Arthroscopy

What is arthroscopy?

Arthroscopy is a minimally-invasive procedure used to diagnose and treat of conditions affecting joints. The doctor can directly view the internal structures of a joint using an instrument called an arthroscope. An arthroscope is a small, tube shaped instrument that is used to look inside a joint.

Orthopedic surgeons use arthroscopy to diagnose and treat joint problems. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The arthroscope is often used along with other tools that are inserted through another incision.

The joint most frequently examined using arthroscopy is the knee. However, arthroscopy can be used in other joints, including the following:

  • Shoulder
  • Elbow
  • Ankle
  • Hip
  • Wrist

Why might I need arthroscopy?

An arthroscopic procedure may be used to diagnose and assist in the treatment of the following conditions:

  • Inflammation in the knee, shoulder, elbow, wrist, or ankle
  • Injuries, such as shoulder rotator cuff tendon tears or impingement syndrome (pinching of tendons in the shoulder caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade)
  • Cartilage damage, such as tears, injury, or wear
  • Ligament tears with instability in the knee
  • Tendon damage
  • Carpal tunnel syndrome in the wrist
  • Loose bone and/or cartilage, particularly in the knee, shoulder, elbow, ankle,  wrist, or hip 

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Corrective surgery or a biopsy may be done using arthroscopy. For example, torn ligaments can be repaired or reconstructed. Arthroscopic surgery may eliminate the need for an open surgical procedure.

There may be other reasons for your health care provider to recommend an arthroscopy.

What are the risks of arthroscopy?

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

  • Bleeding
  • Infection
  • Blood clots in the legs or lungs

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure.

How do I prepare for arthroscopy?

  • Your health care provider will explain the procedure to you and offer you the chance to ask any questions that you might have about the procedure.
  • You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • In addition to a complete medical history, your health care provider may perform a complete physical exam to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Tell your health care provider if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
  • Tell your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Tell your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
  • You will be asked to fast for 8 hours before the procedure, generally after midnight.
  • You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
  • Based on your medical condition, your health care provider may request other specific preparation.

What happens during arthroscopy?

Arthroscopy may be done on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices. Arthroscopy may be performed while you are asleep under general anesthesia, or while you are awake under localized anesthesia. The type of anesthesia will depend upon the specific procedure being performed. Your anesthesiologist will discuss this with you in advance.

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Generally, an arthroscopic procedure follows this process:

  1. You will be asked to remove clothing and will be given a gown to wear.
  2. An intravenous (IV) line may be started in your arm or hand.
  3. If there is excessive hair at the surgical site, it may be shaved off.
  4. You will be positioned on an operating table, to provide the best access to the joint being operated on.
  5. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  6. The skin over the surgical site will be cleansed with an antiseptic solution.
  7. The doctor may drain blood from the surgical area by elevating the extremity and/or applying an elastic wrap to the extremity. The doctor may instill a fluid solution (generally a saline solution) before the arthroscope is inserted to help distend the joint and reduce swelling.
  8. The doctor will make an incision in the joint area.
  9. The arthroscope will be inserted through the incision, into the joint.
  10. Other incisions may be made to introduce other small grasping, probing, or cutting tools.
  11. Corrective surgery, if necessary, may be performed.
  12. The incision will be closed with stitches or adhesive strips.
  13. A sterile bandage or dressing will be applied.

What happens after arthroscopy?

After surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending on the type of anesthesia that is given. The circulation and sensation of the affected extremity will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to go home. Arthroscopic surgery is usually done on an outpatient basis.

Once you are home, it’s important to keep the incision site clean and dry. Your health care provider will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

Take a pain reliever for soreness as recommended by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Activity and the use of the joint may be limited for 24 to 48 hours after a diagnostic arthroscopy. If other procedures are done, such as a ligament repair, your activity and use of your joint may be limited for a longer period. Your health care provider will give you specific instructions. For knee surgery, you may be given an immobilizer to wear. Your health care provider may also instruct you to apply ice to the surgical site and to elevate the knee when sitting. Specific instructions will depend on the exact procedure performed.

Notify your health care provider to report any of the following:

  • Fever
  • Redness, swelling, bleeding, or other drainage from the incision site
  • Increased pain around the incision site
  • Numbness and/or tingling in the affected extremity

You may resume your normal diet unless your health care provider advises you differently.

Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure