Arthroscopy Health Article

Definition

Arthroscopy is the examination of a joint, specifically, the inside structures. The procedure is performed by inserting a specifically designed illuminated device, called an arthroscope, into the joint through a small incision. Arthroscopy may be used to diagnose, as well as treat, conditions. When a repair is performed, the procedure is called arthroscopic surgery.

Purpose

Arthroscopy is used primarily by physicians who specialize in treating disorders of the bones and related structures (orthopedics) to help diagnose joint problems. Once described as essential for those who primarily care for athletic injuries, arthroscopy is now a technique commonly used by orthopedic surgeons for the treatment of patients of all ages. The six joints most frequently examined are:

• knee
• shoulder
• elbow
• ankle
• hip
• wrist

A joint is a complex system. Within a joint, ligaments attach bones to other bones, tendons attach muscles to bones, cartilage lines and helps protect the ends of bones, and a special fluid (synovial fluid) cushions and lubricates the structures. Direct visualization of the joint allows the doctor to see exactly which structures are damaged. Arthroscopy also permits earlier diagnosis of many types of joint problems, including those that had been difficult to detect in previous years.

Precautions

Arthroscopy is contraindicated for patients with ankylosis, due to the stiffness of the joint involved. Arthroscopy is also contraindicated in patients with an existing local infection, due to the potential for sepsis. Because of inflammation after the use of contrast dye, arthroscopy is contraindicated in patients who have recently undergone an arthrogram. Most arthroscopic procedures are performed as same-day surgery and do not require hospital admission. A few hours following the procedure, the patient is allowed to return home, although usually someone else must drive. Depending on the type of anesthesia used, the patient may need to remain NPO (nil per os, nothing by mouth) for several hours prior to the arthroscopy. Before the procedure, the anesthesiologist will ask if the patient has any known

allergies to local or general anesthetics. Airway obstruction is always possible in any patient who receives a general anesthesia. Because of this, oxygen, suction, and monitoring equipment must be available. Cardiac status should be monitored in the event that any abnormalities arise during the procedure.

Description

The arthroscope is an instrument used to directly examine the joint. It contains magnifying lenses and glass-coated fibers that send concentrated light into the joint. A camera attached to the arthroscope allows the surgeon to view a clear image of the joint. This image is then transferred to a monitor. By attaching the arthroscope to a monitor, the surgeon is able to view the interior of the joint. This video technology is also important for documentation of the arthroscopic procedure. For example, if the surgeon decides after the arthroscopic examination that a conventional approach to surgically expose or "open" the joint (arthrotomy) must be used, a good photographic record will be useful when the surgeon returns to execute the final surgical plan.

The procedure requires the surgeon to make several small incisions (portals) through the skin's surface into the joint. Through one or two of the portals, the pencil-sized instruments that contain a lens and lighting system to magnify and illuminate the joint structures are inserted. The joint is inflated with a sterile saline solution to expand the joint for viewing. Often, following a recent traumatic injury to a joint, the synovial fluid may be cloudy, making interior viewing of the joint difficult. Therefore, a constant flow of the saline solution may be necessary. In other cases, a tourniquet may be applied in order to distend the joint, rather than use an infusion. The arthroscope is placed through one of the portals to view and evaluate the condition of the joint.