What Is Arthroscopy?

Updated on April 27, 2018
kortneypac profile image

Kortney has been a clinical physician assistant for 13 yrs. When not being a PA, Kortney’s hobbies include writing, research, and investing.

Definition of Arthroscopy

Arthroscopy is defined as a surgical technique during which a small camera is inserted through a small opening in the skin in order to visualize the joint or body part that is being operated on without the need to completely open the area up. That small camera is called an arthroscope. In addition to the arthroscope, two other small openings are made at strategic locations around the joint being operated on. At these openings, the surgeon is able to insert the surgical tools necessary to perform the operation. The surgery is then performed by using these three small openings only.

There are many potential benefits for arthroscopic surgery versus a standard open procedure. Some are more obvious than others, such as a smaller surgical scar and decreased healing time for the surgical wounds. There are also some risks associated with arthroscopic surgery. This article will discuss some of the potential risks, benefits, indications, and expectations for arthroscopic surgery.

Arthroscopy of the Knee: The Tools Are Inserted Through Small Holes
Arthroscopy of the Knee: The Tools Are Inserted Through Small Holes | Source

Arthroscopy:

A surgical technique during which a small camera is

inserted through a small opening in the skin in order

to visualize the joint or body part that is being operated

on without the need to completely open the area up.

Open Surgery: The Alternative to Arthroscopy

Before arthroscopy was an option, surgeries were performed by making a large incision in the skin around the body part or joint being operated on. The skin would then be retracted back on both sides so that the operative field was completely visualized. The larger the joint or body area being operated on, the longer the incision would have to be in order to effectively view the entire operative field. This skin incision then had to be taken down to deep fascial layers in order to allow for retraction. The surgeon would then perform the operation by directly visualizing the area being operated on. Once surgery was complete, the surgeon would then have to suture the deep fascial layers, muscles, surrounding soft tissues, and skin to re-approximate them.

As you can imagine, open surgery (when compared with arthroscopy) is associated with:

1. Longer healing times

2. Bigger surgical scars

3. A greater potential for infection

4. The need for inpatient hospital stay (in a large number of cases)

5. More blood loss

6. Higher levels of post-operative pain

Arthroscopy was first used in the 1960s when fiberoptic imaging was possible. The camera that is used during arthroscopy is attached to fiberoptic cables that allow for projection of the image onto the screen. There is also a light attached to the camera for better visualization of the joint.

Arthroscopy is now commonly used all over the world for multiple different types of orthopedic surgeries. The introduction of arthroscopy as an alternative to open surgery was an improvement for both patients and surgeons. Patients can now benefit from less severe risks with some types of surgeries and less pain and healing time associated with these surgeries. Surgeons can now perform surgeries in less time and have lower complication rates associated with these surgeries.

The Surgical Technique

The arthroscopic technique is quite different from open surgery. For that reason, surgeons need to be specifically trained in the art of this type of surgery. The arthroscope (or camera) is inserted into a small opening in the skin to provide visualization of the joint or body part that is being operated on. The camera is on the end of a very long tube and provides images of the joint that can be seen on a television monitor. Rather than directly visualizing the joint or body area, the surgeon has to rely on the images produced by the camera.

In addition to the camera, there are arthroscopic tools. These tools need to be small enough to be inserted into the skin and down to the body part that is being operated on. This is usually done by inserting the tools down a small tube. These tools are then used to perform the actual surgery that is necessary. The surgeon has handles or scissor-like mechanisms on the end of the long tubes that contain the surgical tools. The surgeon will then use these mechanisms to maneuver around the surgical field to perform the surgery. The surgeon can debride pathological tissue, repair cartilage defects, remove foreign bodies or unnecessary tissues, and perform suturing with these tools.

For example, if you need to have a surgery on your knee because you have a torn meniscus. The surgeon would make 3 small incisions. One of the incisions is for the camera. The other two incisions are used to insert the surgical tools. The camera would visualize the knee joint while the surgical tools would debride the diseased meniscus tissue and repair the cartilage. Typically, the surgeon needs to have an assistant with him to hold the arthroscope/camera in place so that they can perform the actual procedure necessary to treat the pathology.

Arthroscopic Surgery Scars for Knee Surgery

Source

Benefits of Arthroscopy

1. Less risk for infection

2. Smaller surgical wounds/scars

3. Less blood loss

4. Less healing time

5. Less pain

Benefits of Arthroscopy

As briefly discussed above, there are several advantages to having arthroscopic surgery versus open surgery. It is these advantages that have popularized this type of surgery all over the world. Currently, most surgeries are performed arthroscopically, if possible. However, some types of surgeries, such as total joint replacement surgeries, can only currently be performed as an open procedure.

