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Arthroscopy is a kind of keyhole surgery that can be used to diagnose and treat joint issues, including preserving joint function or correcting deformities. Common joints to be treated include the knees, elbows, ankles, spine, shoulders, hips and wrists. The procedure uses a thin metal tube called an arthroscope to examine the joint and take pictures, which a surgeon can then use to make a diagnosis. The arthroscope is about the size of a drinking straw, though smaller models are available for smaller joints.
A Japanese orthopaedic surgeon named Professor Kenji Takaji is credited with performing the first arthroscopy in 1918. The technique was improved over the next few decades with the 1960s marking the beginning of its more widespread popularity. The development of fibreoptic technology in particular allowed it to become more efficient. Arthroscopy was seen as particularly advantageous for the treatment of sports injuries as it meant less rehabilitation was needed and athletic careers that may otherwise have been cut short were saved.
Before the procedure
Before you can have an arthroscopy you will need to be assessed to ensure you are OK to go into surgery. Your initial appointment will include an evaluation of your general health as well as advice on preparing for the procedure. This could include rules on what you can drink and eat before your surgery (if having general anaesthetic, you may need to fast for about six hours beforehand) and whether or not you should take any medications. You will also be given information on how likely your recovery time will be and any possible rehabilitation exercises.
Health issues that will have to be considered before you have an arthroscopy (though not necessarily excluding you from the procedure) include heart, lung, liver and kidney function. Diabetes and high blood pressure may also be of concern. Patients who take blood thinning medication may need their regular dose adjusted. The procedure may also need to be delayed if you have an infection (unless it is an infection in the joint that is to be investigated by the arthroscope).
A medical assessment could include blood and urine tests as well as a physical examination. Older patients or those with pre-existing heart and lung problems may need to have an electrocardiogram (ECG) or chest x-ray. If you are a smoker, you will be asked to stop at least until you have recovered from the surgery.
Once you have a thorough understanding of what an arthroscopy could entail, including potential benefits and risks, you will be asked to sign a form to consent to the surgery. You can always ask the surgeon or a nurse if you have any questions or concerns.
About the procedure
The procedure itself is most commonly carried out under a general anaesthetic, but local or spinal anaesthetics can be used in certain circumstances. Your anaesthetist will go through your options and may allow you to choose your preference. A general anaesthetic means you will be unconscious during the surgery, while a local anaesthetic will just numb the relevant joint. You may feel some light sensations such as a tugging while the surgeon is working, but there should not be any pain. A local anaesthetic may be accompanied by sedation to help you relax. Some medications and anaesthesia will be applied by an intravenous line (IV).
When the anaesthesia has taken effect, the skin covering the joint will be cleaned with antibacterial fluid. Next, a cut that is only a few millimetres in length will be made to allow the insertion of the arthroscope into the joint. If other surgical instruments, such as an examining probe, are needed, additional cuts may need to be made.
When the surgeon is examining the joint they may fill it with a kind of sterile fluid so it is easier to see. Any fluid will be drained at the end of the procedure. During the procedure, images captured by the arthroscope will be sent to the surgeon’s eyepiece or video screen so they can have a more detailed view.
If the surgeon does find damage they may make repairs using other surgical tools inserted through small incisions. They may also remove any unnecessary tissue. When the procedure is complete, they will remove the arthroscope and any other tools as well as draining any excess synovial fluid (this helps lubricate the joint). All incisions will be closed with stitches or special tape before they are covered with a sterile dressing.
An arthroscope takes between 30 minutes to two hours depending on the joint and what repairs need to be made. You may be able to go home on the same day or the next morning at the latest.
Why is arthroscopy used?
There are a variety of situations where an arthroscopy may be the best solution for dealing with a joint problem. If a scan such as an x-ray or MRI cannot find the source of any stiffness or swelling, an arthroscope may be the next step. Conditions that may be treated by arthroscopies include:
- Sports injuries
- Torn anterior cruciate ligament (ACL)
- Torn meniscus (cartilage in the knee)
- Temporomandibular disorder (TMD)
- Femoroacetabular impingement (hip abnormality)
- Carpal tunnel syndrome and other repetitive strain injuries
- Baker’s cyst (build up of synovial fluid causing stiffness and swelling)
- Frozen shoulder
- Bone spurs
- Arthrofibrosis (excess scar tissue)
- Synovitis (inflammation of the lining of the joint)
All of these conditions may benefit from an arthroscopy, which can be used to analyse the degree of damage before potentially applying the relevant treatment. Other procedures that may accompany an arthroscopy include:
- Lavage - washing out loose cartilage and inflammatory chemicals
- Debridement - smoothing the surface of the cartilage
- Meniscectomy - removing some or all the torn cartilage
Synovectomy, or removal of part or even all of the synovial membrane, is another potential procedure, but it will only be carried out when an inflamed synovial membrane continues to be unresponsive to other more conservative treatments over an extended period of time. It takes a few weeks for a synovial membrane to regrow. Arthroscopy can also involve the removal of loose bone fragments or foreign objects such as plant matter.
