgical procedure performed to visualize, diagnose, and treat problems inside a joint through a very small keyhole without making any surgical cut in the skin.

Compared to open surgery on a joint, arthroscopy reduces connective tissue damage, scarring, and recovery time, and has a high success rate.

Is this procedure an elective or an emergency procedure?

Arthroscopy is an elective procedure.

Types of procedure

Arthroscopy can be performed on any joint, but mostly it is done to diagnose and treat knee, shoulder, hip, ankle, elbow, and wrist joint abnormalities.

Indications

Arthroscopy may be performed for the following conditions:

• Meniscus injury
• Bony impingement
• Soft-tissue injury
• Articular injury
• Posttraumatic soft-tissue impingement
• Arthrofibrosis
• Synovitis
• Repetitive strain injury of the wrist
• Shoulder joint abnormalities such as rotator cuff tears, subacromial impingement, etc
• Arthroscopic-assisted fracture fixation
• During an ACL reconstruction surgery
• To diagnose the cause of joint pains and joint instability

Contraindications and Risk Factors

Conditions at which an arthroscopy cannot be performed are:

• Presence of any systemic illness
• Local wounds at the arthroscopy site
• Infections at the arthroscopy site
• Presence of any disorders that could affect bone strength or restrict joint mobility

Investigations Before The Procedure

Investigations that are done before performing an arthroscopy are:

• Complete blood count
• Kidney and liver function tests
• Blood sugar tests
• Chest x-ray and ECG

Preoperative Advice

Before performing an arthroscopy:

• Benefits, as well as risks of arthroscopy, are discussed
• The importance of compliance with rehabilitation sessions after the surgery is discussed
• Oral intake should be discontinued after midnight the night before the surgery
• Any blood thinner medications should be discontinued before the surgery

Intraoperative Details

Anesthesia: Arthroscopy can be done under local, regional, or general anesthesia depending upon the joint that is operated and the purpose of arthroscopy. 
Duration: The duration of the procedure depends upon the purpose of arthroscopy.
Description of the procedure: The surgical site is cleaned with an antiseptic solution. After administration of anesthesia, small incisions to the size of a buttonhole are made on the joint. A narrow tube with a fiber-optic video camera on its tip called an arthroscope is inserted into one of the incisions. The arthroscope illuminates and displays the magnified view of the structures inside the joint. Any abnormalities inside the joint are identified. Pencil-sized surgical instruments are inserted through the other incisions to grasp, cut, grind, and provide suction as needed for joint repair. At the end of the procedure, all instruments are slowly withdrawn. Incisions are closed with one or two stitches or adhesive tapes.

Postoperative Details

Postoperatively after an arthroscopy procedure:

• Pain medications are prescribed to relieve pain and discomfort.
• Antibiotics are prescribed to prevent infection and inflammation.
• The operated joint should be placed in a sling or temporary splints for comfort and protection.
• The incision should be observed for any signs of infection like swelling, increased pain, drainage, fever, chills, or blood clots.
• The small puncture wounds may take several days to heal.
• Shower and bathing as directed by the physician. 
• Ice packs can be applied to relieve swelling and pain.

Non-Medical -Role of Diet/Exercise/Lifestyle Changes

Aftercare instructions for an arthroscopy:

• Avoid strenuous activities that put pressure on the operated joint
• There are no specific diet restrictions after an arthroscopy
• Physical therapy is required to improve muscle strength, stability, and range of motion of the joint

Complications

Arthroscopy does not lead to major complications, but some of them are:

• Blood clots
• Infection
• Excessive bleeding
• Damage to nerve structures
• Ligament injury
• Adverse reaction to anesthesia

Prognosis

The overall prognosis of arthroscopy is excellent. The procedure is very effective in diagnosing and treating various joint problems with a high success rate, less scarring, and speedy recovery time.

Indications For Hospitalization If Required

Arthroscopy is a low-risk procedure and is performed on an outpatient basis either in a hospital or clinic. Same-day discharge is common; however, some patients may need to stay overnight. The length of stay largely depends on the type of operative procedure and recovery from anesthesia.

Suggested Clinical Specialist/Department To Consult For The Procedure

Orthopedics
Sports Medicine