Some of the primary benefits of arthroscopic surgery are less risk for significant blood loss, less risk for infection, and less time needed for healing. As compared with open surgery, patients who undergo arthroscopic surgery can expect to have a shorter recovery. With open surgery, the joint needs to be fully exposed for the surgeon to visualize it. This can lead to more blood loss, as the tissues are cut and retracted. This can also expose those tissues and the joint to airborne infections or other bacteria. WIth arthroscopy, the 3 small holes decrease the likelihood for the introduction of infectious bacteria to the joint and for overall blood loss.

Another advantage with arthroscopy is less pain and less healing time. During open surgery, the cutting of multiple layers of soft tissues and the retraction of these tissues back to expose the joint all increase the likelihood for pain after surgery. During arthroscopy, there is some risk for pain due to the actual surgery that is performed within the joint or body part, but it is less likely that there will be significant pain in the soft tissues surrounding the joint. The reason for this is that they are less likely to be included in the surgical area. The only soft tissues that are interrupted during arthroscopic surgery are those tissues that need to be cut to allow the arthroscope and surgical tools to pass through. This decreases the surgical area significantly, which then decreases the time needed for healing and the pain felt by the patient.

Conditions That Can Be Treated Arthroscopically Versus With Open Surgery

Body Part
Open
Arthroscopic
Knee
Total Knee Replacement (for osteoarthritis)
Meniscus surgery, ACL/PCL surgery, patellofemoral syndrome
Shoulder
Total Shoulder Replacement (for osteoarthritis), Reverse Shoulder Replacement
Rotator cuff repair, Subacromial Decompression, Labrum repair
Hip
Total Hip Arthroplasty (for osteoarthritis)
Labrum repair, Femoro-acetabular impingement

View Through An Arthroscopic Camera of the Knee

Source

Risks With Arthroscopy

Although arthroscopy is more favorable to open surgery, there are still some risks with arthroscopic surgery. One of the biggest risks is that the arthroscopic surgery will need to be converted to an open surgery. This could be due to a number of factors. Sometimes, the surgeon cannot adequately view the entire surgical field necessary to do the surgery effectively using the arthroscope. Other times, the pathology that is present may be too advanced to allow the small arthroscopic tools to adequately address it. EIther way, during the arthroscopy, the surgeon would then convert to an open surgery. Patients are usually warned of this risk during their pre-operative appointment. Although it is not common for an arthroscopic surgery to have to be converted to an open surgery, it does happen, so it is one of the risks that surgeons typically discuss before surgery is performed.

Other risks with arthroscopic surgery include instrument breakage during the procedure, blood clots in the veins, infection, joint swelling, and damage to blood vessels and nerves. Although these risks can occur, they are not common. In fact, these risks occur in less than 1% of patients undergoing arthroscopy.

Conclusion

In conclusion, it is quite easy to see how arthroscopy revolutionized the way that surgeons treat their patients. Since arthroscopy was introduced, it has become more and more popular. In fact, as more small arthroscopic tools are developed, I expect arthroscopic surgery to be even more prevalent in the future. There are clear advantages to having this type of surgery both for the patient and for the surgeon.

If you are considering proceeding with this type of surgery, but are hesitant, I encourage you to do your research, ask a lot of questions, and try to make an informed decision. If you have any additional questions about this topic, please feel free to list them in the comment section below. Additionally, if you have any comments about this article, I would love to hear them.

What kind of arthroscopic surgery have you had?

See results

Questions & Answers

    © 2018 Kortney Tholen

    Comments

      0 of 8192 characters used
      Post Comment

      No comments yet.

      working

      This website uses cookies

      As a user in the EEA, your approval is needed on a few things. To provide a better website experience, healdove.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

      For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: "https://healdove.com/privacy-policy#gdpr"

      Show Details
      Necessary
      HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
      LoginThis is necessary to sign in to the HubPages Service.
      Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
      AkismetThis is used to detect comment spam. (Privacy Policy)
      HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
      HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
      Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
      CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
      Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
      Features
      Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
      Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
      Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
      Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
      Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
      VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
      PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
      Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
      MavenThis supports the Maven widget and search functionality. (Privacy Policy)
      Marketing
      Google AdSenseThis is an ad network. (Privacy Policy)
      Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
      Index ExchangeThis is an ad network. (Privacy Policy)
      SovrnThis is an ad network. (Privacy Policy)
      Facebook AdsThis is an ad network. (Privacy Policy)
      Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
      AppNexusThis is an ad network. (Privacy Policy)
      OpenxThis is an ad network. (Privacy Policy)
      Rubicon ProjectThis is an ad network. (Privacy Policy)
      TripleLiftThis is an ad network. (Privacy Policy)
      Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
      Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
      Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
      Statistics
      Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
      ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
      Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)