Arthroscopy

Overview

Arthroscopy (ahr-THROS-kuh-pee) is a procedure that uses a fiber-optic camera to diagnose and treat joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside the joint is transmitted to a high-definition video monitor.

Arthroscopy allows the surgeon to see inside the joint without making a large incision. Surgeons can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions.

Why it's done

Orthopedic surgeons use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the:

• Knee.
• Shoulder.
• Elbow.
• Ankle.
• Hip.
• Wrist.

Diagnostic procedures

Arthroscopy may be used if X-rays and other imaging studies have not offered clear answers.

Surgical procedures

Conditions treated with arthroscopy include:

• Loose bone fragments.
• Damaged or torn cartilage.
• Inflamed joint linings.
• Torn ligaments.
• Scarring within joints.

Risks

Arthroscopy is a very safe procedure and complications are not common. Problems may include:

• Tissue or nerve damage. The placement and movement of the instruments within the joint can damage the joint's structures.
• Infection. Any type of invasive surgery carries a risk of infection. But risk of infection from arthroscopy is lower than infection risk from open incision surgery.
• Blood clots. Rarely, a procedure that lasts longer than an hour can increase the risk of blood clots developing in the legs or lungs.

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

• Avoid certain medicines. Your healthcare team may want you to avoid taking medicines or dietary supplements that can increase your risk of bleeding.
• Fast beforehand. Depending on the type of anesthesia you'll have, you may need to avoid eating solid foods eight hours before starting your procedure.
• Arrange for a ride. You won't be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day.
• Choose loose clothing. Wear loose, comfortable clothing — gym shorts, for example, if you're having knee arthroscopy — so that you can dress easily after the procedure.

What you can expect

Although the experience varies depending on why you're having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard.

• You'll remove your street clothes and jewelry and put on a hospital gown or shorts.
• A healthcare team member will place an IV into a vein in your hand or forearm and inject a medicine to help you feel calm or less anxious, called a sedative.

During the procedure

The type of anesthesia used varies by procedure.

• Local anesthesia. For this form of anesthesia, numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.
• Regional anesthesia. The most common form of anesthetic for regional anesthesia is delivered through a small needle placed between two of the spine's lumbar vertebrae. This numbs the bottom half of your body, but you remain awake.
• General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure. For general anesthesia, the anesthetic is delivered through a vein.

You'll be placed in the best position for the procedure you're having. This may be on your back or on your side. The limb being examined or repaired may be placed in a positioning device. A tourniquet might be used to decrease blood loss and enhance visibility inside the joint.

Another technique to improve the view inside the joint involves filling the joint with a sterile fluid. This expands the area around the joint.

One small incision is made for the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools. These tools can be used to grasp, cut, grind and provide suction as needed for joint repair.

Incisions usually will be small enough to be closed with one or two stitches or with narrow strips of sterile adhesive tape.

After the procedure

After your arthroscopy, you'll be taken to a separate room to recover for a few hours before going home.

Your aftercare may include:

• Medicines. You may be prescribed medicines to relieve pain and inflammation.
• R.I.C.E. At home, it may be helpful to rest, ice, compress and elevate the joint for several days. These steps are referred to as "R.I.C.E." Doing these steps can reduce swelling and pain.
• Protection. You might need to use temporary splints — slings or crutches — for comfort and protection.
• Exercises. Your healthcare team might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.

Call your surgeon or surgical team if you develop:

• A fever.
• Pain not helped by medicine.
• Drainage from your incision.
• Swelling.
• A change in skin color.
• New numbness or tingling.

Results

Talk with your surgeon or surgical team to find out when you can resume activities. In general, you should be able to resume desk work and light activity in a few days. You'll likely be able to drive again in 1 to 4 weeks and engage in more-strenuous activity a few weeks after that.

However, not everyone's recovery is the same. Your situation might dictate a longer recovery period and rehabilitation.

Your surgeon or surgical team will review the findings of the arthroscopy with you as soon as possible. Your surgical team also will keep monitoring your progress in follow-up visits and address any potential problems.