Arthroscopic surgery: everything you need to know

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Arthroscopic surgery, also known as arthroscopy, is a minimally invasive orthopedic procedure used to diagnose and treat joint problems. It involves the use of a narrow endoscope called an arthroscope and specialized surgical instruments to access the joint through small keyhole-shaped incisions. Because arthroscopic surgery requires smaller incisions than open surgery , recovery times are often shorter.

Arthroscopy is becoming an increasingly attractive alternative to traditional procedures, but not in all cases.

What is arthroscopic surgery?

Arthroscopy is not a single procedure, but rather a surgical approach that can be used for many different procedures used to diagnose joint problems or treat acute and chronic joint conditions. ( Arthro means "joint" and -scopy means "study or examination").

These procedures were performed as early as 1912, but it was not until 1959 that the first serial arthroscope (named Watanabe 2 in honor of its inventor, Dr. Masaki Watanabe) was introduced .

Today, arthroscopic surgery is considered routine and indispensable, allowing treatment on an outpatient basis where hospitalization was once required. In fact, arthroscopic surgery is considered a critical part of orthopedic resident training and the standard of care for many joint problems.

The arthroscope used transmits images in real time to the monitor so that the surgeon can see the area to be operated on without seeing it directly. It only requires an incision the size of a buttonhole, which means that arthroscopic procedures are not as difficult and risky as open ones.

The instruments used to perform arthroscopic procedures are also smaller and narrower than the scalpels and surgical equipment used in open surgery.

Contraindications

There are few absolute contraindications to arthroscopic surgery, except those related to the operation as a whole .

Arthroscopic surgery should be postponed if there is a localized soft tissue infection around the joint. Arthroscopic procedures are also often avoided if there is poor circulation, which can interfere with healing (especially in the lower extremities) .

One of the absolute contraindications to arthroscopy is severe degenerative joint disease, such as advanced osteoarthritis , in which the articular cartilage is completely exposed (exposed). In such cases, the use of arthroscopy may do more harm than good than open surgery .

Such concerns are justified if the joint space has been excessively narrowed beyond the expected limits . The suitability of arthroscopic surgery versus open surgery must be evaluated on a case-by-case basis.

Potential risks

Arthroscopic surgeries are generally considered safe and have relatively few complications. That said, arthroscopy is an indirect way of imaging the joints, and there is the potential for tissue and nerve damage as instruments are placed and moved in the joint space.

According to a 2018 survey by the American Academy of Orthopedic Surgeons (AAOS) , 7.9% of arthroscopic shoulder surgeries cause medical complications, from a mild nerve injury to a frozen shoulder . Of these, 1% require repeat surgery.

However, the experience of the healthcare professional plays an important role in the risk of such injuries. The same study review found that Podiatrists who received AAOS certification in shoulder arthroscopy performed procedures that resulted in far fewer surgical complications than those who chose not to receive this certification.

Purpose of arthroscopic surgery

According to AAOS, the six most commonly performed arthroscopic surgeries are:

Such procedures can be performed to diagnose or treat a variety of conditions, the most common of which are:

Arthroscopy of the knee and shoulder joints is by far the most common arthroscopic procedure. The spaces within these joints are large enough to accommodate surgical instruments. Recent advances in arthroscopic technology (including miniature cameras and needle-sized probes) have made it possible to perform more delicate arthroscopic surgeries on the wrist and ankle joints.

Technically, arthroscopic surgery can be performed on any joint. However, the ability and / or desire of an orthopedist to use arthroscopy in each joint is limited by the tools available, the practicality of the procedure, and the possible results it can give in a particular case.

For example, while people with small to medium-sized tendon or ligament tears tend to respond well to arthroscopic surgery, recovery rates are typically faster in people with large tears and tears when open surgery is used.

Arthroscopic and open surgical approaches have their pros and cons, and the best choice depends not only on the prescribed treatment recommendations, but also on the experience of the physician.

Arthroscopic surgery

  • Smaller incision and scar

  • Less blood loss

  • Usually faster recovery

  • Lower risk of infection

  • Minimizes pain / need for pain relievers

  • About acting on an outpatient basis

Open surgery

  • More space for surgery

  • Easier access to large or complex joint injuries

  • Best for small, delicate or difficult joints.

  • It is usually more suitable for joint prostheses.

  • Faster recovery from major injuries and tears

Preoperative evaluation

To decide whether arthroscopic surgery is appropriate and / or plan surgery, orthopedists will perform a series of preoperative tests. The diagnostic exam may include imaging tests such as:

  • X- ray that uses ionizing radiation to create simple film images of bones and joints.
  • Computed tomography (CT) scan , which combines multiple x-ray images on a computer to create three-dimensional "slices" of a joint or joint space.
  • Ultrasound , which uses high-frequency sound waves to create images of soft tissue that can be missed on an X-ray.
  • Magnetic resonance imaging (MRI) , which uses powerful radio and magnetic waves to create high-definition images, especially of soft tissues.

