Arthroscopy (keyhole surgery)

What is Arthroscopy?

Greek word for joints is “Arthros”, and Greek word for looking is “Scope”, so arthroscopy means looking in to the joints. Since this is done through a small cut it is commonly known as a minimally invasive surgery or a key hole surgery. It can be performed on many joints like shoulder, elbow, wrist, hip, knee and ankle joints, though shoulder and knee are the commonest.

Why Arthroscopy?

When investigating the conditions of the joints it is very helpful  to be able to look inside the joint in order to see exactly what is going on in addition to examining the joint from outside. It is done with special equipment. Operative procedures for any abnormalities can be done through a second small cut. It is routinely done as a planned procedure as a day case, but sometimes it is done as a matter of urgency, for example following injury to a joint like a twisted swollen knee joint.

What are the advantages?

a) Small incisions and small scares.

b) Less tissue damage and less chance of infection.

c) Less pain and disability after surgery and patient can return to sedentary work almost immediately and to more vigorous work within 1 to 2 weeks.

d) Better diagnosis of many joint problems.

e) Most procedures can be performed as outpatient basis. If hospitalization is required most procedures need 1-2 days of stay compared to several days of stay with open procedures.

f) Some procedures can be done better with arthroscopic surgery and perhaps for some that is the only way they can be done.

Preparation for surgery

After deciding to proceed with arthroscopy some basic blood tests are done and patient’s fitness is assessed. Like any other surgery patients would be asked not to eat or drink any for at least 6 hours prior to surgery. Patients can watch the surgery if it is done under regional anaesthesia.

 After surgery

Prescription would be given for pain killer tablets and other medicines as necessary. The joint needs to be rested a little for a couple of days but like in case of arthroscopy of the knee joint you can walk to and from the toilet with crutches but to avoid excessive use of the joint. One important aspect is physiotherapy to get full movement in the joint and to strengthen the muscles around the joints. Within the limits of pain these exercises can be started as soon as possible after surgery. The exercises can be carried out many times in a day.  Start with 4-6 repetitions of each exercise, increasing to as many as you feel able to do without getting any pain. When you had any other reconstructive surgery like ligament and meniscal surgery post operative care and advice will be different. Similarly arthroscopy of shoulder would be followed up by specific exercises depending upon the type surgery. You would be asked to visit the hospital after 2 days for a change of dressing.

 Common conditions needing Arthroscopy

Knee Arthroscopy:

A torn meniscus ( to repair or remove), a torn anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL), For removal or biopsy of inflamed or damaged lining of the joint(synovium), Misalignment of the kneecap (patella), Small pieces of broken cartilage and loose bodies in the knee joint, Removal of Baker's cyst(a swelling behind the knee that is filled with fluid), Some fractures of the bones of the knee. Washing the knee which is constantly sore due to arthritis can also be beneficial.

Shoulder Arthroscopy:

Arthroscopy of the shoulder may be recommended for infective arthritis(septic lesions), biceps tear, SLAP lesions, Rotator cuff lesions, impingement syndrome, recurrent dislocation of shoulder and other  instability problems with or without hyper laxity, Frozen shoulder, loose bodies etc. Problems associated with the other joints in shoulder joint complex i.e. subacromial joint, acromio-clavicular joint are also easily examined giving access to rotator cuff lesions, acromion pathology and  clavicular problems.