An arthroscopy is a type of keyhole surgery used to diagnose and treat problems with joints. It’s most commonly used on the knees, ankles, shoulders, elbows, wrists and hips. Arthroscopy uses arthroscope which allows the surgeon to see inside of 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.

Advantages

  • less pain after the operation
  • faster healing time
  • lower risk of infection
  • Patient can often go home the same day
  • Able to return to normal activities more quickly

Difference between Arthroscopic and open surgeries

      Arthroscopic Surgery Open Surgery
  • Smaller incision and scar
  • Less loss of blood
  • Generally faster recovery
  • Less risk of infection
  • Minimizes pain/need for pain medications
  • About to be performed in outpatient settings
  • More room to perform surgically
  • Easier access to large or complex joint injuries
  • Better suited for small, delicate, or complex joints
  • Generally better suited for joint prosthetic placement
  • Higher recovery rates for major tears and injuries

How an arthroscopy is carried out

Preparing for surgery

  • To decide whether arthroscopic surgery is appropriate and/or to map out a surgical plan, orthopedists will perform a number of preoperative tests including:
  • Xray: which uses ionizing radiation to create plain film images of bones and joints
  • Computed tomography(CT): which composites multiple X-ray images on a computer to create three-dimensional “slices” of a joint or joint space
  • Ultrasound: which uses high-frequency sound waves to generate images of soft tissues that may be missed on an X-ray.
  • Magnetic resonance imaging(MRI): which uses powerful magnetic and radio waves to generate high-definition images, particularly of soft tissues.
  • C-reactive protein (CRP), Erythrocyte sedimentation rate(ESR): both of which are biomarkers for generalized inflammation
  • White blood cell(WBC)count: elevations of which are suggestive of an infection.
  • Rheumatoid factor(RF): used to detect antibodies produced in response to autoimmune diseases like rheumatoid arthritis and gout.
  • Before having arthroscopy or any other procedure, be sure to tell the doctor about any medications or vitamins that you are taking
  • Leave all jewelry, watches, and other valuables at home. Wear comfortable clothing that is easy to put on and take off.
  • The night before arthroscopy, do not drink or eat anything unless doctor advised. 
  • The health care provider will scrub the surgical site with some soapy sponges or antiseptic solution  before  going for the procedure.

During the procedure

An arthroscopy is usually carried out under general anesthetic although sometimes a spinal or local anesthetic is used.

In  local anesthetic, the joint will be numbed and not feel any pain patient  may feel some sensations during the procedure, such as a slight tugging, as the surgeon works on the joint.

Antibacterial fluid is used to clean the skin over the affected joint and a small cut, a few millimeters long, is made in the skin next to the joint so that an arthroscope (a thin, metal tube with a light and camera at one end) can be inserted.

The joint is sometimes filled with a sterile fluid to expand it and make it easier for the surgeon to view. The arthroscope sends images to a video screen or eyepiece, allowing the surgeon to see inside of the joint.

Surgeon will be able to remove any unwanted tissue or repair damaged areas using tiny surgical instruments inserted through the additional incisions.

After the procedure, the arthroscope and any attachments are removed, along with excess fluid from the joint. The incisions are usually closed using special tape or stitches and covered with a sterile dressing.

An arthroscopy usually takes 30 minutes to 2 hours, depending on the type of procedure carried out

 be able to go home on the same day as the surgery or the following morning

After Surgery

If general or regional anesthesia was used, patient may take to a recovery room and monitored until they are fully awake. This can take anywhere from 10 to 45 minutes. When steady enough to change into own clothes, patient can be shifted . Pain medication may be provided along with detailed wound care instructions.

People who have undergone in-office arthroscopy under local anesthesia can usually leave immediately after the procedure. Even so, arthroscopy is still considered surgery, and precautions may need to be taken. These may include joint immobilization, pain medications, and the use of crutches or other mobility devices.

Recovery

Arthroscopic surgery usually results in less joint pain and stiffness than open surgery. Recovery also generally takes less time.

The patient may have  small puncture wounds where the arthroscopic tools went into the body. The day after surgery, he will  be able to remove the surgical bandages and replace them with small strips to cover the incisions. The doctor will remove non dissolvable stitches after 1 or 2 weeks.

Recovery from arthroscopic surgery can vary by the type of procedure used. Typically, pain and inflammation are treated with R.I.C.E (rest, ice application, compression, and elevation of the joint).

Less extensive surgeries may only require over-the-counter acetaminophen to alleviate pain. More extensive procedures or those involving larger joints may require a short course of prescription opioid pain killer (usually for no more than three to five days).

In addition to pain management, consistent wound care is needed to avoid infection and wound dehiscence (an opening of the incision). This requires the daily change of dressing during which patient should check for signs of infection. While the wounds heal, patient have to keep the site as dry as possible. This means covering them with a plastic bag when taking shower.

When to Call a Healthcare Provider

Call the health care provider if there is 

  • Uncontrolled bleeding
  • Increasing pain, redness, swelling, and heat at the surgical site
  • High fever (over 100.5 degrees F) and chills
  • A greenish-yellow discharge from the wound
  • Broken sutures with a visibly open wound after arthroscopic surgery 

Returning to normal activities

The health care provider  will tell  what kind of activities to avoid at home. 

Patient will be able to resume desk work and light activity in a few days. and likely be able to drive again in one to three weeks, and engage in more strenuous activity a few weeks after that

Full joint recovery typically takes several weeks. It may take several months to get back to normal.

Rehabilitation or specific exercises can help to speed up the recovery. The doctor will tell once it is  safe to do normal activities.

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

The surgeon will review the findings of the arthroscopy  and may send a written report. And he  will continue to monitor the progress in follow-up visits and address problems

References

https://www.mayoclinic.org/        myoclinic

https://www.nhs.uk/                    NHS

https://www.webmd.com/             web MD

https://orthoinfo.aaos.org/             Ortho info 

 https://www.verywellhealth.com/   verywellhealth