Arthroscopy Surgery - Procedure, Benefits and Recovery

Arthroscopy is a surgical procedure to diagnose or repair the structural problems of a joint. The surgeon inserts a narrow tube into a fibre-optic video camera through a small incision (about the size of a buttonhole attached) to view inside the joint. 

The arthroscopy procedure is most commonly done for the following:

1. Knee arthroscopy for knee
2. Elbow arthroscopy for elbow
3. Shoulder arthroscopy for shoulder joints
4. Ankle arthroscopy for ankle
5. Hip arthroscopy for hip
6. Wrist arthroscopy for wrist conditions

Anatomy and Physiology of Joints in the Human Body

A joint in the human body is a point where two bones are connected to each other. The joints have been classified based on functionality (the range of motion) and histologically (the type of tissue that holds two bones together).

Histological Classification of joints:

1. Fibrous joint: It is a fixed joint. The fibrous tissue filled with collagen connects the bones in this joint. They are usually immovable (synarthroses) and have no joint cavity.
2. Cartilaginous joint: It is the joint where the bone is attached by hyaline cartilage or fibrocartilage. These joints are more flexible than fibrous joints. 
3. Synovial joint: They are the main functional joints of the body. They are freely mobile. These joints are characterized by a cavity filled with synovial fluid, secreted by the synovial membrane. 

Functional classification of joints includes:

1. Hinge joint: It is uniaxial, which means the joint allows movement in one direction (like a hinge of the door). The knee and elbow joints are hinge joints.
2. Pivot joint: It is also known as the rotary joint, which is characterised by one bone that can rotate within the ring formed by the second bone. For example, the joint between the first and second vertebrae in the neck.
3. Saddle joint: It is a biaxial joint, which means the joint allows movement back and forth and side to side. It does not allow rotation. The joint at the base of the thumb is an example of a saddle joint.
4. Condyloid joint: It allows movement without rotation, such as in the jaw or finger joints.
5. Ball and socket joint: It is a multiaxial joint that allows movement in all directions. In such joints, the round head of one bone sits within the cavity of another bone, like the hip or shoulder joint. 
6. Gliding joint: It is a multiaxial joint that allows many movements. In this, bones with smooth surfaces slip over one another, such as the wrist joints.

Generally, an arthroscopy procedure is done to diagnose and treat joint conditions. Below mentioned are some of the common conditions treated using arthroscopy: 

1. Loose bone fragments
2. Damaged or torn cartilage
3. Joint inflammation (synovitis)
4. Torn ligaments
5. Joint scarring
6. Recurrent shoulder dislocation
7. Conditions associated with arthritis

The doctor may recommend an arthroscopy procedure if a person has an injury or damage to the meniscus, cartilage, tendons and ligaments. Arthroscopy surgery is needed for patients:

1. Experiencing joint pain, stiffness, swelling, or other symptoms.
2. Non-surgical treatments, such as medication, physical therapy, and rest, have not provided sufficient relief from joint pain symptoms.
3. An injury to the joint, such as a tear or fracture.
4. The doctor determines that arthroscopy is the most appropriate treatment option based on the individual's medical history, symptoms, and the severity of the joint condition.

Arthroscopy is typically an out-patient invasive procedure and usually takes about 30 to 45 mins to complete. The procedure is done under anaesthesia. The type of anaesthesia used varies depending on where and for what procedure is being used.

The steps involved in arthroscopy surgery may vary depending on the condition. During an arthroscopy, an orthopaedic surgeon:

1. Anaesthesia (general or local) is given based on the surgery of the joint.
2. The surgeon makes a small incision (which can be closed with 1 or 2 stitches or sterile adhesive tape) in the skin after appropriately positioning the area to be examined (positioning may involve fixing the area with a tourniquet and managing the blood flow to the area using pressure cuffs). 
3. Inserts an arthroscope (a small, thin pencil-sized instrument attached to a camera and light source). This instrument helps magnify and illuminate the structures inside the joint. 
4. Views the joint from the inside together with cartilage, ligaments or tendons by images sent from the arthroscope on a video monitor. The extent or type of injury is then determined.
5. If possible, the problem is corrected by making additional small incisions around the joint to insert surgical tools to grasp, cut, grind and provide suction as needed for repairing the joint. 
6. Removes the arthroscope and other instruments.
7. Closes the incision (either with sutures or sterile adhesive tape), and the patient is moved to a recovery room to monitor vitals and post-operative recovery.
8. Will monitor the patient’s vitals throughout the procedure.

