Arthroscopy

Answer 1

Definition

Arthroscopy is a method of viewing a joint, and, if needed, to perform surgery on a joint. An arthroscope consists of a tiny tube, a lens, and a light source.

See also:

• Knee arthroscopy
• Rotator cuff repair
• Shoulder arthroscopy

How the test is performed

This procedure is typically performed on the knee, shoulder, elbow, or wrist. The type of anesthesia depends on the particular joint and other factors. A regional anesthetic numbs the affected area, but the patient may remain awake, depending on whether other medications are used. For more extensive surgery, general anesthesia may be used. In this case the patient is asleep and pain-free.

The area is cleaned and a pressure band (tourniquet) may be applied to restrict blood flow. The health care provider then makes a surgical cut into the joint. Sterile fluid is passed through the joint space to provide a better view.

Next, a tool called an arthroscope is inserted into the area. An arthroscope consists of a tiny tube, a lens, and a light source. It allows a surgeon to look for joint damage or disease. The device also allows the surgeon to perform reconstructive procedures on the joint, if needed.

Images of the inside of the joint are displayed on a monitor.

One or two small additional surgical cuts may be needed in order to use other instruments. These instruments can be used to remove bits of cartilage or bone, take a tissue biopsy, or perform other minor surgery. In addition, ligament reconstruction can be performed using the arthroscope in many cases.

How to prepare for the test

You should not eat or drink anything for 12 hours before the procedure. You may be told to shave your joint area. You may be given a sedative before leaving for the hospital.

You will be asked to wear a hospital gown during the procedure so the body part for surgery is accessible.

You must sign a consent form. Make arrangements for transportation from the hospital after the procedure.

How the test will feel

You may feel a slight sting when the local anesthetic is injected. After this medicine starts to work, you should feel no pain.

The joint may need to be manipulated to provide a better view, so there may be some tugging on the leg (or arm, if done on the shoulder).

After the test, the joint will probably be stiff and sore for a few days. Ice is commonly recommended after arthroscopy to help relieve swelling and pain.

Slight activity such as walking can be resumed immediately, however excessive use of the joint may cause swelling and pain and may increase the chance of injury. Normal activity should not be resumed for several days or longer. Special preparations may need to be made concerning work and other responsibilities. Physical therapy may also be recommended.

Depending on your diagnosis, there may be other exercises or restrictions.

Why the test is performed

Your doctor may order this test if you have:

• A need for joint surgery
• Damaged meniscus (the piece of cartilage that cushions the knee joint area)
• Joint pain from an injury
• Joint disease
• Lesions or other problems detected by x-rays
• Signs of bone fragments from a fracture
• Signs of a torn ligament
• Unexplainable joint pain

Arthroscopy can also help see if a disease is getting better or worse (this is called monitoring the disease), or to determine whether a treatment is working.

What abnormal results mean

Abnormal results may be due to:

• Bleeding
• Bone fragments
• Damaged meniscus cartilage
• Dislocation
• Lesions
• Rotator cuff tendinitis
• Torn ligaments

What the risks are

• Joint stiffness
• Increased pain
• Infection (fever)
• Inflammation
• Swelling

Special considerations

The diagnostic accuracy of an arthroscopy is about 98%, although x-rays and sometimes MRI scans are taken first because they are noninvasive.

Answer 2

Definition

Arthroscopy is surgery that is done using a tiny camera on the end of a tube to check for and treat joint problems.

See also:

• Knee arthroscopy
• Rotator cuff repair
• Shoulder arthroscopy

Alternative Names

Arthroscopy - hip; Arthroscopy - wrist; Arthroscopy - ankle

Description

This procedure is typically done on the knee, hip, ankle, shoulder, elbow, or wrist.

Three different types of anesthesia (pain management) may be used for arthroscopy surgery:

• General anesthesia. You will be unconscious and unable to feel pain.
• Painkilling medicine. Your joint may be numbed, and you may be given medicines that relax you. You will stay awake.
• Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.

The area is cleaned and a pressure band (tourniquet) may be applied to restrict blood flow. The health care provider will then make a surgical cut into the joint. Sterile fluid is passed through the joint space to expand the joint and provide a better view.

Next, a tool called an arthroscope is inserted into the area. An arthroscope consists of a tiny tube, a lens, and a light source. It allows the surgeon to look for joint damage or disease.

Images of the inside of the joint are displayed on a monitor. One or two other surgical cuts may be needed so the doctor can use other instruments to remove bits of cartilage or bone, take a tissue biopsy, or perform other minor surgery. In addition, ligament repairs can be done using the arthroscope.

Indications

A number of different injuries and diseases may cause joint pain or problems.

Arthroscopy may be needed to:

• Diagnose the cause of joint pain after an injury
• Perform carpal tunnel surgery
• Remove loose bone or cartilage fragments in the joint
• Remove the lining of the joint. This lining is called the synovium, and it may become swollen or inflamed from Arthritis.
• Repair a torn ligament or tendon
• Repair damaged cartilage or meniscus (the piece of cartilage that cushions the knee joint area)

Risks

The risks from surgery are:

• Allergic reactions to medications
• Breathing problems

Other risks from this surgery include:

• Bleeding into the joint
• Blood clot
• Damage to the cartilage, meniscus, or ligaments in the knee
• Infection in the joint
• Injury to a blood vessel or nerve
• Joint stiffness

Expectations after surgery

After the procedure, the joint will probably be stiff and sore for a few days. Ice is commonly recommended after arthroscopy to help relieve swelling and pain.

You can resume gentle activities, such as walking, immediately. However, using the joint too much may cause swelling and pain, and may increase the chance of injury. Do not restart normal activity for several days or longer.

You may need to make arrangements for work and other responsibilities. Your doctor may also recommend physical therapy.

Depending on your diagnosis, you may have other resrictions or need to do certain exercises.

Before You Have the Procedure

You will usually have an MRI scan of the joint done before surgery is planned.

Always tell yoru doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

You will be asked to stop taking drugs that make it harder for your blood to clot beginning 2 - 3 weeks before surgery. These drugs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Naprosyn, Aleve).

Ask your doctor which drugs you should still take on the day of your surgery.

You will usually be asked not to eat or drink anything for 6 - 12 hours before the procedure. Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.

You must sign a consent form. Make arrangements for transportation from the hospital after the procedure.

References

Azar FM. General principles of arthroscopy. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 47.

Miller MD, Hart J. Surgical principles. In: DeLee JC, Drez D Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:chap 2.

Reviewed By

Review Date: 07/28/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, Unviersity of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.