Arthroscopy of the Hip, Knee or Shoulder
What is Arthroscopy?
Arthroscopy is a surgical procedure orthopaedic
surgeons use to visualise, diagnose and treat problems inside a
joint.
In an arthroscopic examination, an orthopaedic surgeon makes a small
incision 1 to 1.5 cm in length, then inserts tubes through the incision
in which a fibre optic camera and instruments can be inserted. This
enables the surgeon to see the interior of the joint and undertake
certain procedures, through this very small incision rather than
a large incision needed for surgery.
The television camera displays the image of the inside surfaces
of the joint on a television screen, allowing the surgeon to see
the cartilage and ligaments. The surgeon can then determine the
amount or type of injury, and sometimes undertake repairs or clean
out any debris from the joint.
Why
is Arthroscopy Necessary?
Diagnosing joint injuries and disease begins with
a thorough examination of the patients medical history a complete
physical examination, X-rays, CT scans and sometimes an MRI. When
the surgeon believes there may be a benefit and for certain conditions
an arthroscopy examination is appropriate either to determine an
accurate final diagnosis or to undertake a repair.
Some of the most frequent conditions found during arthroscopic examinations
of joints are:
Inflammation Synovitis - inflamed lining (synovium) in knee, shoulder,
elbow, wrist, or ankle injury - acute and chronic
Shoulder
- rotator cuff tendon tears, impingement syndrome, and recurrent
dislocations
Knee
- meniscal (cartilage) tears, chondromalacia (wearing or injury
of cartilage cushion), and anterior cruciate ligament tears with
instability
Wrist
- carpal tunnel syndrome
Loose
bodies of bone and/or cartilage in the joint of the knee,
shoulder, elbow, ankle, or wrist
Although the inside of nearly all joints can be
viewed with an arthroscope, six joints are most frequently examined
with this instrument. These include the knee, shoulder, elbow, ankle,
hip, and wrist.
How is Arthroscopy
Performed?
Arthroscopic surgery is normally performed under
general anesthetic, but depending on the patients medical history
and the suspected problem, sometimes a spinal or a local anesthetic
is used.
A small incision 1 to 1.5 cm in length (about the size of a buttonhole)
is made to insert the arthroscope. Several other incisions may be
made to see other parts of the joint or insert other instruments.
When indicated, corrective surgery is performed with specially-designed
instruments that are inserted into the joint through accessory incisions.
Nowadays more and more medical conditions can be treated arthroscopically.
Most ligament tears in the knee can be treated successfully with
arthroscopic surgery.
Some problems associated with arthritis also can be treated. Several
disorders are treated with a combination of arthroscopic and standard
surgery.
The following are typically repaired by arthroscopic
surgery:
- Rotator cuff tear
- Repair or resection of torn cartilage (meniscus)
from knee or shoulder
- Reconstruction of anterior cruciate ligament
in knee
- Removal of inflamed lining (synovium) in knee,
shoulder, elbow, wrist, ankle
- Release of carpal tunnel
- Repair of torn ligaments
- Removal of loose bone or cartilage in knee,
shoulder, elbow, ankle, wrist
After arthroscopic surgery, the small incisions
will be covered with a dressing. The patient will be moved from
the operating room to a recovery room. Often little or no pain medication
is needed.
The patient can be discharged the same day or the following day
if general anaesthesia is used.
The amount of surgery required and recovery time
depends on the complexity of the problem. Occasionally, during arthroscopy,
the surgeon may discover that the injury or disease cannot be treated
adequately with arthroscopy alone. Then open surgery may be performed
while the patient is still anesthetized, or at a later date.
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What are the Advantages?
- Less cost in terms of time
Recovery
after Arthroscopy
The small puncture wounds take several days to heal.
The operative dressing can usually be removed the morning after
surgery and adhesive strips can be applied to cover the small healing
incisions.
Although the puncture wounds are small and pain in the joint that
underwent arthroscopy is minimal, it takes several weeks for the
joint to maximally recover. A specific activity and rehabilitation
program may be suggested to speed your recover and protect future
joint function.
It is not unusual for patients to go back to work or school or resume daily activities within
a few days. Athletes and others who are in good physical condition may in some cases return
to athletic activities within a few weeks. Remember, though, that people who have arthroscopy
can have many different diagnoses and preexisting conditions, so each patient's arthroscopic
surgery is unique to that person. Recovery time will reflect that individuality.
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