Arthroscopy: Indications and Complications

Arthroscopy is a procedure done to visualize, diagnose and treat ailments of the joints. Majority of arthroscopic procedures are done on the knee, 1 million interventions and 2 million diagnoses annually. This procedure, in contrast to open surgeries, requires small incision the size of buttonholes. Through these incisions pencil-thin instruments containing a camera and a light source, and sometimes miniature surgical instruments are inserted. The instrument transmits a high resolution image of the inside of the joint, hence allowing the surgeon to visualise and assess the cartilage and the ligaments inside the joint.

Procedure of Arthroscopy

Arthroscopy is used as a diagnostic and treatment modality. This procedure is generally performed on an out patient basis on the shoulder, elbow, wrist, hip, knee or the ankle joint. After reaching the hospital you will be requested to change into a hospital gown or shorts. Your nurse or anaesthetist will then proceed to give you anaesthesia, the type of which will depend upon the discussion that you’ve had with your surgeon while planning for the procedure. The choices that you might be given are:

• Local anaesthesia: a numbing agent will be injected around the joint which will be undergoing the procedure. You might also be given a sedative along with this to help you relax.
• Regional anaesthesia: an anaesthetic solution is injected into the lower part of your vertebral column to numb the sensations from the procedure. This is one of the most commonly used methods. It makes the lower half of your body numb; you will stay awake and conscious during this type of anaesthesia.
• General anaesthesia: this type of anaesthesia ensures that you are unconscious throughout the procedure. It is administered as an inhalational gas or via an intra venous line.

The joint undergoing the procedure will be cleaned with an anti bacterial fluid. After the effects of anaesthesia have kicked in, a small incision the size of a button hole is made near this joint to insert an arthroscope. Other small incisions may be made to insert surgical instruments if necessary. Your surgeon might opt to inject fluid into your joint to increase visibility. Conditions like torn meniscus in the knee are now being treated arthroscopically. On completion of the procedure the instruments are removed from the joint and the incisions are closed with the help of sutures or sterile tape, depending upon the size of the incisions. The length of the procedure ranges from thirty minutes to two hours.

Indications for arthroscopy

Arthroscopy is a diagnostic and therapeutic procedure. Your doctor might suggest you undergo one when the results from other tests like x ray and CT scans do not yield enough evidence to reach a diagnosis. The conditions that can be treated with the help of arthroscopy are:

• Broken bone or cartilage fragments in the joint capsule
• Torn ligaments (like the anterior cruciate ligament of the knee)
• Inflamed linings of the joint as in many types of arthritis
• Scarring of joints
• Carpel tunnel

Preparation for arthroscopy

Arthroscopy is a procedure that can be performed on an outpatient basis; hence you might be allowed to go home on the same day as the procedure. It is advisable to arrange for someone to drive you home.

While preparing for the procedure you will be requested to follow a specific set of instructions from your doctor to ensure rapid and easy recovery. The instructions vary slightly from person to person, they are:

• Your doctor would want to know the list of medications that you’ve been consuming before the surgery. Inform you doctor if you’ve been taking any herbal supplements. You will be requested to stop taking blood thinning medications before the surgery to reduce the risk of bleeding during the procedure.
• You will be requested to stop taking solid food eight hours before the surgery.

Complications of arthroscopy

Arthroscopy is a relatively safe procedure with low rates of complication. The complications that may arise are:

• Infection at the site of surgery
• Damage to tissue and nerve
• Excessive bleeding and swelling
• Formation of blood clots in the vein
• Instrument breakage.

Recovery from an arthroscopy

Following the procedure, you will be monitored for a few hours until the effect of anesthesia started to wear off. You will be allowed to return home on the same day itself unless there are any complications. It is normal to be able to return to school or work a few days after the surgery, although it may take a few weeks before you gain full mobility in the joint. Your doctor will prescribe medications to help you manage the pain. Rehabilitation and physical therapy might be prescribed by your doctor to help strengthen the muscles surrounding the joint and improve mobility.

Call your doctor immediately if you have:

• Drainage of pus or other fluid from the joint on which the procedure was done
• Pain that doesn’t resolve on consumption of pain medication
• New numbness and tingling.

Sources

• www.nhs.uk
• www.orthoinfo.aaos.org
• https://lsintel.com/market-reports-page.php?id=A315