Arthroscopy

Test Overview

Arthroscopy is a surgical procedure that allows your doctor to look at the inside of a joint in your body through a thin viewing instrument called an arthroscope. Arthroscopy allows your doctor to look at the joint surfaces and the surrounding soft tissues, such as tissue that connects bone to bone (ligaments) and the tough tissue that covers the ends of the bones at the joints (cartilage) and provides a cushion between the bones. This procedure can be used to diagnose a joint problem, perform surgery that repairs a joint problem, remove a loose or foreign body, or monitor a disease or the effectiveness of a treatment. Arthroscopy is commonly performed on the knee, shoulder, and ankle. It also can be done on the hip, elbow, and wrist.

During arthroscopy, the arthroscope is inserted into your joint through a small cut (incision) in the skin. The arthroscope has a light source and a video camera attached to it. Images from the camera can be seen on a video monitor. These magnified images provide a clear picture of your joint. A sample of joint tissue can be collected during arthroscopy for biopsy. If surgery is done, additional instruments will be inserted into your joint through other small incisions.

See a picture of arthroscopy of the knee.

Like open surgery (which is done using a larger incision), arthroscopy allows your doctor to see what is wrong with your joint. But compared to open surgery, arthroscopy:

• Is usually less painful.
• Is usually less costly.
• Usually allows for a quicker recovery time, depending on what is done.
• Can be done on an outpatient basis without requiring an overnight stay in a hospital. Open surgery often requires an inpatient stay in the hospital.

Why It Is Done

Arthroscopy is used to:

• Evaluate and diagnose a joint problem when a physical exam and other diagnostic tests, such as X-rays, blood tests, computed tomography (CT) scans, or magnetic resonance imaging (MRI), are not conclusive.
• Perform surgery to repair a joint problem.

Examples of when arthroscopy is used to perform surgery:

• Bone tissue can be shaved to remove calcium deposits or bone spurs.
• Soft tissues (such as ligaments, tendons, or cartilage) can be repaired or trimmed.
• Ligaments can be cut, repaired, or reconstructed.
• Cutting or releasing a tight ligament may allow increased range of motion for a stiff joint.
• A sample of joint tissue or joint fluid (synovial fluid) may be collected for laboratory analysis (biopsy).
• Scar tissue or an area of joint lining (synovium) that is inflamed can be removed.

Some joint problems may sometimes be repaired using a combination of arthroscopy and open surgery.

How To Prepare

Arthroscopy is often done on an outpatient basis without requiring an overnight stay in a hospital.

Tell your doctor if you:

• Have allergies to any medicines, including anesthetics.
• Are taking any medicines, including blood-thinning medicines (such as warfarin [Coumadin]) or aspirin.
• 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 previous 10 days. The contrast material may cause inflammation within your joint that makes performing arthroscopy difficult. This inflammation also can prevent a clear picture of your joint during arthroscopy.
• 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.

Before the procedure, you will be asked to sign a consent form. 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 additional 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 having crutches available after the procedure. If you have arthroscopy of a joint in your arm, you will likely wear a sling or splint after the procedure.

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.

If general or regional is used, an anesthesia specialist will administer the medication. A general anesthetic will make you unconscious during the procedure. Your heart rate and rhythm, blood pressure, and respirations will be monitored 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 and you will be relaxed and drowsy but will remain conscious.

You usually lie on your back. Depending on which joint is being looked at, an inflatable band (tourniquet) may be used to temporarily restrict blood flow to your joint so your doctor can see all the structures in your joint. Your joint is scrubbed with an antiseptic solution and draped with sterile towels. Before the tourniquet is inflated, the joint will be elevated and may 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 inserting the arthroscope, an irrigation solution (usually saline) will be used to flush the joint space to provide a better view of the entire joint. A steady low flow of solution is usually used during the procedure to clear out any debris or blood in the joint so your doctor can evaluate your joint.

Once the arthroscope is inserted, your doctor will be able to see inside the joint by viewing a video monitor attached to the arthroscope. Your doctor or the surgical assistants may bend, extend, and reposition the joint to see it from different angles. Videotapes or photographs of the joint may also be taken.

