Arthroscopy is a test used to examine joints and surrounding tissues, and to repair joint problems (including complications related to arthritis or sports injuries). A surgeon inserts a tube called an arthroscope into the joint through small incisions in the skin. A small camera on the tube as well as a light allow the surgeon to display images of the joint on a video screen. Later, the surgeon may insert other tools through the arthroscope to repair the joint.

The test takes place in a hospital or clinic. Orthopedic surgeons often perform this test. The use of either general or local anesthesia depends on which joint is being tested.

Arthroscopy allows for the visualization of the interior of a joint through the use of optic instruments. Surgery can now be performed on larger joints using direct visualization and miniaturized techniques. After this procedure, the person can often go home the same day.

An arthroscopy is performed to diagnose joint problems. These joints include shoulder, knees, ankles, elbows, or hips. It is also performed to surgically repair a joint problem.

If you require arthroscopy, it is likely because you have:

    • symptoms related to certain bone conditions (e.g., arthritis, osteoporosis, rheumatoid arthritis, bone spurs)

    • an inflammation of a joint

    • damaged ligaments or tendons

    • an infections of a joint

    • pain in joints or bones that has not been diagnosed

During an arthroscopy, a doctor can also remove samples (a biopsy) of the bone and joint for microscopic examination in a lab. An arthroscopy can also help doctors monitor whether a specific medications or treatments are working over time.

Arthroscopy is a relatively safe procedure and complications are rare, occurring in less than 1% of people. These complications may include bleeding, infection, blood clots, damage to surrounding muscles and ligaments, nerve or blood vessel damage, or a reaction to the general anesthesia.

If you experience fever, bleeding, or drainage from the incision, this may indicate infection - call your doctor. Additionally, call your doctor if you feel numbness, tingling, or pain at the site.

After the test you may experience:

    • pain

    • swelling for several days

    • bruising

    • tenderness of the area

To prevent infection, it is important to keep your bandages clean and dry. Take pain medication and apply ice as instructed by your doctor.

Your doctor reviews the test and images taken during the test to assess your joint. Your doctor may discuss the results with you immediately following the test.

Understanding joints

A joint is where two bones meet. Joints allow movement and flexibility of various parts of the body. The movement of the bones is cased by muscles which pull on tendons that are attached to bone.

Cartilage covers the end of bones. Between the cartilage of two bones which form a joint there is a small amount of thick fluid called synovial fluid. This fluid 'lubricates' the joint which allows smooth movement between the bones.

The synovial fluid is made by the synovium. This is the tissue that surrounds the joint. The outer part of the synovium is called the capsule. This is tough, gives the joint stability, and stops the bones from moving 'out of joint'. Surrounding ligaments and muscles also help to give support and stability to joints

In the knee joint, the cartilage covering the lower part of the joint is thickened in the inner and outer part of the joint. These two areas of cartilage are sometimes called 'menisci'. The menisci act as 'shock absorbers' in the knee and are sometimes torn following a knee injury. Also, there are two strong 'cruciate' ligaments in the middle of the knee joints which are attached to the ends of the tibia and femur (the calf bone and thigh bone). These also can be torn following a knee injury.

What is an arthroscopy?

Arthroscopy is a procedure to look inside a joint by using an arthroscope. An arthroscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside a joint. An arthroscope is passed through a small cut in the skin and into a joint.

Arthroscopy may be done to investigate symptoms such as pain, swelling, or instability of a joint. An arthroscopy may show damage to cartilage or ligaments within a joint, fragments of bone or cartilage which have broken off ('loose bodies'), or signs of arthritis.

What is arthroscopic surgery?

In addition to simply looking inside, a doctor can use fine instruments which are also passed into the joint through a small incision in the skin ('key-hole surgery'). These instruments are used to cut, trim, biopsy, grab, etc, inside the joint. Arthroscopic surgery can be used for various procedures which include:

    • taking out small bits of bone or cartilage that have broken off into the joint space.

    • repairing or taking out torn ligaments.

    • removing damaged cartilage.

    • removing inflamed synovium.

About 17 in 20 arthroscopic procedures are done on the knee joint, about 2 in 20 involve the shoulder, and a small number are done on other joints including the ankle, elbow, wrist and hip.

Arthroscopic surgery can often treat or repair joints without the need for a more traditional 'open' surgery of a joint which involves a large cut. As a rule, compared to traditional 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).

    • a quicker recovery.

How is it done?

Arthroscopy and arthroscopic surgery may be done under local or general anaesthesia. The type of anaesthesia chosen depends on the joint being examined, and various other considerations. The skin over the joint will be cleaned. You will be asked to adopt a position best suited for the procedure. For example, you may need to lie on your back with your knee bent for knee procedures, or lie on your side for shoulder procedures, etc. For arthroscopy of the knee a tourniquet (pressure band) may be put round the upper part of the leg to restrict blood flow.

The surgeon makes a small incision (cut) next to the joint just a few millimetres long. The arthroscope is pushed through the incision into the joint. An arthroscope used for the knee joint is about the width of a pencil. A thinner one is used for smaller joints such as the wrist and ankle. One or more separate incisions are made to push a thin examining probe into the joint, or fine instruments which are used for surgery, or fluid to make viewing easier and to 'flush out' the joint.

The arthroscope transmits pictures through a camera attachment onto a TV monitor. By looking at the monitor the surgeon can see inside the joint including the ends of the probe or operating instruments. So, for much of the time the surgeon is watching the TV monitor to guide him or her as he or she manipulates the instruments within the joint.

Arthroscopic surgery can last about one hour, depending on what is done. When the procedure is finished, the arthroscope and other instruments are removed. The incisions may need a stitch or two, but stitches are often not needed as the incisions are so small. A sterile dressing is put over the incisions. An ice pack may be applied for a while to minimise any swelling. Depending on what was done and the problem you have, a knee joint may then be covered with a large bandage or other knee support.

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.)

Are there any possible complications?

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).