Arthroscopy Health Article

Preparation

The patient should be kept NPO after midnight the day of the procedure. Follow facility procedure for shaving the skin area around the joint, if needed.

Before the arthroscopy, the surgeon completes a thorough medical history and evaluation, which may reveal other disorders of the joint or body parts. Anatomical models and pictures are useful aids to explain to the patient the proposed arthroscopy and what the surgeon may be looking at specifically.

Proper draping of the body part is important to prevent contamination from instruments used in arthroscopy. Draping packs used in arthroscopy usually include disposable paper gowns and drapes with adhesive backing.

General or local anesthesia may be used during arthroscopy. Local anesthesia is preferred because it reduces the risk of lung and heart complications. The local anesthetic may be injected in small amounts in multiple locations in skin and joint tissues in a process called infiltration. In other cases, the anesthetic is injected into the spinal cord or a main nerve supplying the area. This process is called a "block," as it blocks all sensation below the main trunk of the nerve. For example, a femoral block anesthetizes the leg from the thigh down. Most patients are comfortable once the skin, muscles, and other tissues around the joint are numbed by the anesthetic; however, some patients may be given a sedative if they express anxiety about the procedure. It is important for the patient to remain still during the arthroscopic examination.

General anesthesia may be used if the procedure is unusually complicated or painful, or extensive surgery is planned. For example, people who have relatively "tight" joints may be candidates for general anesthesia because the procedure may take longer and cause more discomfort.

Aftercare

The portals are closed by small tape strips or sutures and covered with sterile dressings and a pressure bandage. The patient spends a short amount of time in the recovery room after arthroscopy. Most patients can go home after about an hour in the recovery room. A routine arthroscopy may take from 30 minutes to two hours.

Following the surgical procedure, the patient needs to be aware of the signs of infection, which include redness, warmth, excessive pain, and swelling. The risk of infection increases if the incisions become wet too early following surgery. Patients can cover the joint with plastic (for example, a plastic bag) while showering after arthroscopy. If a knee arthroscopy was performed, the patient should be instructed to elevate the knee while sitting, and to avoid twisting the joint. Ice may be applied to relieve pain and swelling.

The use of crutches is common after arthroscopy of the knee or hip, with progression to independent walking on an "as tolerated" basis by the patient. Generally, a rehabilitation program, supervised by a physical therapist, follows shortly after the arthroscopy to help the patient regain mobility and strength of the affected joint and limb.

Alternative procedures

Alternatives to arthroscopy depend upon the condition, and have limitations. X rays only examine bones, they will not show ligaments or torn cartilages. Magnetic resonance imaging (MRI) will reveal ligaments and cartilages but does not treat the condition. If a torn cartilage were discovered with MRI, an arthroscopy would be performed to correct the problem. Lateral ligament reconstruction for the treatment of ankle injuries is preferred over arthroscopy.

Complications

The incidence of complications is low compared to the number of arthroscopic procedures performed every year. Possible complications include infection, swelling, damage to the tissues in the joint, thrombophlebitis (blood clots in the leg veins), hemarthrosis (leakage of blood into the joint), pulmonary embolus (blood clots that move to the lung), and injury to the nerves around the joint. Low molecular weight heparin has been found to achieve effective prophylaxis for arthroscopy.

Results

Arthroscopy may show normal ligaments, menisci, and articular surfaces. Findings that require further treatment include spur formation, torn meniscus, and torn ligaments. Another finding that may require further treatment include adhesive capsulitis. In this condition, the joint capsule that naturally forms around the joint becomes thickened, forming adhesions, which results in a stiff and less mobile joint. This problem may be corrected by manipulation and mobilization of the joint with the patient placed under general anesthesia.

Arthroscopic examination is often followed by arthroscopic surgery performed to repair the problem with appropriate arthroscopic tools. The optimal result is decreased pain, increased joint mobility, and improved quality of the patient's activities of daily living (ADL).