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“ If you are considering having surgery, ask your surgeon

if the procedure can be done arthroscopically”

What is orthopaedic surgery?

Orthopaedic surgery treats musculoskeletal problems. In simplistic terms that includes all the bones in the body except for the skull, all the large and small joints of the body as well as tendon and muscular problems.

Treatment options consist of conservative measures such as drug therapy, physiotherapy, occupational therapy, splintage, muscle conditioning, injections and lastly, surgical treatment. When surgical treatment is being considered, conventionally, open surgery is performed. In recent years, the development of keyhole or minimally invasive surgery has also led to similar developments in the field of orthopaedics. Such minimally invasive surgery in orthopaedics is called arthroscopy when the surgery involves the inside of a joint and endoscopy when the surgery is near to but outside a joint. Arthroscopy is the latest development in orthopaedic surgery.

What is a Joint?

The Parts of a Joint

1. Cartilage: The end of each bone is covered with articular cartilage. This is a tough material that cushions and protects the ends of the bones. When it degenerates, arthritis develops.

2. Synovium or Synovial Membrane: Around each joint is the synovium which protects the joint and also secretes the synovial fluid. Synovial fluid serves to protect the joint, lubricate the joint and provide nourishment to the articular cartilage. In early arthritis, the ability to generate lubrication is diseased. Some new treatment is now available to deal with this.

3. Bursa : A bursa is a small sac that is not part of the joint but is near the joint. It contains a fluid that lubricates the movement of muscles as the muscle moves across muscle or as the muscle moves across bone. In some ways it is similar to the synovial sac.

4. Muscle: Muscles are powerful elastic tissues that have the ability to change length. By becoming shorter and longer, muscles control motion at the joints.

5. Tendon: Tendons are fibrous cords that attach muscles to the bones. Unlike muscles which change length (contract), the tendons do not change length. However, as the muscle moves, the tendon to which it is attached also moves. You can feel the tendons on the back of your hand or in the back of your knee.

6. Ligaments: Ligaments are much shorter fibrous cords that attach from bone to bone. Typically, ligaments are located around the joints. They provide for the stability of a joint and hold the adjacent bones in the proper alignment.

7. Meniscal Cartilage: Meniscal cartilage is a type of specialized tissue. It is not found in every joint in the body. It is a C-shaped piece of cartilage which is located between the major weight bearing bones of the knee. It has several functions including stability, lubrication, nutrition, and shock absorption. To get some idea of what cartilage is like, feel the middle of your nose or ears. These are also made of cartilage. Meniscal cartilage tissue is similar to the "gristle" that is found in at the joint of a chicken leg and a chicken wing.

What is arthroscopy?

Arthroscopy is the surgical treatment of pathologies that involve the inside of a joint. Using the latest fibre optics, a rigid lens (“arthroscope”) similar to a pencil is inserted into the joint to provide illumination and visualisation. A special CCD camera attached to the end of this lens conveys the images to a large TV screen for the operating surgeon. The inside view of the joint is thus highly magnified and can be seen more clearly then open surgery. The arthroscope can be manipulated and even tight corners can be inspected. The joint is pumped with fluid in order to gently inflate the joint to facilitate this. The condition of the cartilage, intra-articular ligaments, the joint capsule or any pathology within the joint can be easily visualised. Using another keyhole, the surgeon can insert a probe into the joint and feel the various structures that he can see. The surgeon thus has tactile assessment of the condition of the structures e.g. the flexibility of the cartilage, the tension in a ligament etc. There has been a rapid development in numerous surgical instrumentation and devices that can now be used, via keyhole surgery, to perform surgical treatment inside the joint. In the early days of arthroscopy, it was confined to “taking a look” (making a diagnosis) and then possibly converting to conventional open surgery. Nowadays in experienced hands, apart from being merely a diagnostic tool, most treatment can actually be completed with the arthroscopic procedure.

What is arthroscopic surgery?

If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery of the patient.

Arthroscopic surgery can be used for various procedures which include:

the diagnosis and treatment of many noninflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.
taking out small bits of bone or cartilage that have broken off into the joint space, commonly called the ‘loose bodies'. Also taking out foreign objects, such as plant thorns, that become lodged within the joint.
repairing or taking out torn ligaments.
removing damaged cartilage.
removing diseased synovium.

It is now applicable to the treatment of the large joints of the limbs i.e. shoulders, elbows, wrists, hips, knees and ankles.

While an arthroscope is used in many different types of surgical procedures, the recovery time and outcome of the procedure is related to the type of injury and the type of arthroscopic surgical procedure performed. For example, an arthroscopic surgical ligament reconstruction will take longer to heal and the recovery time will be longer when compared to the patient who has an arthroscopic removal of a loose body.

What are the benefits of arthroscopic versus conventional open surgery?

Arthroscopic surgery can often treat or repair joints without the need for a more traditional 'open' surgery of a joint which involves a large wound. The deeper the joint, the larger the benefit with arthroscopic surgery. As a rule, compared to traditional open surgery of a joint, with arthroscopic surgery there is usually:

less pain following the procedure.
less risk of complications.
a shorter hospital stay (it is often done as a day-case procedure)
earlier return to work.
smaller scar, less damage to normal tissues.
a quicker recovery.
options of alternative type of anaesthesia apart from general anaesthesia.
better cosmetic outcome.

Many people can go home shortly after the procedure. The type of problems differ. Therefore, instructions for follow up and what you should and should not do will be give to you by a doctor or nurse. (For example, if you should have physiotherapy, or if you should rest, or if you should exercise, etc.)

What are the possible complications with arthroscopic surgeries?

As with any procedure, complication may arise. In most cases the procedure is done without any problems. Complications occur in less than 1 in 100 cases and can include:

Accidental damage to structures inside or near to the joint.
Excessive bleeding inside the joint which can cause a lot of swelling and pain.
Infection within the joint - this can be serious.
As with any operation, there is a risk of allergy to local anaesthetics, or complications of anaesthesia if a general anaesthetic is used.

After arthroscopy or arthroscopic surgery, see a doctor urgently if you:

Have pain or swelling in the joint which gets worse. In particular, if the joint is also hot, tender and red. (This may indicate bleeding or infection in the joint.)
Develop a high temperature.
See fluid, pus or blood coming from the site of the incision.
Develop numbness or tingling near to the joint (which may indicate nerve damage).

THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.