Arthroscopy

Why It Is Done

Arthroscopy is used to:

• Evaluate and diagnose a joint problem when a physical exam and other tests don't give a clear result. These tests may include X-rays, blood tests, CT scans, or magnetic resonance imaging (MRI).
• Do surgery to repair a joint problem.

It may be used during surgery to:

• Shave bone tissue to remove calcium deposits or bone spurs.
• Repair or trim soft tissues, such as ligaments, tendons, or cartilage.
• Cut ligaments to help relieve tightness in a stiff joint. They can also be repaired or rebuilt.
• Collect a sample of joint tissue or joint fluid (synovial fluid) for testing (biopsy).
• Remove scar tissue or an area of joint lining (synovium) that is swollen.

Some joint problems may be repaired using arthroscopy with open surgery.

How To Prepare

Arthroscopy is often done on an outpatient basis without the need for an overnight stay in a hospital.

Tell your doctor if you:

• Are allergic to any medicines, including anesthetics.
• Are taking any medicines, including aspirin or some other blood thinner.
• Have had any bleeding problems, including blood clots in a vein (deep vein thrombosis, or DVT).
• Are or might be pregnant.
• Have a history of joint stiffness or arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
• Have had an X-ray of your joint that used contrast material (arthrogram) within the last 10 days. The contrast material may cause swelling within your joint that makes doing arthroscopy hard. This swelling can also prevent a clear picture of your joint during the procedure.
• Have a history of infection, such as septic arthritis, in the affected joint.
• Have a history of a broken bone (fracture) or injury to the affected joint.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form (What is a PDF document?).

You may have more tests, such as blood tests or urine tests, before your arthroscopy.

Arrange to have someone drive you home after the procedure.

If you have arthroscopy of your ankle, knee, or hip, your doctor will talk to you about using crutches after the procedure. If you have arthroscopy of a joint in your arm, you will likely wear a sling or splint afterward.

How It Is Done

Arthroscopy is usually done by a doctor who specializes in bone, muscle, and joint surgery (orthopedic surgeon).

You will be asked to remove any jewelry and to wear a hospital gown. You may be given a sedative shortly before the procedure to help you relax. The skin around your joint may be shaved.

During the procedure

If general or regional anesthesia is used, an anesthesia specialist will give the medicine. A general anesthetic will make you sleep during the procedure. Your heart rate and rhythm, blood pressure, and breathing will be watched closely during the procedure. If a local anesthetic is used, it will be injected into the skin and joint space. If a local or regional anesthetic is used, your limb will be numb. You will be relaxed and drowsy but will be awake.

You probably will lie on your back. Depending on which joint is being looked at, an inflatable band (tourniquet) may be used to briefly restrict blood flow to your joint. This allows your doctor to see all the parts inside your joint. Your joint is scrubbed with an antiseptic solution and draped with sterile towels. Before the tourniquet is inflated, the joint will be raised. It may also be wrapped with an elastic bandage to reduce blood flow to the joint.

A small incision about 0.25 in. (0.6 cm) will be made near your joint. Before the doctor inserts the arthroscope, an irrigation fluid (usually saline) will be used to flush the joint space. This gives the doctor a better view of the entire joint. A steady low flow of fluid is usually used during the procedure. This clears out any debris or blood in the joint so your doctor can evaluate your joint.

After the scope is put in, your doctor will be able to see inside the joint by viewing a video screen attached to the scope. Your doctor or the surgical assistants may bend, extend, and change the position of the joint to see it from different angles. Videotapes or photos of the joint may also be taken.

If more surgery is needed to repair your joint problem, more small incisions will be made. Other thin tools will be put into your joint. When the arthroscope and any other tools are taken out, any blood and debris will be flushed with saline and drained. To reduce swelling or pain, local anesthetics or corticosteroids may be injected into your joint.

The small incision is closed with stitches. Depending on which joint was looked at, you may need to use splints, slings, or crutches while you recover from surgery.

How long the procedure takes depends on what is done. It may take only about 15 minutes, but it could take an hour or longer.

After the procedure

After the procedure, you may need to rest your joint for several days. You may not be able to drive for 24 hours. This will depend on which joint was looked at and what type of anesthetic you had. If your stitches aren't the type that dissolve over time, they will be removed in 7 to 10 days. You can use ice, elevation, and a compression bandage to reduce any swelling. And you can take pain relievers to relieve any pain or discomfort. Ask your doctor for advice on strengthening your joint with exercise and when you can do your normal activities.

How It Feels

If you get a local anesthetic before the procedure, you will feel a brief burning or stinging in your skin. As the arthroscope is put into the joint, you will notice a thumping feeling. You may feel slight pulling in the joint area as your doctor moves joint structures around.

If you get a general anesthetic, you will be asleep and will not feel anything. If you get a regional anesthetic, your arm or leg will be numb for several hours.

You may have some soreness and pain after the procedure. Your doctor will give you instructions on using pain medicine and applying ice to your joint to reduce swelling and pain. You may also need to prop it up on pillows. You will have bandages to cover your incision. Keep them clean and dry.

After the procedure, you may notice bruises around the incision. This will not last long and should disappear within 2 weeks. It is normal for your joint to feel tender for about a week. Ask your doctor how much bleeding, drainage, or swelling from the incision site to expect. If you needed more extensive joint surgery, you may have more bleeding, drainage, pain, and swelling than if you had a simpler surgery.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

• You had an X-ray of the joint that used contrast material (arthrogram) within the previous 10 days. The contrast material may cause swelling inside the joint. The swelling can prevent a clear picture of the joint during arthroscopy.
• You have arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
• You have some other medical condition, such as a thickening of tissue (fibrosis) in the joint area or widespread infection (sepsis).

What To Think About

• Surgical procedures done by arthroscopy usually result in shorter hospital stays and faster recovery times than open joint surgery.
• Arthroscopy usually is not done if:
  • You have a skin or wound infection near the joint to be looked at. But it may be done to clean out an infected joint.
  • You have ankylosis. This is a condition that causes stiffness and poor flexibility of a joint. It may be caused by a disease (such as ankylosing spondylitis), a joint injury, or surgery.
  • Joint destruction is severe (for example, with severe arthritis).
  • You have a severe bleeding disorder. But arthroscopy may be done if clotting factor medicines are used.
• It may take several weeks for your joint to heal. If extensive surgery is done during your arthroscopy, it may take longer than a few weeks to recover. Your doctor will give you pain medicine and recommend exercises or physical therapy for you to do while you recover. Depending on which joint was examined, you may need to use splints, slings, or crutches to support movement of your joint during recovery.
• Many doctors use ultrasound, CT scans, or MRI scans before doing an arthroscopy. This is to make sure that any problems that need surgery can be done at the same time.