Minimally Invasive Surgery (Arthroscopy)

Arthroscopy

Description

Arthroscopy is a minimally invasive surgical procedure used by orthopaedic surgeons to visualize, diagnose, and treat problems inside the joint. Because it requires only tiny incisions, arthroscopy can be performed without a major, invasive operation and many procedures can be done on an outpatient basis. The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means, "to look within the joint."

• Arthroscope—Arthroscopy is performed using an arthroscope, an instrument that is approximately the diameter of a drinking straw or pencil. The arthroscope is a thin, fiberoptic scope fitted with a light source and a miniature camera connected to a television screen. Precision tools at the end of flexible tubes are used to perform procedures in the joint while viewing through the scope. The arthroscope can be used for diagnostic procedures as well as a wide range of surgical repairs. High definition monitors and high resolution cameras are among continuing technological advances that make arthroscopy an increasingly effective tool for treating a variety of joint problems.

Arthroscopic Examination

An arthroscopic examination begins with your orthopaedic surgeon making a small incision in the skin that allows insertion of the arthroscope. This instrument provides a clear, illuminated view of structures inside your joint, enabling your surgeon to make a diagnosis of the type and extent of your injury that may be more accurate than can be obtained through X-rays, MRI or open surgery. Although arthroscopy was initially used only as a diagnostic tool for planning standard open surgery, today's advanced instrumentation and surgical techniques enable orthopaedic surgeons to treat many conditions arthroscopically.

Arthroscopic Surgery

Much easier than open surgery in terms of recovery, arthroscopic surgery still requires the use of anesthetics and specialized equipment in a hospital operating room or outpatient surgical suite. Depending on the joint or suspected problem, you may be given general anesthesia (you are put to sleep), spinal anesthesia (you are awake but your body is numb from the waist down), or a local anesthetic (you are awake and only the problem area becomes numb). Discuss anesthesia with your surgeon to determine which option is best for you.

During arthroscopic surgery, a small, buttonhole-sized incision will be made, allowing insertion of the arthroscope. Additional incisions may be necessary to view other areas of the joint or to insert other instruments. If indicated, corrective surgery will be performed using specially designed instruments that are inserted into the joint through accessory incisions. After surgery, the incision(s) will be covered with a dressing and you will be moved to a recovery room.

Advantages

Arthroscopic surgery has received public attention because it is often used to treat well-known athletes, but it is an extremely valuable tool for all orthopaedic patients. Generally easier on the patient than open surgery, most undergo arthroscopic surgery as outpatients and are home several hours afterwards.

Before being discharged, you will be given instructions on how to care for your incisions, what activities to avoid, and any exercises you should do to aid your recovery. During your follow-up visit, your orthopaedic surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program. Occasionally, the surgeon discovers during the procedure that the injury or disease cannot be treated adequately with arthroscopy alone. In this case, extensive open surgery may be performed, either while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon. Several procedures may combine arthroscopic and standard open surgery.

Recovery

The operative dressing can usually be removed within a day or two after surgery and replaced with adhesive bandage strips. The small incisions are typically healed within several days. Although the wounds themselves are small and pain is minimal, depending on what is done inside the joint, recovery can vary from a few weeks to several months. Your surgeon may provide a specific activity and rehabilitation program to speed recovery and protect future function of your joint.

It is not unusual for patients to resume their work, school, or other normal activities within a few days. Athletes and others in good physical condition are, in certain cases, able to return to athletic activities within a few weeks. Of course, recovery times vary with each individual, depending on the complexity of the problem treated, the amount of surgery that was required, and any preexisting conditions.

Complications

Although unusual, complications do occur occasionally during or following arthroscopy. The most common of these include: infection, phlebitis (blood clots of a vein) or DVT (deep vein thrombosis), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage, however these occur in far less than 1 percent of all arthroscopic procedures.