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In the past, if you needed a joint problem repaired, you could usually count on a long hospital stay and painful recuperation — due mostly to the large incisions doctors had to make to access the affected area. But today, thanks to the advent of arthroscopy in the late 1960s and advancements in the procedure in the 1980s, doctors can examine and repair many joint problems using just a few small incisions.
During arthroscopy, the surgeon makes a tiny incision in the area around your joint and then inserts a tubular instrument called an arthroscope. The arthroscope contains a light and a small camera, which projects an enlarged image of the interior of your joint onto a video monitor so that your surgeon can view it. If your joint needs repair, the surgeon can insert surgical instruments into the joint through the arthroscope or through additional small incisions.
Doctors use arthroscopy to help diagnose and treat a variety of joint ailments — most commonly those of the knees, shoulders, ankles, hips, elbows and wrists — in people of all ages.
Joint ailments that may benefit from arthroscopy include:
- Bone spurs or loose bone fragments
- Damaged or torn cartilage
- Inflamed joint linings
- Joint diseases, such as arthritis, that cause tissue or bone to break down
- Joint infections
- Scar tissue
- Torn ligaments
- Unexplainable joint pain
Your doctor may also use arthroscopy to:
- Collect a joint tissue sample (biopsy) for microscopic examination, as is used, for example, to diagnose rheumatoid arthritis
- Monitor the progression of a disease, or determine whether a treatment is working
How you prepare for arthroscopy depends on the joint you need examined and the type of anesthesia you need. Some arthroscopy procedures may require only local or regional anesthesia — anesthesia limited to the general area of your body that's being evaluated. Other arthroscopy procedures may require general anesthesia, which affects your entire body and puts you in a temporary state of unconsciousness.
Because the effects of anesthesia and pain medications may take several hours to wear off, make advance arrangements for transportation home from the hospital or clinic.
Regardless of the type of anesthesia used, you likely need to avoid eating for at least six hours before your arthroscopy. This reduces your risk of vomiting. You're allowed a glass or two of clear liquids, such as water or apple juice, until a few hours before the surgery.
Certain circumstances can complicate the procedure. So before the arthroscopy, tell your doctor if:
- You're pregnant — this may preclude treatment with general anesthesia or certain medications
- You're allergic to any medications, including anesthetics
- You have a skin infection or an infected wound near the affected joint
- You or any family members have had adverse reactions to anesthesia in the past
Expect to have your arthroscopic exam in a hospital or outpatient surgical clinic. Before the surgery, you may be asked to wear a hospital gown. You may be given a sedative to help you relax.
If your procedure requires general anesthesia, an anesthesiologist gives you the anesthetic through a vein (intravenously) or through a mask, from which you inhale the anesthetic as a gas. If a regional anesthetic is used, only a section of your body is numb and you remain conscious.
An orthopedic surgeon specializing in bone, muscle and joint surgery performs the procedure. The surgeon cuts a small incision into your skin. He or she then inserts the arthroscope, which is about the width of a pencil. The joint is filled with saline solution to provide a better view. A beam of light and a small video camera with a magnifying lens are attached to the arthroscope and connected to a monitor so that the surgeon can see the magnified image of the joint.
If your joint needs repair, the surgeon may insert surgical instruments through additional small incisions made around the joint.
When the surgery is complete, your surgeon removes the arthroscope and any other instruments and flushes the joint with a saline solution. The surgeon may also inject local anesthetics into the joint to reduce pain. The incisions may be closed with stitches, if necessary.
During the procedure, the surgeon disinfects the area around the joint and applies sterile drapes to further prevent infection. He or she may use a pressure band (tourniquet) to decrease blood loss and to see the joint better.
A simple arthroscopic procedure generally lasts about an hour. Once the surgery is complete, you're taken to a separate room to recover for a few hours before going home. Your doctor may give you medication to relieve pain and inflammation.
After you go home, you'll need to wrap, rest, ice and elevate the joint for several days to reduce swelling and pain. Depending on which joint required the procedure, you may need to temporarily use splints, slings or crutches for comfort and protection. You may also have stitches, or there may be small adhesive strips over the incisions. Your doctor removes these when you return to see him or her for a follow-up visit.
Your doctor may suggest a rehabilitation program that includes physical therapy to speed your recovery. Most likely, you can resume daily activities within a few days, but it may take several weeks for the joint to fully recover.
Arthroscopy is a relatively low risk procedure. Complications are rare and occur in less than 1 percent of all surgeries.
Possible risks include:
- Bleeding within the joint
- Blood clot
- Damage to ligaments, tendons, muscles or cartilage
- Nerve or blood vessel damage
- Reaction to general anesthesia
Call your doctor immediately if:
- You have a fever greater than 100.5 F, which may indicate an infection
- The incision site bleeds excessively or there is drainage from the incision, which also could signal an infection
- You experience numbness, tingling, severe pain or swelling