Types of arthroscopy
There are some differences between different types of arthroscopy. For instance, knee arthroscopy is one of the most common procedures, but arthroscopic knee surgery is not usually recommended for osteoarthritis (except in certain circumstances) because it has limited effect. Knee arthroscopy can be used for cartilage and ligament damage and inflammation, or if osteoarthritis cannot be managed through other treatments (such as weight loss and exercise) and is causing the knee to give way. The knee arthroscopy cost will depend on whether you seek private treatment or go to the NHS.
Shoulder arthroscopies are probably the other most common form of arthroscopy and again can be used to alleviate pain and repair damage. They could also be used to clean an infected shoulder joint. The hips, spine, elbows, wrists and feet are less common subjects of arthroscopy, but can still benefit from the procedure. Smaller joints such as those in the wrist require a smaller arthroscope.
Advantages of arthroscopy
Most of the main advantages of an arthroscopy are those associated with keyhole surgery in general. The use of smaller incisions means:
Risks and complications of arthroscopy
Any surgery comes with a risk of complications. An arthroscopy is considered a relatively safe procedure, but you are likely to experience some short-term symptoms in the immediate aftermath. These could include bruising, swelling, stiffness and other discomfort. These types of symptom tend to disappear in few weeks if not a few days.
More serious complications can include:
- Deep vein thrombosis, or a blood clot. This can cause an affected limb to swell painfully.
- Septic arthritis, which is a type of infection inside the joint. It causes pain and swelling as well as a potential fever.
- Bleeding inside the joint can also cause swelling and pain.
- Nerve damage can lead to numbness and loss of sensation. This can be temporary or permanent.
These more serious complications happen approximately once in every 100 cases, or even less.
Recovery times can vary after an arthroscopy depending on both your health and the nature of your procedure. Most people will be ready to go home on the same day or the day after, though you may need painkillers to manage any soreness or discomfort in the joint. A general anaesthetic can cause wooziness for up to 48 hours, so you will need someone else to drive you home and potentially stay with you while you until it wears off. Proper rest is vital in the aftermath of surgery. Avoid alcohol, heavy machinery and any important paperwork that requires concentration.
In some cases swelling can be reduced by elevating the joint and applying icepacks (do not apply ice directly to bare skin). You will need to keep your dressings dry, which may mean covering them with a plastic bag during baths or showers. If they do get wet or otherwise fall off you will need to get them replaced. Most dressings can finally be removed within five to ten days. If you have non-dissolvable stiches, these can be removed between one and two weeks later by a local practice nurse.
Other recovery aids may include a sling (for the shoulder), splint or crutches (for the knee) for a short while. Special compression bandages or pumps may improve blood flow. It is also important to complete any exercises assigned to you by your physiotherapist. These will strengthen the muscles around the joint and help alleviate possible scarring as well as reducing stiffness. If you feel pain during any exercise, talk to your physiotherapist in case your need to adjust your regimen.
After a few weeks you will have a follow-up appointment with your care team to discuss your recovery and any additional treatment that might be necessary.
Symptoms that you should be particularly aware of during your recovery include:
- Having a high temperature/fever
- Severe increasing pain
- Severe increasing swelling and redness
- Discolouration, foul smells and discharge around the wound
- Tingling or numbness
If you experience any of these symptoms, contact your GP or the clinic where you had your surgery immediately. They could signal nerve damage or infection.
Returning to normal life
After you have left the hospital it may still take some time before you are ready to fully return to everyday life. You will be able to drive again once you are strong enough to conduct an emergency stop and are no longer experiencing pain. This may take a few weeks, but it could be months.
It could also be a week or two before you can go back to work, though again this can vary depending from person to person. Obviously, professions that involve heavy manual labour may require a longer recovery period because of the increased risk of re-damaging the joint. Your surgeon will be able to give you more specific advice.
Strenuous physical activity, whether manual labour or sport, will be possible after about six weeks for most people but again could take months depending on your circumstances. As always, consult with your surgeon and be sure to follow all advice from medical professionals including your surgeon and your physiotherapist. The most important thing is to take it slow and do not push the joint before it is ready.
You may find the following information useful which relates to the use of Arthroscopy in the management of osteoarthritis of the knee: