What is Arthroscopy?
A surgical procedure through which the internal structure of a joint is inspected for the purpose of diagnosis or treatment, using a tube-like viewing instrument called arthroscope, is known as arthroscopy.
History of Arthroscopy
While Danish physician Dr. Severin Nordentoft first reported on arthroscopies of the knee joint in 1912, it was Professor Kenji Takagi in Tokyo who is known to have performed the first arthroscopic examination of a knee joint in 1919. With the advent of fiber optic technologies in the 1960s, it was Masaki Watanabe, a Japanese physician who invented the arthroscope and also became the first person to use arthroscopy for interventional surgery. Arthroscopy gained popularity thereafter and this technique is now commonly used world over. Arthroscopy is generally performed by an orthopaedic doctor. Patients who undergo arthroscopy need not stay overnight in a hospital and can return home the same day once the procedure is completed.
Technique of Arthroscopy: How is Arthroscopy Done?
Generally performed as an outpatient procedure, arthroscopy requires an intravenous line (IV) to be established for administration of medications, fluids and anaesthesia to the patient in the facility where the procedure will take place. Based on the medical health of the patient and the joint being examined, the type of anaesthesia to be administered is determined. A general, local, regional block or even spinal anaesthesia can be administered for performing arthroscopy.
When the adequate level of anaesthesia is achieved, arthroscopy is initiated. A surgical cut is made on the side of the joint to be inspected and the arthroscope is then carefully inserted into the incision. Additional instruments for surgical repairs are also introduced into the joint through other small incisions. These instruments can be used to sew, cut and remove damaged tissues. Once the arthroscopy procedure is completed, the arthroscope is carefully removed and the incisions are sutured and closed. The incisions are then covered with a sterile dressing and an ACE wrap or brace is placed around the joint.
As mentioned above, the technique of arthroscopy involves the insertion of an arthroscope, i.e. a small tube containing lenses and optical fibers, into the joint via tiny incisions in the skin. A video camera is connected to the arthroscope and the interior of the joint can be viewed on a television monitor. The size of the arthroscope differs according to the size of the joint, which is supposed to be examined. For instance, the arthroscope used to examine the knee is around 5 mm in diameter, while the one used to inspect small wrist joints has an approximate diameter of 0.5 mm. If other procedures are performed using the arthroscope along with the examination of the joint, then it is termed as an Arthroscopic Surgery. Nowadays, there are multiple procedures that are executed in this manner because an arthroscopic surgery is less painful, quicker in recovery and causes less tissue trauma when compared to traditional surgical techniques.
Which Diseases or Conditions Call for an Arthroscopy?
Many inflammatory, non-inflammatory and infectious forms of arthritis and various internal joint injuries can be diagnosed and treated using Arthroscopy. Osteoarthritis or non-inflammatory degenerative arthritis can be seen as an irregular and worn out cartilage through an arthroscope. Young patients suffering from an isolated injury to the cartilage covering the bone ends within a joint can be treated using a paste of their own cartilage cells with the help of arthroscopy. In this procedure, the cells are grown and harvested in the laboratory and are then re-implanted in the knee with the use of an arthroscope, on a later date.
In case of inflammatory arthritis, like rheumatoid arthritis, patients with isolated chronic joint swelling can at certain times get benefited from the arthroscopic removal of the inflamed joint tissue. The synovial membrane can be biopsied and inspected under a microscope to identify the cause of the inflammation and spot infections like tuberculosis, etc. Arthroscopy can offer more concrete information in conditions, which cannot be detected by simply extracting and testing the joint fluid. Although arthroscopy is widely used in the assessment of the shoulders and knees, it can also help in examining and treating conditions of the feet, hips, spine, wrist, elbows and ankles. Arthroscopy can also be used to remove any foreign objects like needles of thorns or loose tissues like chips of cartilage which get lodged within the joint.
Preparing for Arthroscopy
The evaluation of a patient’s health prior to arthroscopy generally includes blood tests, urinalysis and physical examination Patients who are over 50 years of age or have a history of lung and heart problems will usually need to get a chest x ray and electrocardiogram (EKG) done. The arthroscopy usually gets shifted to a late date if there is any sign of infection, except for possible infection in the joint that needs to be treated with the help of arthroscopy.
Minimal blood loss and minor complications may occur during arthroscopy. The underlying health of the patient is given the utmost consideration when evaluating whether they are fit to undergo arthroscopy or not. It is very vital that the patient is tolerant to anaesthesia. The lungs, kidney, heart and liver of the patient should be functioning adequately. It is important to optimize the patients who are also suffering from emphysema or consuming medicines like anticoagulants before performing arthroscopy on them. Medical issues like high blood pressure and diabetes should be controlled before performing the arthroscopic procedure.
What is Recovery Process like Post Arthroscopy?
If general anaesthesia or sedative has been administered during arthroscopy, the patient may feel sleepy after the arthroscopic surgery. Medications for controlling pain may also be given to the patient. The pain may not be felt immediately post surgery by patients on whom a local anaesthetic is used. Patients on whom spinal or regional anaesthesia is used may experience numbness and weakness of the extremities that would gradually get relieved before the patient leaves for his home.
During arthroscopy, one or more 5 mm or 0.25 inch long incisions are made on either side of the joint which are bandaged post surgery. Some of the tissue drainage from these wound areas may get absorbed by the bandage. However, this bandage and wound should be kept as dry as possible during the initial few days after the arthroscopy procedure. The removal of the bandage should only be done under the advice and supervision of the treating nurse or surgeon. On experiencing swelling, warmth, redness, peculiar joint pain or any injury in the involved joint, the patient must immediately report the same to their doctor.
Post arthroscopy, patients are generally asked to rest for several days and keep their joint elevated and also apply icepacks to reduce the pain and the swelling. An exercise program is also gradually initiated to strengthen the muscles surrounding the joint and prevent contracture of the surrounding soft tissues. These are done with the aim of recovering the range of motion, improving stability and strengthening the joint safely and rapidly while averting any build-up of scar tissue. This program is a vital part of the recovery process for an optimal result of this procedure.
What are the Potential Risks and Complications of Arthroscopy?
Arthroscopy is generally considered to be a safe procedure with rare chances of complications. However, there are certain potential complications, like infections and bleeding into the joint and side effects from anaesthesia, which can arise during arthroscopy.
With the progress of technology over the years, superior quality fiber optic equipment has given way to the development of miniature arthroscopes. This has made it possible to examine smaller joints with arthroscopy. Arthroscopy has evolved as an essential tool for orthopaedic surgery and its role will keep on amplifying as more and more improvements are made in arthroscopes and arthroscopic instruments in the times to come.