Arthroscopy For Joint Pain
Arthroscopy is a surgical procedure that allows surgeons to view, diagnose and treat the inside of large joints. The word arthroscopy comes from the Greek words ‘athros’ (joint) and ‘scopos’ (to look). It is most often used to inspect knee joints as part of treatment for arthritic joint pain. Although arthroscopy of the shoulder, elbow and hip are also possible. Even hand and ankle joints can be viewed using arthroscopy with the technology now available. This surgical procedure is widely used in rheumatic diseases such as arthritis or osteoarthritis.
Almost all arthroscopic procedures can be performed as an outpatient. Any major procedures and operations to be performed alongside arthroscopy are done under general anaesthesia. In less complicated cases, local anaesthesia is used.
In the case of knee joint arthroscopy, a tourniquet is often applied above the knee and around the thigh. This is used to temporarily interrupt local circulation in order to properly investigate the joint.
Some of the most common conditions found during arthroscopic examination of knee joints include:
- Torn or degenerate meniscus or menisci (semilunar cartilage)
- Inflammation of the joint lining (synovitis)
- Maltracking and tilted patella (kneecap)
- Loose fragments of cartilage or bone (loose bodies)
- Damaged joint surface (articular cartilage)
- Torn anterior cruciate ligament (ACL)
With a scalpel, the physician makes one or two incisions approximately 5 mm wide. A probe with a camera is inserted through the incision. The camera transmits an image on a monitor so that the operator can look directly into the knee joint. The great advantage of this method is that it is minimally invasive.
Small retractors, scissors, knives or other cutting instruments can be introduced via the probe into the joint. This makes it possible for the physician to treat minor damage and deformation of the joint surfaces. This can be very beneficial for patients with a progressive joint disease such as osteoarthritis.
It’s possible to minimize join abrasion by smoothing the articular surfaces and removing broken cartilage fragments from the synovial fluid (joint fluid)1. During arthroscopy, surgeons will often take a sample of synovial fluid for analysis. This fluid contains important biomarkers that can be used to identify degenerative processes or inflammation2. Results from this analysis can help to devise ongoing treatment plans.
What are the Advantages of Arthroscopy?
The biggest advantage of arthroscopy is that it’s a minimally invasive procedure. There are very few cuts required for the operation. This helps to minimize scarring and the risk of infection. The procedure is less painful than other forms of surgery. Also patients recover much faster and can often regain full mobility of their joints.
Risks of Arthroscopy
As with any form of surgery, arthroscopy is not a risk-free operation. Although uncommon, the following complications have been reported: excessive bleeding or swelling, skin and joint infection, blood clots, phlebitis, and technical problems with arthroscopic instruments. There are also risks with anaesthetic during and after the procedure. There is some evidence to suggest that only in rare cases can knee arthroscopy actually prevent osteoarthritis3. There is also the risk of injury to ligaments and meniscus of the knee during surgery.
Since the surgery is minimally invasive and recovery time is quick, sometimes patients put too much pressure on their joints too soon after the procedure. This can cause further damage to the articular cartilage. Thus, surgeons recommend only gentle exercise, such as swimming, cycling or walking following surgery. These sports encourage the formation of synovial fluid, which ensures adequate lubrication of the joints. This exercise also strengthens the muscles to better support the joint and musculoskeletal system.
- Richmond, J.C. ‘Surgery for osteoarthritis of the knee’, Rheum Dis Clin North Am., 2013 Feb;39(1):203-11. doi: 10.1016/j.rdc.2012.10.008. Epub 2012 Nov 9. ↩
- Singhal O, Kaur V, Kalhan S, Singhal MK, Gupta A, Machave Y. ‘Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision.’ Int J Appl Basic Med Res., 2012 Jul;2(2):102-6. doi: 10.4103/2229-516X.106351. ↩
- Shin CS, Lee JH., ‘Arthroscopic treatment for osteoarthritic knee’, Knee Surg Relat Res. 2012 Dec;24(4):187-92. doi: 10.5792/ksrr.2012.24.4.187. Epub 2012 Nov 29. ↩