Arthroscopy and Arthroscopic Surgery

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Note: The information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals and doctors. Always follow the instructions given by your local hospital or doctor relating to any test or procedure.

Understanding joints

A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is cased by muscles which pull on tendons that are attached to bone.

Cartilage covers the end of bones. Between the cartilage of two bones which form a joint there is a small amount of thick fluid called synovial fluid. This fluid 'lubricates' the joint which allows smooth movement between the bones.

The synovial fluid is made by the synovium. This is the tissue that surrounds the joint. The outer part of the synovium is called the capsule. This is tough, gives the joint stability, and stops the bones from moving 'out of joint'. Surrounding ligaments and muscles also help to give support and stability to joints

In the knee joint, the cartilage covering the lower part of the joint is thickened in the inner and outer part of the joint. These two areas of cartilage are sometimes called 'menisci'. The menisci act as 'shock absorbers' in the knee and are sometimes torn following a knee injury. Also, there are two strong 'cruciate' ligaments in the middle of the knee joints which are attached to the ends of the tibia and femur (the calf bone and thigh bone). These also can be torn following a knee injury.

What is an arthroscopy?

Arthroscopy is a procedure to look inside a joint by using an arthroscope. An arthroscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside a joint. An arthroscope is passed through a small cut in the skin and into a joint.

Arthroscopy may be done to investigate symptoms such as pain, swelling, or instability of a joint. An arthroscopy may show damage to cartilage or ligaments within a joint, fragments of bone or cartilage which have broken off ('loose bodies'), or signs of arthritis.

What is arthroscopic surgery?

In addition to simply looking inside, a doctor can use fine instruments which are also passed into the joint through a small incision in the skin ('key-hole surgery'). These instruments are used to cut, trim, biopsy, grab, etc, inside the joint. Arthroscopic surgery can be used for various procedures which include:

• taking out small bits of bone or cartilage that have broken off into the joint space.
• repairing or taking out torn ligaments.
• removing damaged cartilage.
• removing inflamed synovium.

About 17 in 20 arthroscopic procedures are done on the knee joint, about 2 in 20 involve the shoulder, and a small number are done on other joints including the ankle, elbow, wrist and hip.

Arthroscopic surgery can often treat or repair joints without the need for a more traditional 'open' surgery of a joint which involves a large cut. As a rule, compared to traditional surgery of a joint, with arthroscopic surgery there is usually:

• less pain following the procedure.
• less risk of complications.
• a shorter hospital stay (it is often done as a day-case procedure).
• a quicker recovery.

How is it done?

Arthroscopy and arthroscopic surgery may be done under local or general anaesthesia. The type of anaesthesia chosen depends on the joint being examined, and various other considerations. The skin over the joint will be cleaned. You will be asked to adopt a position best suited for the procedure. For example, you may need to lie on your back with your knee bent for knee procedures, or lie on your side for shoulder procedures, etc. For arthroscopy of the knee a tourniquet (pressure band) may be put round the upper part of the leg to restrict blood flow.

The surgeon makes a small incision (cut) next to the joint just a few millimetres long. The arthroscope is pushed through the incision into the joint. An arthroscope used for the knee joint is about the width of a pencil. A thinner one is used for smaller joints such as the wrist and ankle. One or more separate incisions are made to push a thin examining probe into the joint, or fine instruments which are used for surgery, or fluid to make viewing easier and to 'flush out' the joint.

The arthroscope transmits pictures through a camera attachment onto a TV monitor. By looking at the monitor the surgeon can see inside the joint including the ends of the probe or operating instruments. So, for much of the time the surgeon is watching the TV monitor to guide him or her as he or she manipulates the instruments within the joint.

Arthroscopic surgery can last about one hour, depending on what is done. When the procedure is finished, the arthroscope and other instruments are removed. The incisions may need a stitch or two, but stitches are often not needed as the incisions are so small. A sterile dressing is put over the incisions. An ice pack may be applied for a while to minimise any swelling. Depending on what was done and the problem you have, a knee joint may then be covered with a large bandage or other knee support.

Many people can go home shortly after the procedure. The type of problems differ. Therefore, instructions for follow up and what you should and should not do will be give to you by a doctor or nurse. (For example, if you should have physiotherapy, or if you should rest, or if you should exercise, etc.)

Are there any possible complications?

In most cases the procedure is done without any problems. Complications occur in less than 1 in 100 cases and can include:

• Accidental damage to structures inside or near to the joint.
• Excessive bleeding inside the joint which can cause a lot of swelling and pain.
• Infection within the joint - this can be serious.
• As with any operation, there is a risk of allergy to local anaesthetics, or complications of anaesthesia if a general anaesthetic is used.

After arthroscopy or arthroscopic surgery, see a doctor urgently if you:

• Have pain or swelling in the joint which gets worse. In particular, if the joint is also hot, tender and red. (This may indicate bleeding or infection in the joint.)
• Develop a high temperature.
• See fluid, pus or blood coming from the site of the incision.
• Develop numbness or tingling near to the joint (which may indicate nerve damage).

© EMIS and PIP 2006   Updated: February 2006   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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