The doctor may also order blood tests to check for inflammation, infection, or signs of an autoimmune disease. They may include:

A healthcare professional may also perform arthrocentesis , a procedure in which fluid is removed from a joint with a needle and syringe for examination under a microscope. In addition to detecting abnormalities such as crystallization, the fluid can be cultured to determine if there is a bacterial infection.

How to prepare

If arthroscopic surgery is recommended, you will meet with your orthopedic surgeon (also known as an orthopedic surgeon ) in advance to review the results of the preoperative examination and to discuss the procedure in detail, including preparation and recovery.

Location

Depending on the condition being treated, arthroscopic surgery can be performed in a hospital operating room or in a specialized orthopedic surgery center. Less complex procedures can be performed in an orthopedic surgeon's office under local anesthesia .

In either case, the treatment room will be equipped with a flexible or rigid arthroscope with a built-in lamp and camera. Live images are transmitted to a video monitor over a cable. The surgeon will also have access to specialized surgical instruments such as scissors, hammers, retractors, forceps, cutters, and punches. Some of them pass through the neck of the endoscope, while others are used separately.

What to wear

Depending on the joint being treated, you may need to partially or completely undress. Dress in easy-to-remove, casual clothing. A medical gown will be provided if necessary.

Food and drink

If you are under regional or general anesthesia , you will need to stop eating at midnight the night before the procedure. The same applies to controlled anesthesia (MAC) , a form of intravenous sedation used to relax and wake up from "twilight sleep."

If only local anesthesia is used, there are no food or drink restrictions. That said, MAC is sometimes used under local anesthesia and requires the same restrictions as regional or general anesthesia.

If you are unsure about food / drink restrictions, ask your doctor.

Medicines

To prepare for your surgery, your surgeon will look at the list of medications you are taking. Some of these may need to be temporarily suspended before and after surgery. These include drugs that promote bleeding, especially non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin , Alev (naproxen) , and celebrex (celecoxib) , or blood thinners like Coumadin (warfarin) and Plavix (Clopidogrel) .

These restrictions depend on the type of operation that is performed. To avoid complications, tell your doctor about any medications or supplements you are taking, whether they are prescription, over-the-counter, herbal, nutritional, or recreational.

What Brig

To check in at the hospital or clinic, bring your driver's license (or other government identification), your insurance card, and an approved form of payment if copayment or coinsurance costs are expected to be paid in advance. Leave all valuables at home.

While you should never drive or operate heavy equipment after undergoing general anesthesia, regional anesthesia, or MAC, it is best to exercise caution and have a friend or family member drive you home no matter what type of anesthesia you are using. . Receive. Even if carpal tunnel surgery is performed under local anesthesia, limiting wrist movement can make driving dangerous.

Preoperative lifestyle changes

There are many different reasons for arthroscopic surgery, some of which may require lifestyle changes to ensure a full recovery. For example, joint problems in the lower extremities are often exacerbated by obesity and can be improved by losing weight before and after surgery.

The same applies to repetitive stress injuries, which often require prolonged immobilization of the joint and correction of the behavior that contributed to the injury . This may include stopping playing certain sports or changing responsibilities if the injury is work-related.

What to Expect the Day of Surgery

On the morning of your procedure, you may need to wash and cleanse yourself with an antibacterial agent before leaving home.

Upon arrival, you will be asked to register, complete a medical information sheet, and sign a consent form confirming that you understand the purposes and risks of the procedure. They then take him to the back to undress and put on a hospital gown.

In addition to the orthopedic surgeon, the surgical team may include a surgical nurse, an anesthesiologist , a medical technician, and a nurse. In office procedures, only a podiatrist and assistant may be required.

Before the surgery

After the change, the nurse measures your height, weight, and vital signs (including temperature, blood pressure, and heart rate). A blood sample may also be taken to check blood chemistry.

For procedures involving general anesthesia, regional anesthesia, or MAC, an intravenous (IV) line is inserted into a vein in your arm to deliver medications and fluids. Adhesive probes are then placed on the chest to monitor the heart rate on an electrocardiogram (ECG) machine , while a pulse oximeter is attached to a finger to monitor the oxygen saturation in the blood .

During the operation

After preparation for the operation, appropriate anesthesia is administered, either by local or intravenous injection.

After that, you will be in the best position for the procedure. It can be supine (face up), face down (face down) or lateral sores (face up). In elbow and wrist surgery, the joint is usually placed in an elevation called a hand table.

