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.
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
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
Total Knee Replacement (for osteoarthritis)
Meniscus surgery, ACL/PCL surgery, patellofemoral syndrome
Total Shoulder Replacement (for osteoarthritis), Reverse Shoulder Replacement
Rotator cuff repair, Subacromial Decompression, Labrum repair
Total Hip Arthroplasty (for osteoarthritis)
Labrum repair, Femoro-acetabular impingement
View Through An Arthroscopic Camera of the Knee
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.
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.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
Questions & Answers
Question: Can I request to have my surgery done with arthroscopy? Or does the doctor need to make the decision to use arthroscopy?
Answer: Most of the time, your doctor will make these decisions for you. There are multiple factors for surgeons to consider when deciding upon the right surgical approach and patient preference isn't usually a major factor for most surgeries. However, there are some surgeries that can be done either way and your surgeon can and will leave that decision up to you, if possible. Although I would suggest that you have a conversation with your doctor about open versus arthroscopic surgery, I would discourage you from demanding one approach or the other. Arthroscopy is not always possible, but, if it is, your doctor will have already considered it.
© 2018 Kortney T