Arthroscopic surgery

Arthroscopic surgery is a procedure used to identify, monitor, and diagnose joint injuries and disease, to remove bone or cartilage, or repair tendons orligaments. Diagnostic arthroscopic surgery is performed when medical history,physical exam, x rays, and other tests such as MRIs or CTs do not provide adefinitive diagnosis.

In arthroscopic surgery, an orthopedic surgeon uses an arthroscope (a fiber-optic instrument) to see the inside a joint. After making an incision about the size of a buttonhole in the patient's skin, a sterile sodium chloride solution is injected to distend the joint. The arthroscope, an instrument the sizeof a pencil, is then inserted into the joint.

The arthroscope has a lens and a lighting system through which the structuresinside the joint are transmitted to a miniature television camera attached to the end of the arthroscope. The surgeon uses irrigation and suction to remove blood and debris from the joint before examining it. Other incisions may be made in order to see other parts of the joint or to insert additional instruments. Looking at the interior of the joint on the television screen, the surgeon can determine the amount or type of injury and, if necessary, take a biopsy specimen or repair or correct the problem.

Arthroscopic surgery can be used to remove floating bits of cartilage and treat minor tears and other disorders. The site of the incision is bandaged.

Arthroscopic surgery is also used to diagnose and treat joint problems, mostcommonly in the knee, but also in the shoulder, elbow, ankle, wrist, and hip.Some of the most common joint problems seen with an arthroscope are inflammation of the joints injuries to the shoulder (rotator cuff tendon tears, impingement syndrome, and recurrent dislocations), knee (cartilage tears, wearingdown of or injury to the cartilage cushion, and anterior cruciate ligament tears with instability), and wrist (carpal tunnel syndrome). Loose pieces of bone or cartilage in the knee, shoulder, elbow, ankle, or wrist also show up frequently.

Corrective arthroscopic surgery is performed with instruments that are inserted through additional incisions. Arthritis can sometimes be treated with arthroscopic surgery. Some problems are treated with a combination of arthroscopic and standard surgery.

Also called arthroscopy, the procedure is performed in a hospital or outpatient surgical facility. The type of anesthesia (local, spinal, or general) andthe length of the procedure depends on the joint operated on and the complexity of the problem. Arthroscopic surgery rarely takes more than an hour. Mostpatients are released that same day, although some stay in the hospital overnight.

Considered the most important orthopedic development in the 20th century, arthroscopic surgery is widely used. The use of arthroscopic surgery on famous athletes has been well publicized. It is estimated that 80% of orthopedic surgeons practice arthroscopic surgery. This technique was initially a diagnostictool used prior to open surgery, but as better instruments were developed, it began to be used to actually treat a variety of joint problems. Recently, lasers were introduced in arthroscopic surgery, and other new energy sources are being explored. Lasers and electromagnetic radiation can repair rather than resect injuries and may be more cost effective than instruments.

Immediately after the procedure, the patient spends several hours in the recovery room. An ice pack will be put on the joint that was operated on for up to 48 hours after the procedure. Pain medicine, prescription or non-prescription, is given. The morning after the surgery, the dressing can be removed andreplaced by adhesive strips. The patient should call his/her doctor upon experiencing an increase in pain, swelling, redness, drainage or bleeding at thesite of the surgery, signs of infection (headache, muscle aches, dizziness, fever), or nausea and vomiting.

It takes several days for the surface wounds to heal, and several weeks for the joint to fully recover. Many patients resume their daily activities, including going back to work, within a few days of the procedure. A rehabilitationprogram, including physical therapy, may be suggested to speed recovery andimprove the future functioning of the joint.

Complications are rare in arthroscopic surgery, occurring in less than 1% ofpatients. These include infection and inflammation, blood vessel clots, damage to blood vessels or nerves, and instrument breakage.

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