Catherine Spader, RN
What is arthroscopy?
Arthroscopy is a minimally invasive surgery used to diagnose and treat joint injuries and diseases. Common conditions include damaged cartilage and ligaments. Arthroscopy involves inserting small surgical tools and an arthroscope (a tiny camera) through small incisions. The arthroscope sends pictures of the inside of your joint to a video screen that your doctor watches while performing surgery.
Arthroscopy has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having an arthroscopy.
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Other surgical procedures that may be performed
Your doctor may also perform a biopsy. A biopsy is the removal of a sample of cells or tissue. The sample is tested for cancer and other diseases.
You may need open surgery (arthrotomy) for a joint condition that your doctor cannot treat with arthroscopy. Open surgery involves making a longer incision that allows your doctor to directly view and treat the joint.
Why is an arthroscopy performed?
Your doctor may recommend an arthroscopy to diagnose and possibly treat joint conditions of the knee, shoulder, elbow, hip, wrist or ankle. Joints conditions treated by arthroscopy include:
Acute and chronic joint pain from such conditions as a torn ligament or arthritis
Arthritis, or inflammation of the joint. Both osteoarthritis and rheumatoid arthritis can lead to pain, swelling and destruction of the joint.
Carpal tunnel syndrome, which is compression of the median nerve in the wrist
Cartilage conditions, such as loose or torn cartilage, meniscal tears in the knee and shoulder, and wearing down or injury of cartilage
Frozen shoulder (adhesive capsulitis), which is inflammation of the shoulder joint, or shoulder impingement, which is pinching of a shoulder tendon or bursa, a fluid-filled sac that helps cushion joints
Joint infection, which is also called septic arthritis
Joint inflammation, most commonly of the knee, shoulder, elbow, wrist or ankle. Inflammation can be caused by a variety of conditions, such as rheumatoid arthritis, bursitis, and lupus.
Joint scarring, which can be due to an injury, previous surgery, or chronic inflammation
Ligament injuries and conditions, such as anterior cruciate ligament (ACL) tear in the knee and recurrent shoulder dislocations
Loose bone and bone spurs, which are abnormal bony growths found most often in the joints. Loose bone and bone spurs are most commonly caused by osteoarthritis.
Tendon injuries and conditions, such as a tear of the rotator cuff tendon in the shoulder and patellar tendon rupture in the knee
Tissue biopsy, which involves removing and testing samples of tissues for cancer and other diseases
Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on arthroscopy.
Who performs arthroscopy?
An orthopedic surgeon or podiatric surgeon performs arthroplasty. Orthopedic surgeons specialize in conditions of the bones and connective tissues. Podiatric surgeons are podiatrists who specialize in foot and ankle surgery.
How is an arthroscopy performed?
Your arthroscopy will be performed in a hospital. Your surgeon will insert an arthroscope through a small incision near or over the joint. A camera attached to the arthroscope allows the surgeon to see the joint on a video screen during surgery. Your surgeon will examine and repair joint damage with special instruments as needed. You may need more than one small incision, depending on your condition.
Types of anesthesia that may be used
Your surgeon will perform your arthroscopy using either general anesthesia or regional anesthesia, depending on the specific procedure:
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your arthroscopy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and all vital signs are stable.
What are the risks and potential complications of an arthroscopy?
As with all surgeries, an arthroscopy involves risks and the possible complications that may become serious in some cases. Complications can occur during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of arthroscopy procedures
Potential complications of arthroscopy are uncommon but include:
- Blood vessel damage
- Nerve damage
- Severe swelling of the joint
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy, and other rehabilitation treatments.
Informing your doctor if you are nursing or there is any possibility of pregnancy or if you are nursing
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my arthroscopy?
You are an important member of your own healthcare team. The steps you take before your surgery can improve your comfort level and outcome.
You can prepare yourself for arthroscopy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your blood thinner medication dosage may be adjusted before surgery. Your doctor will give you instructions for taking your medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. You should contact your doctor with concerns and questions before surgery and between appointments.
It is a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need an arthroscopy? Are there any other options for diagnosing or treating my condition?
What will happen if you find a condition during surgery that cannot be treated with arthroscopy? Will you treat it right away with an open procedure, or will I need to have another surgery later?
How long will the procedure take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you treat my pain?
When should I follow-up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my arthroscopy?
Knowing what to expect after an arthroscopy will help you get back to your everyday life as soon as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You might feel a little drowsy for 24 hours after surgery if you had a narcotic pain medication, a sedative, or general anesthesia. You may also have some nausea. Tell your doctor if you are nauseated so it can be treated.
Full recovery after arthroscopy is a gradual process. Recovery time varies depending on the procedure, your general health, age, and other factors. Your doctor or physical therapist will prescribe a rehabilitation program to build joint strength and function.
Many people can return to moderate daily activities, such as work or school, within a few days. Your doctor will advise you when you can safely return to sports and exercise activities as you progress through rehabilitation.
Will I feel pain?
Pain control is an important element to healing and a smooth recovery. There will be discomfort after surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes in any way because it may be a sign of a complication.
You may have some residual numbness for a short period if you had a nerve block. Contact your doctor if you have numbness longer than expected.
When should I call my doctor?
It is important to keep your follow-up appointments after arthroscopy. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
Sore throat or hoarseness that lasts longer than expected
How might an arthroscopy affect my everyday life?
In most cases, arthroscopy improves joint function and reduces symptoms so you can lead the most active life possible.
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- Arthroscopy. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00109
- Arthoscopy.com. The Center for Orthopaedics& Sports Medicine. http://www.arthroscopy.com/
- Patient Information and Brochures. Arthroscopy Association of America. https://www.aana.org/Home/tabid/36/Default.aspx
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62.http://ccjm.org/content/73/Suppl_1/S62.full.pdf