Arthroscopy

Introduction

Arthroscopy is a surgical procedure used to inspect and treat problems inside a joint. It allows a surgeon to look inside a joint and examine it closely so that they can determine what is wrong.

An arthroscope is a narrow tube with a light source attached to a tiny video camera, which transmits pictures back to a TV monitor. The arthroscope is passed through a small incision in the skin (arthroscopy is known as a 'keyhole' procedure) and then used to light-up and magnify the joint, so the surgeon can see any damage.

Arthroscopy can be used to investigate conditions such as arthritis, symptoms such as pain or joint weakness, and damage to cartilage or ligaments. Small instruments can be attached to the arthroscope to take a biopsy sample or to cut, trim or remove any loose fragments of tissue, bone or cartilage.

Arthroscopy is most often used to examine the knee joint, but techniques have been developed for using the procedure to examine other joints, including the shoulder, hip, ankle, wrist and the small joints of the fingers.

What is it used for?

Arthroscopy is used when it is necessary to know exactly what is happening within a joint and what can be done to put it right.

An arthroscopy may be done if:

there is a need to look inside a joint to find out exactly what is causing a problem such as pain, swelling or inflammation,
there is a tear in the cartilage of a joint (cartilage is the smooth, connecting tissue that covers the ends of the bones in a joint),
there is a tear in one of the ligaments in a joint (a ligament is a band of fibrous tissue that connects bones or cartilage together),
there is a loose piece of bone in a joint, the joint has become unsteady, or the joint has been affected by arthritis.

Arthritis can cause a thickening of a membrane within the joints called the synovium. This membrane can be easily removed with an arthroscopy.

Advantages

Arthroscopy allows a surgeon to look inside a joint, a place that would otherwise only be reachable by opening up the joint using traditional surgery. Surgeons don't like opening joints wide because they are particularly sensitive to the slightest infection. Joints can be seriously damaged by infection, so anything that reduces this risk is an advantage.

The 'keyhole' technique of arthroscopy has a lower risk of complications than traditional surgery and usually results in less pain after the procedure, a shorter hospital stay and a quicker recovery.

How is it performed?

Arthroscopy can be performed using local or general anaesthetic and may last from 30 minutes to over an hour, depending on the amount of work to be done.

The skin over the affected joint will be cleaned with an anti-bacterial fluid and then two small incisions made - one for the arthroscope and the other for an examining probe or any attachment that is needed to assist with the procedure. The joint may be filled with a sterile fluid to make viewing the inside easier.

The surgeon will be able to see inside the joint using an eyepiece or a TV monitor and, if possible, will repair any damaged areas or remove any unwanted tissue during the procedure. Fluid is sometimes used to 'wash out' a joint, particularly in joints affected by arthritis, as this can relieve symptoms for a few months.

At the end of the procedure the arthroscope and attachments are removed, any fluid is drained from the joint, and the incisions are closed with paper tapes or stitches. A sterile dressing is used to cover the incisions and the joint may be bandaged.

Recovery

Recovery after arthroscopic surgery is normally much quicker than after traditional surgery and you will usually be able to go home the same day.

The incisions are normally pain-free but for a couple of weeks after surgery you may experience some swelling and discomfort in the joint. This can sometimes last longer if the treatment has been for arthritis. You may be given painkillers to take home to ease any discomfort.

Depending on which joint has been examined, for a short while after you may need to use splints, a sling, or crutches, to protect the joint or for comfort.

Most people are able to return to work fairly soon after an arthroscopy, usually within a week, but it does depend on the job you do. For example, the time will be longer if your job involves bending, lifting or carrying, or if it will put increased pressure on the joint that has been examined.

Your surgeon will advise you whether you need to rest the joint or exercise it after the arthroscopy. They will also make arrangements to discuss the results of the arthroscopy with you at a later date.

Results

Most arthroscopies for sports-type injuries do allow a return to sport. In the case of the knee joint, arthroscopy can normally treat damage to cartilage or ligaments successfully.

The scars from an arthroscopy are usually tiny and barely noticeable.