A B C D E F G H I J K L M N O P R S T U V W

ARTHROSCOPY

What is an Arthroscopy ?

Arthroscopy is the internal examination of a joint performed with a small telescope containing its own light source.

Why is an Arthroscopy performed ?

Arthroscopy enables the surgeon to obtain information about the internal structure of a joint which he could not gain from an external examination. It allows the diagnosis of conditions affecting the joint and operative procedures to be carried out through further small incisions. It may also be possible to repair structures within the joint and to remove small pieces of bone or debris floating inside. It is most commonly performed on the knee to confirm and diagnose tears of the knee cartilages and internal knee ligaments. Many of these cartilage tears may be treated using special instruments at the same time that they are observed using the arthroscope. Other joints which may be examined are the shoulder, elbow, wrist, hip and ankle.

Preparations needed for an Arthroscopy

In many hospitals, arthroscopy may be performed in the day ward and you can then be discharged the same day. Preparations will depend upon whether you are being admitted for one day or several days. This in turn depends upon your fitness, the condition for which the arthroscopy is being performed, and the surgeon's normal practice. If it is a day case procedure, it is important that you should attend having had nothing to eat from a time specified by the surgeon. Arrange to be collected by a member of the family or a friend, as driving is not possible after the operation. You will be off work for several days at least, as although the operation uses very small holes, the joint may take several days to recover from the surgery. If there is a delay between the outpatient appointment and the day of surgery, the function of the muscles around the joint should be kept up by exercise, if possible. This will speed recovery.

What Happens during an Arthroscopy

In most cases the operation is performed under a general anaesthetic, although some limited forms of arthroscopy of the knee may be performed under local anaesthetic. A small hole is made through the skin over the joint to be examined and a telescope with its own light source inserted to examine the inside of the joint. Often at least one extra hole is made in order to fill the joint with fluid, while other incisions are made around the joint to insert special instruments to carry out further diagnostic procedures or minor surgical procedures within the joint. At the end of the operation, the small holes may be treated in one of several ways: some surgeons use a single stitch or a small piece of sticking plaster called a Steristrip. Others use no stitches or steristrips at all. (In these cases there may be some early bleeding into the bandages and dressings over the wound. This is usually slight and of no significance.) After the operation a firm bandage is usually applied to the knee to prevent the joint swelling and to give support to the limb. Before the patient is discharged they will be seen by the physiotherapist and given exercises to keep the muscles around the joint functioning, and to prevent unnecessary muscle wasting. If the procedure is performed as an inpatient (several days stay) this may be because the patient is medically unfit to be a day case. In that case a list of any drugs the patient is taking should be provided for the doctor. Otherwise, the procedure is the same.

Possible Complications with an Arthroscopy

There are few major complications associated with this operation. There is the risk of the general anaesthetic. In a few cases a blood clot may form in the leg (deep venous thrombosis) and require treatment with special drugs to thin the blood. Very rarely, a small piece of clot from the leg will dislodge and move to the lungs (pulmonary embolism). This is a serious condition and may warrant drug treatment, or in rare cases, surgical treatment. It may be prevented by keeping the leg mobile. In a very small percentage of cases the joint may become infected and antibiotics and/or surgical drainage may then be required.

After an Arthroscopy

After the operation you will be allowed to go home and will be given exercises by the physiotherapist to keep the muscles around the joint functioning and to prevent unnecessary muscle wasting. The bandages may usually be removed after 2 to 3 days, leaving small Elastoplast dressings in place. You will then be seen in the outpatient clinic at between 7 and 14 days to check that all is progressing satisfactorily. Further appointments will be required, depending on the underlying problem. Once the joint is comfortable after the operation, it may be walked on without fear of damage. All movements may be carried out unless forbidden by the operating surgeon. Depending upon the procedure undertaken, further surgery may be required in the future to correct the conditions identified during the arthroscopy, if these cannot be treated during the arthroscopy.

If an an Arthroscopy is not performed

The original problems that caused the patient to attend the orthopaedic surgeon will continue to give trouble in that there may be locking or giving way of the joint. If an operation is not performed to treat the condition, these symptoms will usually continue.