Q What is Arthroscopy?
Human body has several important joints that may suffer from injuries or damage over time. Mostly, a few tests help doctors determine the exact cause of the problem and treat it through medication.
Arthroscopy is the process of inserting minor surgical tools to visualize, diagnose and treat joint problems.
The process involves the use of a pencil sized tool that holds a micro camera and lighting system. The tool is inserted in a button hole like incision at the joint area that the surgeon makes and allows the surgeon and other doctors to visualize the internal structure of the joint area on a large screen, wherein they can understand and make out the flaws and injuries that need to be set right.
An injury in joints can be treated through medication. However, in some cases minor surgery is required. In case of a minor surgery, the appropriate tool is inserted and the minor correction is done. This could include trimming of a torn cartilage or addition of surgical cement in a replaced knee joint.
This process is highly important in arthritis diagnosis and treatment. Open surgeries like knee replacement of an osteoarthritis knee can be opted for on a later date after discussion of findings of the arthroscopy. Arthroscopy is also widely used in back pain treatment, although the technique of combining arthroscopy with open surgery is not very well defined.
Q What conditions will a doctor prescribe it?
Arthroscopy is prescribed whenever there is a requirement to confirm any kind of medical doubts generated during previous diagnostic tests like MRI scans, CT scans, X-ray scans and physical examinations, which have indicated towards a certain problem in a particular joint area.
Usually, undertaken as the final diagnostic step, arthroscopy is known to be more accurate than open surgery or X-rays as the process allows surgeons to visualize internal details of the joint on a magnified screen. Bones, cartilages, muscles, tendons and ligaments experience injury and damage during various diseases and also during accidents.
Following are the main conditions that make orthopedics prescribe arthroscopy:
Inflammation at the joint area is often seen in diseased conditions wherein the lining in the knee, wrist, shoulder and ankle suffers from synovitis. A complete diagnosis through arthroscopy is required to finally determine the process.
Joints often suffer acute or chronic injuries which could be in the shoulder, knee, wrist or elbow region. The most common form of injury is the occurrence of loose bodies of cartilage and bones that happen due to partial fracture suffered in minor accidents.
Other important injuries may include tendon tear (rotator cuff), impingement syndrome ad recurring dislocations in the shoulder joint, cartilage tears (meniscus), chondromalacia (cartilage cushion wearing), and ligament tears (often with instability in the knee joints, carpal tunnel syndrome in wrists, and other ligament or tendon injuries in joints.
Problems related to arthritis like cartilage wearing and inflammation are also treated using arthroscopy. The process is often used over multiple times to ensure proper arthritis treatment.
Arthroscopy is also undertaken along with other important surgeries which include rotator cuff surgery, repair and resection of torn cartilage from knee or shoulder, carpal tunnel removal, torn ligament repairs, ligament repair and reconstruction, and removal of loose bones and cartilage in the joint area.
Q How is Arthroscopy performed?
The process of arthroscopy is simple and easy to understand. The patient is asked to change into an operating gown and an anesthetic is administered either locally or generally. A small incision in the skin is made above the joint and the arthroscope is inserted in to the joint area. The extent of damage is observed on a large screen and if treatable surgically, the appropriate surgical process is administered. The complete view of the joint is recorded in the computer and once the procedure is complete, the incision is sealed using small stitches or surgical staplers or simple dressing.
In recent times, multiple buttonhole like incisions are made in different parts of the joint and similar tools are inserted all at the same time to give a complete view of the interiors to the surgeon. These incisions are tiny and do not cause blood loss to patients and are sealed using proper dressings, which allow the incisions to close naturally over time.
Arthroscopy is often a compulsory element of surgeries that involve knee, shoulder, elbow, ankle, hip, and wrist corrections. Other joints may be treated more frequently in the future with more development in orthopaedic techniques and advances in fiberoptic technology.
Q What are the risks?
Every procedure has some risks or the other. Some of the common risks of this process are as follows:
Although designed to detect and rectify injury, the process of arthroscopy may lead to accidental injury to nerves and blood vessels surrounding the joint, leading to unwanted bleeding and numbness. This condition however, occurs rarely. It is important to note that bleeding at the test site can cause obstruction in visualizing the interior details of the joint and therefore, impede with the process making it longer than usual. The skill of the surgeon is to be highly reliable in this regard.
There are minimal chances of infection in arthroscopy as the incision is small and the tools used are highly sterilized. However, accidents like breakage of tools (reported in only one percent of these surgeries) may require creating a larger incision to retrieve external elements from within the body and this might lead to an infection.
#3 Blood Clots
Reported rarely, blood clots in the vessels in and around the joint may occur when obstructive flow happens during the process of arthroscopy. This is a minor risk and can be treated with suitable medication when detected. However, if the clot goes undetected, it may lead to pain and swelling at a later stage.
Q What happens after Arthroscopy is done?
The process is not time consuming and is usually completed within one or two hours.
All patients are required to have normal breathing and pulse rate before being shifted to the recovery ward as the anesthetic administered is either local, general or a spinal. After the patient is shifted to a recovery ward, he/she is observed for swelling or any secondary reaction after the surgery.
There is no need for pain killers at any stage since most arthroscopic procedures help in reducing or diagnosing the cause of pain and does not trigger new pain unless there is a complication. Excessive pain must be reported to the doctor immediately. The findings of the process can be discussed and the patient can opt for a bigger open surgery on a later date or the family may allow it while under the same anesthesia.
Q What is the post op care required?
Post-op care for arthroscopy is mainly geared towards healing of the incisions and recovery of normal movement in the joint area. The doctor prescribes certain measures to allow quick healing of the incisions followed by a few exercises to allow normal activity in the treated joint. For the joint to heal, he may prescribe a few sessions with the physiotherapist. For the incisions, he prescribes the right dressing medication. The doctor also schedules follow-ups to check the rate of healing and remove sutures if any.
Q Will I need home-care services?
Home care services are not needed unless a thorough open surgery has been conducted along with the arthroscopy. When only arthroscopy has been conducted, patients can resume normal activities within a few days and do not experience any joint related pain. However, for the joint to become completely normal, it may take several weeks. Careful movement of the joint area and trained physiotherapy help in the process. You can get home care services for dressing the puncture incisions, although it is not important unless in specific occasions.
Q Will my pain completely subside?
The process of arthroscopy does not cause any new pain at the site of puncture or treatment. Instead, in most cases it reduces the pain that has been caused by defect in the joint area. The corrective surgeries help reduce the pain that the patient chronically suffers from. Once the joint completely heals, the pain is expected to subside entirely.