If additional surgery is required to repair your joint problem, more small incisions will be made and other thin instruments will be inserted into your joint. When the arthroscope and any other instruments are taken out, any blood and debris will be flushed with saline and drained. To reduce inflammation 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 to support movement of your joint during recovery.

After the procedure, you may need to rest your joint for several days. You may not be able to drive for 24 hours after the procedure, depending on which joint was looked at and what type of anesthetic you had. If your stitches are not absorbable, they will be removed in 7 to 10 days. Ice, elevation, and a compression bandage may be used to reduce any swelling, and pain relievers may be used to relieve any pain or discomfort. Ask your doctor for advice on strengthening your joint with exercise and when you can resume normal activity.

The time arthroscopy takes depends on what is done. It may take only about 15 minutes but it could take an hour or longer.

How It Feels

If you are given a local anesthetic before the procedure, you will feel a temporary burning or stinging sensation in your skin. As the arthroscope is inserted into the joint, you will feel a thumping sensation. You may feel slight pulling sensations in the joint area as your doctor moves joint structures around.

If you are given a general anesthetic before the procedure, you will be unconscious and will not feel anything during the procedure. If you are given 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 (and possibly to elevate it) to reduce swelling and pain. Keep the bandages that cover your incision clean and dry.

After arthroscopy, you may notice bruising of your skin around the incision. This is temporary 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, and it may last longer than a more simple surgery.

Risks

Complications are not common during arthroscopy. Sometimes there is joint stiffness or long-lasting joint pain. Bleeding within the joint can occur, particularly if surgery is done during the procedure.

There is a small chance of infection, formation of a blood clot in the affected limb, or nerve or joint damage. Also, there is a small risk of damage to the structures within the joint.

In rare cases, a serious condition called compartment syndrome can occur if pressure builds within a muscle compartment (most commonly in the front of the calf or forearm). When this occurs, immediate medical treatment is needed to release the pressure.

In very rare cases, death can occur from complications of general anesthesia.

After the test

Contact your doctor immediately if:

• Your pain or swelling (or both) continue or get worse.
• Your incision site bleeds excessively.
• You experience redness, swelling, pain, or a sensation of heat in your calf or arm. These may be signs of a blood clot in a vein, a condition called thrombophlebitis. If you have these symptoms, do not massage the area.
• You develop signs of infection. These signs may include:
  • Increased pain, swelling, redness, or warmth around the affected area.
  • Red streaks extending from the affected area.
  • Drainage of pus from the area.
  • Swollen lymph nodes in the neck, armpit, or groin.
  • Fever or chills with no other known cause.

Results

Arthroscopy is a surgical procedure that allows your doctor to look at the inside of a joint in your body through a thin viewing instrument called an arthroscope. Your doctor can determine whether your joint is normal by looking at it through the arthroscope. Usually your doctor will be able to discuss the results with you right after the test.

After your doctor has evaluated your joint, further treatment with medicine, physical therapy, or surgery may be recommended.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• Having had an X-ray of the joint that used contrast material (arthrogram) within the previous 10 days. The contrast material may cause inflammation within the joint that can prevent a clear picture of the joint during arthroscopy.
• Having arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
• Having some other medical conditions, 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:
  • A skin or wound infection is present near the joint to be examined. But arthroscopy may be done to clean out an infected joint.
  • Ankylosis is present. Ankylosis is a condition that causes stiffness and poor flexibility of a joint and may be caused by a disease (such as ankylosing spondylitis), a joint injury, or surgery.
  • Joint destruction is severe (for example, with severe arthritis).
  • A severe bleeding disorder is present. But arthroscopy may be done if clotting factor medicines are used.
• It may take several weeks for your joint to recover. 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 rehabilitation exercises or physical therapy for you to do during your recovery period. 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, computed tomography (CT scan), or magnetic resonance imaging (MRI) before doing an arthroscopy to make sure that any problems that need surgery can be done at the same time as the arthroscopy.

References

Other Works Consulted

• Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
• Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

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