Arthroscopic surgery

What is it?

Arthroscopic surgery refers to procedures in which surgeons operate on joints through small incisions. This is in contrast to the single large incision used in traditional open surgery.

Using an arthroscope, surgeons can illuminate and magnify the internal structure of joints. An arthroscope is a thin, tubular instrument. It contains a light source and specialized lenses.

Arthroscopic surgery uses small incisions, so recovery is usually less painful than traditional surgery.

In addition, arthroscopic surgery:

• has fewer complications
• requires a shorter hospital stay (or no stay)
• is less expensive
• allows a quicker recovery.

Most arthroscopic procedures are done on the knee joint. Others involve the shoulder. Arthroscopic surgery can also be done on the ankle, elbow, wrist, and hip. But these procedures are much less frequent, and success is less certain.

What it's used for

You doctor may recommend arthroscopic surgery for one or more of the following:

• to remove small bits of bone or cartilage that are floating in the joint space
• to repair or remove torn ligaments
• to remove inflamed joint lining (synovium)
• to remove damaged cartilage
• to reattach a bone fragment that has broken off the end of a bone and is in a joint
• to transplant cartilage (usually limited to knees with limited cartilage injury)
• to drain fluid from an infected joint
• to look at the joint directly
• to take a sample of joint tissue when the cause of knee symptoms is not clear.

Preparation

To prepare for surgery, the doctor will review your allergies and your medical and surgical history. Your doctor will ask for a list of all medications that you are taking. This will include prescription drugs, nonprescription medicines, and herbal remedies.

Before your procedure, your doctor may arrange for you to meet with a physical therapist. The therapist will discuss your postoperative care and rehabilitation program. If necessary, the therapist may fit you for a brace or sling. He or she may teach you how to walk with crutches.

Do not eat or drink anything after midnight the night before surgery. Dress in casual clothes for your trip to the hospital. Leave your jewelry at home.

If you have been using any special orthopedic equipment (crutches, sling, brace, knee immobilizer), bring it to the hospital. Arrange for someone to drive you home after surgery.

How it's done

Arthroscopic surgery takes place in a hospital operating room or outpatient surgical suite.

When you arrive for surgery, you will remove your clothing and put on a hospital gown. A nurse will check your pulse, blood pressure, and temperature. An intravenous (IV) line will be placed in your arm. The IV administers fluid and medications directly into a vein.

In the operating room, the skin over the affected joint will be cleaned thoroughly. Your body will be positioned to give the surgeon the best access to your affected joint. For example, for knee surgery, you may need to lie down with your knee slightly bent.

You will be given anesthesia to make you comfortable (or asleep) during the procedure. Arthroscopic surgery can be performed under local, regional, or general anesthesia. The type of anesthesia depends on several factors. These include:

• the joint being repaired
• the severity of joint damage
• the level of pain before surgery
• other health problems
• your willingness to be awake during surgery.

The surgeon makes a small incision in your joint and inserts the arthroscope. Two additional incisions are made for an irrigation device and surgical instruments. In some cases, a tourniquet will be placed near the affected joint to control bleeding.

An arthroscope used for surgery on the knee joint is about the width of a pencil. The incision is about the size of a buttonhole. For smaller joints, such as the wrist and ankle, a smaller arthroscope is used.

Arthroscopic surgery usually lasts about one hour. When the surgeon finishes repairing your joint, he or she closes the incisions with stitches. Or the surgeon may cover the incisions with sterile dressings. In many cases, sutures are not needed because the incisions are so small.

You will be taken to the recovery room. There, the medical team will monitor your condition. Depending upon the type of arthroscopic surgery, you may have a large bandage, ice pack, or brace on your joint.

After a short period, you should be stable enough to be transferred to a hospital room. In cases of same-day surgery, you will be allowed to go home once you have recovered from the effects of anesthesia.

If necessary, a physical therapist will visit you in your room. He or she can help you adjust to crutches, a sling or a joint brace.

Follow-up

In the days following your surgery, keep the area of your incisions clean and dry. Change your bandages as directed by your doctor. Rest your joint, elevate it and apply ice packs as you have been instructed. Follow the rehabilitation program developed by your doctor and physical therapist. Your doctor may prescribe pain medications, antibiotics or other treatments. Take these exactly as prescribed.

Your doctor will tell you when to return for a follow-up office visit. At this visit, the doctor removes any stitches and assesses the condition of your joint.

Additional visits may be scheduled based on the specific type of surgery and your progress.

Risks

Possible complications of arthroscopic surgery include:

• accidental damage to cartilage or ligaments inside the joint
• excessive bleeding inside the joint
• accidental damage to nerves or blood vessels near the joint
• inflammation and formation of blood clots inside veins, most often in the leg
• joint infection
• breakage of a surgical instrument inside the joint
• allergic or other reaction to an anesthetic.

Complications occur in very few arthroscopic surgeries. Overall, the risk of complications in arthroscopic surgery is much less than for conventional open surgery.

When to call a professional

After arthroscopic surgery, call your doctor immediately if you:

• have increased pain or swelling in the affected joint, especially if the joint is also hot, tender, and red
• develop a fever
• see fluid draining from an incision site, especially fluid that is bloody, foul-smelling, or discolored
• notice that a stitch has come undone and the incision has opened
• observe that the area near a stitch is red and tender
• develop numbness or tingling near your repaired joint.

Additional info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/

American Academy of Orthopaedic Surgeons (AAOS)
https://www.aaos.org/

American Orthopaedic Society for Sports Medicine
https://www.sportsmed.org/