Arthroscopy
Arthroscopy is a method of viewing or performing surgery on a joint by use of an
arthroscope, which consists of a tube, a lens, and a light source utilizing fiber optics
to visualize the surgical area. Arthroscopy allows for the
visualization of the interior of a joint through the use of optic instruments. Surgery can
now be performed on larger joints using direct visualization and miniaturized techniques.
After this procedure, the person can often go home the same day.
Information about Arthroscopy
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose and
treat problems inside a joint.
The word arthroscopy comes from two Greek words, "arthro" (joint) and
"skopein" (to look). The term literally means "to look within the
joint." In an arthroscopic examination, an orthopaedic surgeon makes a small incision
in the patient's skin and then inserts pencil-sized instruments that contain a small lens
and lighting system to magnify and illuminate the structures inside the joint. Light is
transmitted through fiber optics to the end of the arthroscope that is inserted into the
joint. By attaching the arthroscope to a miniature television camera, the surgeon is able
to see the interior of the joint through this very small incision rather than a large
incision needed for surgery.
The television camera attached to the arthroscope displays the image of the joint on a
television screen, allowing the surgeon to look, for example, throughout the knee-at
cartilage and ligaments, and under the kneecap. The surgeon can determine the amount or
type of injury, and then repair or correct the problem, if it is necessary.
Before having Arthroscopy
Most arthroscopic procedures today are performed in same-day surgery centers where the
patient is admitted just before surgery. A few hours following the procedure, the patient
is allowed to return home, although usually someone else must drive. Depending on the type
of anesthesia used, the patient may be told not to eat for several hours before arriving.
Before the procedure, the anesthesiologist will ask if the patient has any known allergies
to local or general anesthetics. Airway obstruction is always possible in any patient who
receives a general anesthesia. Because of this, oxygen, suction, and monitoring equipment
must be available. The patient's cardiac status should always be monitored in the event
that any cardiac abnormalities arise during the arthroscopy.
More information about Arthroscopy
The arthroscope is an instrument used to look directly into the joint. It contains
magnifying lenses and glass-coated fibers that send concentrated light into the joint. A
camera attached to the arthroscope allows the surgeon to see a clear image of the joint.
This image is then transferred to a monitor located in the operating room at the time of
the arthroscopy. This video technology is also important for documentation of the
arthroscopic procedure. For example, if the surgeon decides after the arthroscopic
examination that a conventional approach to surgically expose or "open" the
joint (arthrotomy) must be used, a good photographic record will be useful when the
surgeon returns to execute the final surgical plan.
Before an arthroscopy can take place, the surgeon completes a thorough medical history
and evaluation. Important for the accuracy of this diagnostic procedure, a medical history
and evaluation may discover other disorders of the joint or body parts, proving the
procedure unnecessary. This is always an important preliminary step, because pain can
often be referred to a joint from another area of the body. Anatomical models and pictures
are useful aids to explain to the patient the proposed arthroscopy and what the surgeon
may be looking at specifically.
Proper draping of the body part is important to prevent contamination from instruments
used in arthroscopy, such as the camera, light cords, and inflow and outflow drains placed
in the portals. Draping packs used in arthroscopy include disposable paper gowns and
drapes with adhesive backing. The surgeon may also place a tourniquet above the joint to
temporarily block blood flow to the area during the arthroscopic exam.
General or local anesthesia may be used during arthroscopy. Local anesthesia is usually
used because it reduces the risk of lung and heart complications and allows the patient to
go home sooner. The local anesthetic may be injected in small amounts in multiple
locations in skin and joint tissues in a process called infiltration. In other cases, the
anesthetic is injected into the spinal cord or a main nerve supplying the area. This
process is called a "block," and it blocks all sensation below the main trunk of
the nerve. For example, a femoral block anesthetizes the leg from the thigh down (its name
comes from femur, the thighbone). Most patients are comfortable once the skin, muscles,
and other tissues around the joint are numbed by the anesthetic; however, some patients
are also given a sedative if they express anxiety about the procedure. (It's important for
the patient to remain still during the arthroscopic examination.)
General anesthesia, in which the patient becomes unconcious, may be used if the
procedure may be unusually complicated or painful. For example, people who have relatively
"tight" joints may be candidates for general anesthesia because the procedure
may take longer and cause more discomfort.
The portals are closed by small tape strips or stitches and covered with dressings and
a bandage. The patient spends a short amount of time in the recovery room after
arthroscopy. Most patients can go home after about an hour in the recovery room. Pain
medication may be prescribed for a short period; however, many patients find various
over-the-counter pain relievers sufficient.
Following the surgical procedure, the patient needs to be aware of the signs of
infection, which include redness, warmth, excessive pain, and swelling. The risk of
infection increases if the incisions become wet too early following surgery. Because of
this, it is good practice to cover the joint with plastic (for example, a plastic bag)
while showering after arthroscopy.
The use of crutches is commonplace after arthroscopy, with progression to independent
walking on an "as tolerated" basis by the patient. Generally, a rehabilitation
program, supervised by a physical therapist, follows shortly after the arthroscopy to help
the patient regain mobility and strength of the affected joint and limb. |
