Arthroscopy

Arthroscopy (which comes from two Greek words, "arthro" for joint and "scope" meaning to look) is a surgical procedure that lets doctors see inside the joints to diagnose and treat joint problems.


Purpose/indications
Arthroscopy is done most often in the knee, but it can be done in most joints, including the ankle, hip, elbow, wrist and shoulder. It's typically used to diagnose joint injuries and diseases, including:
minor tissue tears
torn ligaments (strong bands of tissue that connect bones to other bones)
damaged cartilage (dense connective tissue in the joints)
damaged joint surfaces
inflammation of the lining of a joint
Doctors can also use arthroscopy for surgical repairs and other procedures, such as a biopsy (taking a tissue sample for further evaluation) from inside the joint, as well as:

removing loose pieces of bone or cartilage
realigning bones
repairing minor tears in the tissue
irrigating and cleaning an infected area
reconstructing or replacing ligaments

Patient preparation
Before the procedure, discuss the risks and benefits of arthroscopy with your doctor. You'll be asked to sign an informed consent document.
Your doctor will review your medical history and do a physical exam. You may need X-rays of the affected area. In some cases, computed tomography (CT scan -- an imaging technique that creates a computer-generated, cross-sectional picture of internal body parts) or magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) may also be needed. If you're having the procedure on your leg, you'll learn how to use crutches, a walker or a cane while you recover. Follow your doctor's instructions for dietary restrictions the day before your surgery.


Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
Arthroscopy may be done in an outpatient surgical center or a hospital operating room. Depending on the circumstances, you may receive one of the following types of anesthesia:

local (numbs a small area of the body)
regional (numbs a larger area of the body)
general (renders you temporarily unconscious)
Just before the procedure, you'll probably meet with your doctor and anesthetist or anesthesiologist. The affected extremity and joint will be identified and properly marked to ensure that the correct joint is the one treated.

Once you've been anesthetized, the doctor will insert an instrument called an arthroscope into the affected joint through a small incision in your skin. The arthroscope consists of a pencil-sized tube, an optical system of magnifying lenses and a fiberoptic light source. Arthroscopic instruments -- such as probes, irrigating tools, scissors and surgical knives -- may be inserted through other small incisions, depending on the type of surgery being done. To enlarge the joint and make it more visible, the doctor may inject sterile fluid or gas into the joint through another small incision.

Once the arthroscope is inserted into the joint, an image of the joint is displayed on a monitor. The arthroscope can be redirected so that different areas of the joint can be viewed. This magnified view of the inside of the joint can help the doctor diagnose the cause of joint pain, weakness or dysfunction. The doctor may also collect tissue samples or complete certain treatments, as described above.

Arthroscopic surgery typically lasts about an hour. Depending on the circumstances, stitches may be used to close the incision. Most people go home a few hours after the procedure, unless surgical repair is extensive.


Postprocedure care
The affected joint may be somewhat sore and stiff after the procedure. Recovery generally takes a few days to a week, depending on the joint involved and your general health. Ask your doctor for specific instructions about resting the area, changing the dressing, and when to return for a checkup. If appropriate, ask about the need for physical therapy, bearing weight on the affected joint, and how long to use crutches, a walker or a cane.
Call your doctor if:

You notice any signs of infection, such as unusual drainage, increased redness and swelling near the incision site.
You develop a fever.
The pain increases or there's an unusual amount of pain.

Benefits
Arthroscopy allows for greater accuracy in diagnosing joint problems. When you have vague symptoms, for example, arthroscopy can provide specific information that helps the doctor decide the most appropriate treatment. Most arthroscopic procedures can be done on an outpatient basis, which makes them less costly than traditional surgeries. The inside of the joint can be seen better than with an "open" procedure, and recovery and rehabilitation are faster. There is often less pain and scarring, and local anesthesia (which has fewer risks than general anesthesia, which is required for traditional surgery) may be an option.

Risks
Complication rates are low. Possible complications may include:
issues associated with anesthesia, such as problems with blood pressure, heart rate and rhythm, breathing or temperature
injury to blood vessels, nerves, tissues or bone
infection
bleeding
excessive swelling
phlebitis (inflammation of a vein)
thrombophlebitis (inflammation of a vein caused by a blood clot in the vein)
rarely, pulmonary embolism (a blood clot, air bubble, fat deposit or other foreign substance that travels through the bloodstream and lodges in an artery in the lung)
Depending on the degree of injury or disease, some joint conditions may require an "open" surgery.


Considerations
If you're concerned about having surgery, discuss your worries with your doctor. Find out if a noninvasive imaging study, such as a CT scan or MRI, may be accurate enough to diagnose your condition. Ask if a nonsurgical treatment would be appropriate, such as physical therapy, medication for pain and swelling, or support devices (braces, for example). Before choosing a surgical diagnosis or treatment, you may want to seek a second opinion.