Arthroscopy

What is an arthroscopy?

Arthroscopy is a surgery done to view, diagnose, and treat joint problems. It is a minimally-invasive surgery done on an outpatient basis. This means that the patient can go home on the same day after the surgery.

Arthroscopy comes from the Greek words “arthro” (joint) and “skopien” (to look). So, arthroscopy means looking into the joint.

In arthroscopy, an orthopedic surgeon makes a small incision in the skin. The surgeon then inserts a miniature instrument called an arthroscope. It helps to view the interior of the joint. The surgery repairs joint damages.

What is an arthroscope?

An arthroscope is a tube-like instrument that contains optical fibers, a small lens, and a video camera to view the interior parts of the joints. The light projected through the fiber optics illuminates the interior of the joint. The small camera takes the images and projects them on a television screen. The surgeon views and treats the problem.

Arthroscopes are of different sizes. The size depends on the joint examined. For e.g., for treating small joints, doctors use arthroscopes about 0.5 mm in size. For joints that are big in size like knee joints, doctors can use a 5 mm long arthroscope.

Where is arthroscopy done?

Arthroscopy helps to diagnose and treat the various parts of the joint such as:

• Knee
• Ankle
• Hip
• Shoulder
• Elbow
• Wrist

Arthroscopy vs open surgery

Whether the surgeon will perform open surgery or arthroscopy depends on the type of joint problems or the injury. A few years back, traditional open surgery was the only option to treat joint problems. Arthroscopy is less invasive, uses a small incision, and shows real-time images of the interior of the joints.

Benefits of arthroscopy:

• Small incision site
• Less blood loss
• Faster recovery
• Limited risks
• Minimal pain
• Less need for pain medications
• Performed in the outpatient setting

Benefits of open surgery

• Used to treat severe and complex injuries
• More space to visualize the injury
• Best suited for small and complex joints
• Broader scope to insert large prosthetics

To date, many surgeons prefer open surgery due to the limited scope of arthroscopy.

Arthroscopic surgery is a good choice for young athletes who want to return to their profession and is also suitable for old people who have exhausted all surgical options for joint treatments. The choice of surgery depends on the orthopedic surgeon and the type of disease.

Preparation for arthroscopy surgery

Preoperative evaluation

The doctor will perform certain diagnostic tests to map the surgical plan such as:

• An x-ray
• CT (computed tomography) scan
• Ultrasound of the soft tissues
• MRI (magnetic resonance imaging) scan of the soft tissues
• Blood tests to ascertain CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), WBC (white blood cell) count, RF (rheumatoid factor), etc.
• Urinalysis

The doctor may also perform a joint aspiration (arthrocentesis) procedure to remove some joint fluid with the help of a syringe to spot abnormalities.

Preparing for the procedure

• Your doctor or healthcare provider will advise you to make certain lifestyle changes. Discontinue certain activities like sports or rigorous exercises if you have injury or pain in the joints.
• The surgical team will explain to you the surgery, aftercare, and potential risks.
• You will be asked to sign a consent form on the day of the surgery.
• On the day of the operation, you have to bring your identification card and other documents.
• The doctor will review your medications. Some medications will be discontinued such as aspirin, NSAIDs (nonsteroidal anti-inflammatory drugs), blood thinners, etc. You must talk to your healthcare provider about other medications, herbal supplements, vitamins, prescription, or non-prescription medications you are taking to avoid complications post-surgery.
• Depending on the type of anesthesia, you will be asked to stop eating foods or drinking liquids after midnight, the night prior to the surgery. There are generally no food restrictions for local anesthesia.
• Ask a friend or a family member to accompany you on the day of the surgery.
• Make arrangements for a ride home.

Procedure

• On the day you are having the surgery, you have to arrive early in the hospital or clinic.
• The nurse will ask you to change to a hospital gown.
• The surgeon may apply local, general, or spinal anesthesia.
• If local anesthesia is applied, you will feel numbness in the joint and slight tugging sensation during the surgery.
• The surgeon will clean the area of the incision site with an antibacterial fluid.
• A small incision will be made.
• The arthroscope will be inserted through the incision site.
• Additional punctures will be made to insert the probe and other instruments.
• A sterile solution will be put inside the joint for improved vision.
• The arthroscope will send images for inspection.
• Corrective surgery will be done to remove damaged tissues.
• After the surgery is over, the fluid and the arthroscope will be removed.
• The incision sites will be closed with stitches or tapes.
• A sterile dressing will be applied.

After surgery

The patient is to the recovery room. The nurse will monitor the patient and check the vital signs. After proper rest, the patient can go home. The nurse or the doctor will explain the post-operative care and give pain medications. Doctors will give instructions regarding joint mobility and the use of crutches.

When should you go for an arthroscopy?

To diagnose the extent of the damage, the doctor will examine the patient. He/she will check the medical history and order x-rays and other imaging studies like an MRI or CT scan.

An arthroscopy helps to treat:

Inflammation

For patients suffering from inflammatory arthritis or rheumatoid arthritis, arthroscopy removes the inflamed inner lining of tissues (synovium) in the joints of the knees, shoulder, wrist, ankles, and elbow. The tissue is biopsied to determine the cause of the inflammation such as arthritis or tuberculosis.

Non-inflammatory diseases

Arthroscopy is used to diagnose irregular cartilages in non-inflammatory diseases like osteoarthritis.

