Arthroscopy [2]

Arthroscopy has greatly expanded orthopedic surgeon's understanding of problems around the joints. In many cases, conditions that were completely unknown before the invention of the arthroscope have been discovered and are now being treated with arthroscopic surgery.

What is the Arthroscope used for?

Very complex surgical procedures are now done inside the joints with the aid of the arthroscope. For example, the anterior and posterior cruciate ligaments inside the knee are now almost always reconstructed without opening the knee joint. The procedure is done by using the arthroscope to help see where to drill holes in the bone and to place the ligament graft. Even fractures that involve the joint surface of the lower leg bone (the tibia) are being fixed by watching the fracture through the arthroscope while performing internal fixation.

Just about every joint in the body can be scoped, but the vast majority of surgical procedures done with the arthroscope are done on the knee and the shoulder. The knee joint was the primary site of arthroscopic procedures in the early days of arthroscopy and continues to be a common target of the scope. The arthroscope is changing the way orthopedic surgeons deal with ankle surgery as well. Arthroscopy is now being used to repair torn ankle tendons and ligaments, to reconstruct the ankle joint, and to identify articular problems.

Your surgeon will meet with you to explain what the arthroscopic surgery is intending to accomplish and what you can expect. You will be asked to sign a surgical consent form that describes the operation and the potential risks.

Things to Consider Before Arthroscopic Surgery

Most arthroscopic surgical procedures are done on an outpatient basis, which means you will probably be able to go home the same day. Some arthroscopically assisted procedures still require larger incisions to be made around the joint, and these larger procedures may require a night or two stay in the hospital. Generally, you are asked to not eat or drink anything after midnight on the evening before surgery. If you commonly take medications in the morning, ask your doctor whether you should take them or not.

Anesthesia

There are many different types of anesthesia that can be done, depending on your wishes, your doctor's recommendations, and, of course, which joint is involved. In general, anesthesia may be local, regional, or general. Each of these types of anesthesia has advantages and disadvantages.

Local anesthesia involves injecting lidocaine (or a similar medication) into the joint and in the areas where the incisions are made. This is the same type of anesthesia that is typically used to sew up a laceration, for example. The benefits of this type of anesthesia are that it is relatively safe, has less effect on the rest of your body, and returns to normal quickly after the procedure. The disadvantages are that you may still feel some discomfort during the procedure. This type of anesthesia is not generally used for shoulders or hips.

Regional anesthesia is probably the most common type used for arthroscopy. It is often referred to as a block. Regional anesthesia is done by injecting anesthetic into the surrounding nerves. The advantages to this type of anesthesia are that it does not affect the function of other regions of the body. Regional anesthesia does not cause as much nausea as general anesthesia, and it is relatively safer. The disadvantages are that it takes longer to take affect than general anesthesia, and the actual block involves an injection that may be uncomfortable for a short period of time.

General anesthesia is commonly referred to as going to sleep. It is sometimes used for arthroscopic procedures that may be long and complicated. The advantages of general anesthesia are that you are not aware of anything that occurs during surgery. The disadvantages are that you may have side effects (a hangover) and will be at greater risk for post-operative complications.