In arthroscopy, a thin, flexible viewing tube consisting of small lenses, a video camera and a light for viewing (called an arthroscope) is inserted through a small incision and into the interior of a joint, most often the knee. Fiberoptic cables permit the surgeon to visually inspect the internal joint structures. In addition, surgical instruments may be inserted, either through the scope or through other small incisions in the area, in order to obtain tissue or fluid samples or to perform therapeutic procedures.
Purpose of Arthroscopy
- To examine the interior of a joint (most often the knee, but also the hip, ankle, wrist, elbow, shoulder, or jaw) for the presence of disease or injury
- To monitor the course of joint disease and the effectiveness of therapy
- Used therapeutically to irrigate or to perform surgery on a joint
Who Performs Arthroscopy
- A physician or a surgeon trained in arthroscopic procedures.
Special Concerns about Arthroscopy
- Arthroscopy is not appropriate if you have fibrous ankylosis (a condition characterized by the stiffening of joints in a fixed position) or a local skin or wound infection.
- This procedure is usually done under local anesthesia but may require spinal or general anesthesia—especially if arthroscopic surgery is anticipated.
- Arthroscopic surgery is associated with fewer risks, less postoperative pain, and faster recovery than open surgery (arthrotomy); however, if bleeding or other complications occur, or the procedure cannot be completed satisfactorily, arthrotomy may be required.
- If general anesthesia is required, do not eat or drink anything for 6-12 hours before the procedure.
- You will be asked to disrobe and put on a hospital gown.
- Empty your bladder just before the test.
- If the procedure will be performed under local anesthesia, you may be given a sedative before the test to relax you.
- If general anesthesia is required, an intravenous (IV) catheter is inserted into a vein in your arm, and the medication is administered. A thin tube attached to a breathing machine will be inserted through your mouth and into your windpipe to ensure you breathe properly during the procedure.
- Tell your orthopaedic surgeon if you take any medications or supplements
What You Experience
- You will either sit or lie down on a table, depending on the joint being examined.
- The hair surrounding the joint is shaved (if necessary) and the area is cleansed with an antiseptic solution. If applicable, a local anesthetic is injected. (This injection may cause brief discomfort.)
- If the knee is being examined, your leg will be elevated and wrapped in elastic bandages from toe to thigh. A tourniquet may be applied to reduce the amount of blood present within the joint (causing an uncomfortable sensation of pressure), or a fluid mixture containing epinephrine and saline solution may be instilled into the joint to distend the knee and reduce bleeding. These measures will help to improve the doctor’s view.
- A small incision is made, and the arthroscope is inserted into the joint. Magnifying devices allow the doctor to directly view the joint interior, and images of the area may also be transmitted onto a TV screen and recorded for later examination. The scope may be moved to different locations as needed.
- Following inspection of the joint, the doctor may insert surgical instruments through small incisions to remove tissue or fluid samples for laboratory analysis or to perform therapeutic measures.
- The scope and other instruments are removed, the joint is irrigated, and all incisions are closed with stitches or adhesive tape. Steroid medications may be injected to reduce any inflammation, and a pressure bandage may be applied to the joint.
- The procedure usually takes 30 to 40 minutes for examination and up to 2 hours if surgery is required.
- Risks and Complications
- Rare complications include infection, thrombophlebitis (a blood clot in a vein in the leg), accumulation of bloody fluid in the joint, excessive swelling and injury to nerves, blood vessels and joint.
- If general anesthesia is necessary, the procedure carries the associated risks.
- You will rest in bed until you recover from the effects of anesthesia and any sedation. During this time, your vital signs will be monitored and you will be observed for signs of complications.
- The joint that was examined may be wrapped in bandages or (for a shoulder or elbow) placed in a sling.
- If the procedure was performed under general anesthesia, arrange for a ride home.
- Your doctor may ask you to keep the examined joint elevated and to minimize use of the joint for several days (or longer, if surgical treatment was performed). For a knee joint, this may require using crutches.
- The joint may be painful and slightly swollen for several days to weeks, depending on the extent of the procedure. Apply ice to reduce these symptoms. Your doctor may also prescribe pain-relieving medications.
- Call your doctor immediately if you experience severe swelling, fever, or redness or pus at the incision site.
- During visual inspection of the joint, the doctor will note any abnormalities. Any tissue or fluid samples are sent to a laboratory for analysis. Your doctor will consider these results along with your symptoms, your physical exam, and the results of other tests.
- Arthroscopy can often provide a definitive diagnosis. Your doctor will recommend appropriate treatment.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media