Arthroscopic surgery uses different types of instruments, each designed for a specific joint or joint condition. For example, the instruments used for wrist arthroscopy will be different from those used for hip arthroscopy.

There are larger or smaller arthroscopes; some have angled cameras or have special filters or accessories. Others, called needle arthroscopes, have retractable instruments that can cut, shave, clamp, and suture damaged tissue. (In this way, more and more rotator cuff injuries are repaired.)

Your healthcare provider will select the appropriate instruments for your surgery, but the incisions used to access this area are the same regardless of the procedure performed. By definition, arthroscopy includes incisions smaller than 3 centimeters (about 1 inch). Many procedures can be done with incisions as small as 0.25 centimeter ( 1/4 inch) or even smaller.

A primary incision is made to insert the arthroscope to help guide the placement of the instruments. Sometimes only this cut is needed.

In other cases, additional incisions are made to accommodate the various instruments needed to repair, resect (cut), release (cut), reduce (shrink), or process (remove damaged tissue) of the joint or joint space.

The total number of incisions depends on the joint and the purpose of the operation.

If the joint space is particularly narrow, the surgeon can prepare the site with an injection of saline. This helps expand the space and provides a clearer view of the joint.

The following steps differ depending on the procedure being performed. For example, if a surgeon removes inflamed tissue to treat impingement syndrome, he or she can work to surgically repair the damaged tissue during ankle arthroscopy.

At the end of the operation, the incisions are closed with sutures or adhesive strips (called sterile strips) and a bandage is applied to the joint. A support, such as a splint, brace, walking shoes, or a cast, can be used to immobilize the joint and ensure proper healing.

After the operation

If general or regional anesthesia was used, you will be taken to the recovery room and monitored until you are fully awake. This can take 10 to 45 minutes. When you're stable enough to change, you can go. Pain relievers can be provided along with detailed wound care instructions.

People who have had an in-office arthroscopy under local anesthesia can usually leave immediately after the procedure. Even so, arthroscopy is still considered a surgical procedure and precautions may be necessary. These may include immobilizing the joints, taking pain relievers, and using crutches or other means of transportation.

Recovery

Recovery from arthroscopic surgery may depend on the type of procedure used. Pain and swelling are usually treated with RISA (rest, ice, compression, and elevation of the joint).

Less extensive surgeries may require only over-the-counter Tylenol (acetaminophen) for pain relief. Longer procedures or procedures involving larger joints may require a short course of prescription opioid pain relievers (usually no more than three to five days).

In addition to pain relief, ongoing wound care is necessary to prevent infection and wound dehiscence (incision opening). This requires changing the dressing daily, during which you need to check for signs of infection .

When to call your healthcare provider

Call your surgeon if you experience any of the following symptoms after arthroscopic surgery:

  • Uncontrolled bleeding
  • Increased pain, redness, swelling, and fever at the surgery site
  • High fever (over 100.5 degrees Fahrenheit) and chills
  • Greenish-yellow discharge from the wound.
  • Broken stitches with a clearly open wound

Recovery

One of the main benefits of arthroscopic surgery is that it limits damage to the soft tissue that surrounds the joint. Not only are bleeding, swelling, and inflammation minimized, recovery is typically shorter than with open surgery.

When the joint no longer requires immobilization, range of motion and strengthening exercises can usually begin to restore flexibility and strength to the joint. It is often helpful to work with a physical therapist who can provide in-office treatment (such as hydrotherapy and soft tissue mobilization ) and develop an exercise and rehabilitation program that you can do at home.

You should also make sure you have regular follow-up visits to your podiatrist to monitor any new or unexpected complications and make sure your condition improves as expected.

How to deal with your recovery

Although you can usually return to normal activities more quickly with arthroscopic surgery, it may take many months before you fully recover and your symptoms disappear. During this time, there are limits on how much activity you must do.

Type of arthroscopic surgery Recovery time
Recovery from chondromalacia 4 to 5 months
Rotator cuff tear 3 to 6 months
Impact shoulder syndrome 3 to 6 months
Meniscus repair 3 to 8 months
ACL recovery 6 to 9 months
Carpal tunnel surgery Up to 10 months

After all, arthroscopy is traumatic to the body and can increase pain, stiffness, and the risk of re-injury if not treated properly. Increasing your activity level gradually can help prevent these problems from occurring.

Get the word of drug information

Arthroscopic surgery has evolved from an attractive alternative to open surgery to the standard treatment for many types of joint problems. Still, arthroscopic surgery is not a universal solution.

If your healthcare provider doesn't recommend arthroscopic surgery for any reason, try to be unbiased and ask as many questions as you need to understand why. If you are still in doubt, do not hesitate to seek the advice of an orthopedic surgeon who specializes in your condition.

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