Prior to the arthroscopy surgery, the surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Arthroscopy

1. Any allergies must be discussed with the doctor.
2. While taking instructions about the medications, the patient should ensure that they have discussed their full medical history, including any supplements or medications the patient takes.
3. Certain medications or dietary supplements are forbidden before Arthroscpy surgery.
4. It is advised to avoid eating solid food 8 hours before the procedure.
5. The patient will also be instructed about medications, recovery time and the exercises that the patient needs to do after the arthroscopy.

On the day of Arthroscopy

1. The patient will be asked to sign the consent form in the presence of his/her family and change to hospital gown
2. A nurse will place an intravenous catheter in the patient’s hand or forearm and inject a mild sedative.
3. Vitals will be monitored.
4. The patient will then be shifted to the operation theatre.

Usually, arthroscopic surgery doesn’t take long. The patient can go home within a couple of hours after the procedure. The patient may expect the following after the surgery:

The recovery process at the hospital

1. The operating surgeon will remove the dressing the next day of surgery. 
2. The surgeon may prescribe medication to relieve pain and inflammation. Most patients need very little to no pain medication post-arthroscopy. 
3. For most patients, daily activities may be resumed within a few days of arthroscopy surgery. 
4. The puncture wounds (small incisions) and complete joint recovery take several weeks to heal, although arthroscopy is a minimally invasive procedure. 
5. Physical therapy, rehabilitation and specific exercises may help speed up the recovery.
6. The patient should ensure that someone is available to pick them up after discharge, as they won’t be allowed to drive home alone. 

The recovery process after hospital discharge

1. The surgeon may prescribe RICE (R=Rest, I=Ice, C=Compression, and E=Elevation) for several days to reduce swelling and pain.
2. The patient should use temporary splints, slings, or crutches for comfort and protection. 
3. Physical therapy, rehabilitation and exercises recommended by the surgeon should be done to regain muscle strength and improve joint function.
4. The patient should wear loose clothing for ease and comfort.

First follow-up appointment

1. The first follow-up will be scheduled within 2 to 3 weeks after the surgery.
2. The dressing from the incision site would be changed.
3. There could be a change in medication, depending on the condition and recovery of the surgical area. 
4. The doctor will advise the patient for further follow-ups as well.

Generally, arthroscopic surgery is a minimally invasive procedure as it occurs through small incisions. The benefits include:

1. Faster recovery
2. Less pain
3. Minimal blood loss and scarring

Arthroscopy procedure is safe, and just like any other surgical procedure, it has few complications associated with it. The risks and complications of arthroscopy surgery include:

1. Bleeding or swelling
2. Infections
3. Tissue or nerve damage
4. Blood clots
5. Allergic reactions to anaesthesia

When is consultation with the doctor needed?

The patient can consult the doctor if he or she develops:

1. Fever
2. Pain at the site of surgery
3. Drainage from the incision
4. Redness or swelling
5. Numbness or tingling

Delaying arthroscopy surgery can increase the severity of the joint, leading to adverse joint conditions. Below mentioned are some of the common risks of delayed arthroscopy.

1. Severe pain in joints
2. Joint inflammation
3. Infection
4. Stiffness
5. Tenderness of the joints
6. Osteoarthritis
7. Rheumatoid arthritis
8. Frailty in elderly

The cost of arthroscopy surgery ranges from ₹30,000 to ₹80,000. The cost varies based on the following factors:

1. Type of arthroscopy surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.