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CONTENTS
Arthroscopy is the examination
of the inside of a joint with a small telescope. The technique
was developed in the 1970s and allows examination of the joint
through very small incisions which are much less painful than
standard "open" surgery. For the procedure, several
small incisions are made into the joint, and the arthroscope,
which is slightly smaller than a pencil, is inserted and directed
to different portions of the joint. The joint is filled with
saline (mild saltwater) to stretch the parts out allow them to
be seen. Because a lot of saline washes through the joint during
a procedure, the infection rate is quite low. The view of the
inside of the joint is picked up by a small TV camera, and the
surgeon actually watches it on a television.
The structures inside of the
joint can be viewed through the arthroscope. Tissues which are
damaged or deteriorated can be inspected and probed in order
to determine whether they are the source of the problem. Loose
fragments within the joint ("joint mice") often can
be removed. Torn pieces of cartilage, especially in the knee,
shoulder, and wrist, can be trimmed so that the torn fragments
do not get pinched in the joint. Some torn structures can actually
be repaired with sutures, although this can be very difficult.
Structures which are too tight can be partially cut to loosen
them up, and the lining of the joint, which sometimes becomes
so swollen that it becomes pinched, can be trimmed away. Bone
prominences can be smoothed with a burr. In the knee, the arthroscope
can also be used to guide the reconstruction of a torn cruciate
ligament.
Thus, arthroscopy is very useful for diagnosis. In larger joints,
it is often used for the surgical treatment of certain problems.
The most commonly examined joint is the knee, but the shoulder,
elbow, ankle, hip, and wrist can also be examined and sometimes
treated.
Arthroscopy is an operation,
and so you will need to be physically examined and your general
health evaluated prior to an arthroscopic procedure. Once it
has been determined that you are healthy enough for the procedure,
you will be scheduled for surgery in either the main hospital
or the Ambulatory Care Center. An anesthetic is necessary. A
general anesthetic, a spinal anesthetic, or occasionally a local
anesthetic is used. The local anesthetic is safest, but there
will be some discomfort, as the joint is twisted into different
positions to allow visualization of its various parts. After
the surgery is completed, the small incisions are usually closed
with tiny pieces of tape and then covered with a dressing. An
hour or two will be spent in a recovery room and perhaps another
hour or two in the waiting room while you awaken completely.
Your family members may wait with you in the waiting room. You
must have an adult family member or friend stay during the time
you are h ere. This person must be able to take you home and
stay with you the evening after your surgery in case you become
sick or need help.
As surgery goes, arthroscopy
is very safe. As with any surgery, some patients develop unexpected
complications and deaths have been reported. Some patients have
a bad reaction to the anesthetic drugs and that is the reason
that spinal or local anesthetics may be recommended to you, as
they are somewhat safer. Rarely, other complications due directly
to the surgery may occur. These include damage to a nearby blood
vessel or nerve, or possibly an infection or phlebitis after
the surgery. Again, these risks are less than for "open" surgery.
| What Should I Expect Afterwards? |
Patients do have pain after
arthroscopic surgery, although it is much less than with "open" surgery. Some patients are able to walk on an arthroscopically-treated
knee immediately after surgery, although many will use crutches
for a day or two. Depending on the condition treated, patients
may gradually get back to normal activities within a few weeks
to a few months.
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