Arthroscopic surgery is a procedure to visualize, diagnose, and treat joint problems, and the name is derived from the Greek words arthron, which means joint, and skopein, which means to look at. Arthroscopy is a procedure to look inside a joint by using an arthroscope, which is instrument like a thin telescope with a light source. It is used to light up and magnify the structures inside joint. Arthroscope is passed through a small cut in the skin and into a joint. Arthroscopy may be done to investigate symptoms such as pain, swelling, or instability of a joint, and this procedure may show damage to cartilage or ligaments within a joint, fragments of bone or cartilage which have broken off, or signs of arthritis. Understanding joints
A joint is where two bones meet, and joints also allow movement and flexibility of various parts of the body. The movement of the bones is cased by muscles, which pull on tendons that are attached to bone. Cartilage covers the end of all our bones. Between the cartilage of two bones which form a joint there is a small amount of thick fluid. This fluid between bones is called synovial fluid. This fluid lubricates the joint which allows smooth movement between the bones without noise. It is also important to know that the synovial fluid is made by the synovium. This is the tissue that surrounds these joints with synovia. The outer part of the synovium is called the capsule and this is tough capsule, which gives the joint stability, and stops the bones from moving out of joint. Surrounding ligaments and muscles also help to give support and stability to joints in human body. In the knee joint, the cartilage covering the lower part of the joint is thickened in the inner and outer part of this joint. These two areas of cartilage are sometimes in anatomy called menisci. The menisci act as shock absorbers in the knee and are sometimes torn following any kind of knee injury.
Moreover, there are two strong cruciate ligaments in the middle of the knee joints. These strong ligaments are attached to the ends of the tibia and femur, or calf bone and thigh bone. These also can be torn following any kind of knee injury.
What is arthroscopic surgery?
In addition to simply looking inside, a doctor can use fine instruments which are also passed into the joint through a small incision in the skin. These instruments are used to cut, trim, biopsy, and grab inside the joint. Arthroscopic surgery can be used for various procedures which include taking out small bits of bone or cartilage that have broken off into the joint space, repairing or taking out torn ligaments, removing damaged cartilage, or removing inflamed synovium. About 17 in 20 arthroscopic procedures are done on the knee joint, about 2 in 20 involve the shoulder, and a small number are done on other joints including the ankle, elbow, wrist or hip. Arthroscopic surgery can often treat or repair joints without the need for a more traditional open surgery of a joint. This open surgery involves a large cut. As a rule, compared to traditional surgery of a joint, with arthroscopic surgery there is usually less pain following the procedure, less risk of complications and shorter hospital stay.
How is arthroscopic surgery done?
Arthroscopy and arthroscopic surgery may be done under local or general anaesthesia, where the type of anaesthesia chosen depends on the joint being examined, and various other considerations. The skin over the joint will be cleaned and you will be asked to adopt a position best suited for the procedure. For example, you may need to lie on your back with your knee bent for knee procedures. In addition, you may lie on your side for shoulder procedures. For arthroscopy of the knee a tourniquet may be put round the upper part of the leg to restrict blood flow. The surgeon makes a small incision (cut) next to the joint just a few millimetres long, so the arthroscope is pushed through the incision into the joint. An arthroscope used for the knee joint is about the width of a pencil, where thinner one is used for smaller joints such as the wrist and ankle. One or more separate incisions are made to push a thin examining probe into the joint, or fine instruments which are used for surgery. It could be also used to push in fluid to make viewing easier and to flush out the joint. The arthroscope transmits pictures through a camera attachment onto a TV monitor, so by looking at the monitor the surgeon can see inside the joint including the ends of the probe or operating instruments. Therefore, for much of the time the surgeon is watching the TV monitor to guide him or her as he or she manipulates the instruments within your%26rsquo;s joint. Arthroscopic surgery can last about one hour, depending on what will be done. When the procedure is finished, the arthroscope and other instruments are removed and incisions may need a stitch or two. However, stitches are often not needed as the incisions are so small. A sterile dressing is put over the incisions. Also, an ice pack may be applied for a while to minimise any swelling. Depending on what was done and the problem you have, a knee joint may then be covered with a large bandage or some other knee support. Many people can go home shortly after the procedure, although the type of problems differ. Therefore, instructions for follow up and what you should and should not do will be give to you by a doctor or nurse. Corrective arthroscopic surgery is performed with instruments inserted through additional incisions. Arthritis can sometimes be treated with arthroscopic surgery, while some problems are treated with a combination of arthroscopic and standard surgery. Also called arthroscopy, this procedure is performed in a hospital or outpatient surgical facility. The type of anesthesia whether it is local, spinal, or general, and the length of the procedure depends on the joint operated on and the complexity of the suspected problem. Arthroscopic surgery rarely takes more than an hour, and most patients who have arthroscopic surgery are released that same day. Only some patients stay in the hospital overnight. It is considered as the most important orthopedic development in the 20th century. Therefore, it is clear that arthroscopic surgery is widely used. The use of arthroscopic surgery on famous athletes has been well publicized, so it is estimated that 80% of orthopedic surgeons practice arthroscopic surgery. Arthroscopic surgery was initially a diagnostic tool used prior to open surgery, but as better instruments and techniques were developed, it began to be used to actually treat a variety of joint problems patient could develop. New techniques currently under development are likely to lead to other joints being treated with arthroscopic surgery in future. Recently, lasers were introduced in arthroscopic surgery and other new energy sources are being explored, because lasers and electromagnetic radiation can repair rather than resect injuries and may be more cost effective than instruments.
Aftercare
Immediately after the procedure, the patient who undergo arthroscopic surgery, will spend several hours in the recovery room. An ice pack will be put on the joint that was operated on for up to 48 hours after this procedure. Pain medicine, prescription or non-prescription, will also be given. The morning after the surgery, the dressing can be removed and replaced by adhesive strips, so the patient should call the doctor upon experiencing an increase in pain, swelling, redness, drainage or bleeding at the site of the surgery, signs of infection, or nausea and vomiting. It takes several days for the puncture wounds to heal, and several weeks for the joint to fully recover after this procedure. Many patients can resume their daily activities, including going back to work, within a few days after arthroscopic surgery. A rehabilitation program, including physical therapy, may be suggested to speed recovery and improve future functioning of joint.
Risks
Complications are rare in arthroscopic surgery, occurring in less than 1% of patients, and complications are infection and inflammation, blood vessel clots, damage to blood vessels or nerves, and instrument breakage. However, in most cases the procedure is done without any problems. Complications occur in less than 1 in 100 cases and can include accidental damage to structures inside or near to the joint, excessive bleeding inside the joint which can cause a lot of swelling and pain, or infection within the joint, which can be serious. As with any operation, there is a risk of allergy to local anaesthetics, or complications of anaesthesia if a general anaesthetic is used so you must be sure specialized doctor will perform arthroscopic surgery to you. After arthroscopy or arthroscopic surgery, see a doctor urgently if you have pain or swelling in the joint which gets worse. In particular, if the joint is also hot, tender and red you should also seek professional care. The reason is that this may indicate bleeding or infection in the joint. You must call your doctor or surgeon if you develop a high temperature or if you see fluid, pus or blood coming from the site of the incision. It is also important to know that you should not develop numbness or tingling near to the joint. It could be huge problem because this numbness commonly indicate nerve damage. In addition, call your doctor for any strange symptom you notice after arthroscopic surgery, similar to any other surgery.
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