Injuries

Arthroscopy is used to assess joint damage and repair injuries to the ligaments, cartilage, and bones due to:

• Shoulder impingement where the person has difficulty reaching the arms above the shoulders. This happens due to repetitive use of the shoulder, injury, sports activities, or inflammation of the shoulder joints. The lubricating sac between the rotator cuffs known as the bursa can become narrow and cause friction and pain.
• Recurrent shoulder dislocation especially in young athletes.
• Torn rotator cuff repair. To reattach the tendons.
• A meniscus tear in the knees. These injuries mainly occur during sports activities. Aged peope are also prone to degeneration and tear of meniscus tissues.
• Chondromalacia or “runner’s knees” where the cartilage under the patella or the kneecap deteriorates and is torn. This mainly occurs in young athletes but may also affect older adults.
• ACL (anterior cruciate ligament) injury.
• Carpal tunnel syndrome. Pain due to increased pressure in the median nerve of the hand and arm.
• Loose fragments of tissue and cartilage.

Frozen shoulder

Frozen shoulder (adhesive capsulitis) causes stiffness and pain in the shoulder joints. This can occur due to a stroke, mastectomy surgery, shoulder immobilization, inflammation of the muscles or tendons, bursitis, rotator cuff tendinitis, etc.

Removal of fluid from joints

Arthroscopy is often done with joint aspiration. It is a procedure to suck fluid from the knee, shoulder, hip, and other joints. This helps to diagnose arthritis and other joint problems like bursitis, tendinitis, etc. The procedure is done to remove the extra fluid from the joints to allow easy movements.

Surgery options

Most arthroscopic surgeries are done in an outpatient setting. Patients do not have to stay in the hospital. They can go home on the day of the surgery. The decision to have the surgery in a clinic or a specialized hospital depends on the type of surgery and the medical condition of the patient.

Small clinics

Pros

• Cheaper services.
• Many small clinics provide discounts and adjust the cost to individual needs especially if the patient has a long-term relationship with the doctor.
• Individual care.

Cons

• Lack of proper infrastructure to handle emergency situations.
• A small pool of medical staff.
• Lack of proper amenities and latest technologies.

Hospitals

Pros

• Large workforce and medical staff to handle critical patients.
• Specialized doctors from different medical fields.
• Better amenities and high success rates.

Cons

• Big hospitals often fail to provide individual care.
• Doctors have to attend to multiple patients. The quality of services may deteriorate.
• Inability to handle customer grievances.

Cost of surgery

The average cost of routine arthroscopic surgeries comes at an average cost of INR 15,000 to INR 30,000 in India. Arthroscopic repair or reconstruction surgeries may start from INR 50,000 and may go up to 2 lakhs in India. Cost of surgery depends on:

• Type of surgery.
• Hospital facilities.
• Diagnostic tests.
• Inpatient charges include fees for the surgeon and healthcare providers.
• Duration of hospital stay. Aged patients with other medical complications may have to stay for a few days in the hospital.
• Type of implants.
• Specialized surgical instruments.
• Additional care for unwanted complications.

Post-op care and things to keep in mind

Recovery after arthroscopy depends on the type of surgery. Recovery is fast compared to open surgery.

The aftercare regime may include:

R.I.C.E. (rest, ice pack application, compression, and elevation)

Patients at home must follow this regime and take rest, apply ice pack compression, and keep their legs elevated to reduce pain and inflammation.

Exercises

Range-of-motion and stretching exercises can help mobilize the joints and return flexibility. Patients must follow up with their orthopedist and work with physiotherapists for therapies.

Limit activities

Return to normal life is faster in arthroscopic surgery but patients must limit activities to prevent re-injury or trauma to the body. Avoid sports or rigorous activities for a few months.

Eat healthy foods

Eat foods that are good for your body and help to improve the immune system. Avoid alcohol intake.

Medications

After arthroscopy, you may experience pain in the joints. Doctors will prescribe certain pain medications. Take your medications as instructed by the doctor for relief of symptoms.

Dressing wounds

The day after the surgery, you can remove the surgical bandages. Use small strips to cover the puncture wounds. The surgeon will remove the non-dissolvable stitches after one or two weeks. Cover the wound site with a plastic bag before showering. Do not wet the wound site. Keep it clean and dry.

Crutches for protection

Doctors will ask you to use crutches, walkers, or slings for temporary protection and comfort.

Compression stockings

Doctors may recommend wearing compression stockings or socks to increase blood circulation.

Complications

Some patients may complain of certain discomforts or complications after arthroscopic surgery.

• Swelling and redness in the joint.
• Stiffness due to the development of scar tissue in the joint.
• Cartilage damage.
• Infection in the incision sites.
• Formation of blood clots.
• Excessive bleeding.
• Increased pain.
• High fever.
• Breakage of sutures resulting in open wound sites.
• Yellowish-green discharge from incisions showing signs of infection.
• Nerve damage.

Best option

Arthroscopy is a good alternative for open surgeries. Arthroscopic surgeries are minimally invasive, have fewer risks, and recovery is faster. Cost of surgery, procedure, and risks often confuse the patients. A medical care provider can explain to the patients the procedure and possible complications.

Goficure is a medical service provider based in Bangalore. They provide coordinated state-of-the-art medical facilities to patients. Patients having second thoughts about the procedure can contact their services for counseling.

Why choose goficure?

• Best medical assistance.
• Experienced service representatives.
• Easy appointment booking.
• Hassle-free services.
• Get a consultation at the best prices.
• Benefit plans and insurance coverages.
• Proper guidance regarding hospital stays and inpatient charges.
• Transportation facilities.
• Home care facilities.
• Personal service representatives.

References