Harvard Health A-Z

Arthroscopic Surgery

What Is It?

Arthroscopic surgery refers to procedures in which surgeons operate on joints through small incisions rather than through the single large incision that is necessary in traditional "open" surgery. Using an arthroscope, a thin, tubular instrument that contains a light source and specialized lenses, surgeons can illuminate and magnify the internal structure of joints. Because arthroscopic surgery uses small incisions, recovery is usually less painful than traditional surgery. It also has fewer complications, requires a shorter hospital stay (or no stay), is less expensive and allows a quicker recovery.

In the United States, more than 600,000 arthroscopic procedures are done each year. About 85 percent of arthroscopic procedures are on the knee joint, and about 10 percent involve the shoulder. Arthroscopic surgery can be done on the ankle, elbow, wrist and hip, but these are much less frequent, and success is less certain.

What It's Used For

You doctor may recommend arthroscopic surgery for one or more of the following reasons:

• To remove small bits of bone or cartilage that are floating in the joint space

• To repair or remove torn ligaments

• To remove damaged cartilage

• To remove inflamed joint lining (synovium)

• To reattach a bone fragment that has broken off the end of a bone and is in a joint

• To transplant cartilage (a new technique available only in certain areas and usually limited to knees with limited cartilage injury)

• To drain fluid from an infected joint

• To get a direct look at the joint and to take a sample of joint tissue when the cause of knee symptoms is not clear

Preparation

As part of your preparation for surgery, the doctor will review any allergies you have, and your medical and surgical history. Your doctor will ask for a list of all medications that you are taking, including prescription drugs, non-prescription medicines and herbal remedies.

Prior to your procedure, your doctor may arrange for you to meet with a physical therapist. During this meeting, the physical therapist will discuss your postoperative care and your rehabilitation program. If necessary, the therapist may fit you for a brace or sling, or teach you how to walk with crutches.

Unless your doctor tells you otherwise, do not eat or drink anything after midnight the night before surgery. Dress in casual clothes for your trip to the hospital, and leave your jewelry at home. If you have been using any special orthopedic equipment (crutches, sling, brace, knee immobilizer), bring it to the hospital. Arrange for someone to drive you home after surgery.

How It's Done

Arthroscopic surgery takes place in a hospital operating room or outpatient surgical suite.

When you arrive for surgery, you will remove your clothing and put on a hospital gown. A nurse will check your pulse, blood pressure and temperature. An intravenous (IV) line will be placed in your arm. The IV administers fluid and medications directly into a vein.

In the operating room, the skin over the affected joint will be cleaned thoroughly. Your body will be positioned to give the surgeon the best access to your affected joint. For example, for knee surgery, you may need to lie down with your knee bent. For shoulder surgery, you may either lie on your side or sit.

You will be given anesthesia to make you comfortable during the procedure. Arthroscopic surgery can be performed under local, regional or general anesthesia. The type of anesthesia depends on several factors. These include the joint being repaired, the severity of joint damage, the level of pain before surgery, other health problems and your willingness to be awake during surgery.

The surgeon makes a small incision in your joint and inserts the arthroscope. Two additional incisions allow for an irrigation device and surgical instruments. In some cases, a tourniquet will be placed near the affected joint to control bleeding.

An arthroscope used for surgery on the knee joint is about the width of a pencil (4 millimeters in diameter). The incision is about the size of a buttonhole. For smaller joints, such as the wrist and ankle, a smaller arthroscope is used.

Arthroscopic surgery usually lasts about one hour. When the surgeon finishes repairing your joint, he or she closes the incisions with sutures (stitches) or covers the incisions with sterile dressings. In many cases, sutures are not needed because the incisions are so small.

You will be taken to the recovery room, where the medical team will monitor your condition. Depending upon the type of arthroscopic surgery, you may have a large bandage, ice pack or brace on your joint. After a short period (about one hour for knee surgery), you probably will be stable enough to be transferred to a hospital room. In cases of "same-day" surgery, you will be allowed to go home once you have recovered from the effects of anesthesia. If necessary, a physical therapist will visit you in your room to help you adjust to crutches, a sling or a joint brace.

In the days following your surgery, keep the area of your incisions clean and dry. Change your bandages as directed by your doctor. Rest your joint, elevate it and apply ice packs as you have been instructed. Follow the rehabilitation program developed by your doctor and physical therapist.

Follow-Up

Your doctor will tell you when to return for a follow-up office visit. At this visit, the doctor removes any sutures (stitches) and assesses the condition of your joint. Additional visits may be scheduled based on the specific type of surgery and your progress.

Risks

Possible complications of arthroscopic surgery include:

• Accidental damage to cartilage or ligaments inside the joint

• Excessive bleeding inside the joint (hemarthrosis)

• Accidental damage to nerves or blood vessels in a portion of the arm or leg near the joint

• Inflammation and formation of blood clots inside veins (thrombophlebitis), most often in the leg

• Joint infection

• Breakage of a surgical instrument inside the joint

• Allergic or other reaction to an anesthetic

Complications occur in less than 1 percent of all arthroscopic surgeries. Overall, the risk for complications in arthroscopic surgery is much less than for conventional open surgery.

When To Call A Professional

After arthroscopic surgery, call your doctor immediately if you:

• Have increased pain or swelling in the affected joint, especially if the joint is also hot, tender and red

• Develop a fever

• See fluid draining from an incision site, especially fluid that is bloody, foul-smelling or discolored

• Notice that a suture has come undone, or that a suture site is red and tender

• Develop numbness or tingling near your repaired joint. (For example, if your fingers tingle or feel numb after your wrist is repaired.)

Additional Info

National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse1 AMS CircleBethesda, MD 20892-3675Phone: (301) 495-4484Toll Free: (877) 226-4267Fax: (301) 718-6366TTY: (301) 565-2966http://www.nih.gov/niams

American Academy of Orthopaedic Surgeons6300 North River Rd.Suite 200Rosemont, IL 60018Phone: (847) 823-7186Toll-Free: (800) 346-2267Fax: (847) 823-8125http://www.aaos.org/

American Orthopedic Society for Sports Medicine6300 North River Rd.Suite 200Rosemont, IL 60018Phone: (847) 292-4900Toll-Free: (877) 321-3500Fax: (847) 292-4905http://www.sportsmed.org/

American College of Foot and Ankle Surgeons515 Busse HighwayPark Ridge, IL 60068Phone: (847) 292-2237Toll-Free: (800) 421-2237http://www.acfas.org/

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