Arthroscopy

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Test Overview

Arthroscopy is a surgical procedure that lets a doctor look inside your joints. The doctor uses a thin viewing tool called an arthroscope, or scope. It allows the doctor to see the joint surfaces and the tough tissue that covers and cushions the ends of the bones (cartilage). The doctor can also see the surrounding soft tissues, such as tissue that connects bone to bone (ligaments).

This procedure can be used to see if you have a joint problem or to do surgery that repairs a joint problem. It can also be done to remove a loose or foreign object in a joint. Doctors can also do it to keep track of a disease or to see how well a treatment is working. Arthroscopy is most often done on the knee, shoulder, and ankle. It also can be done on the hip, elbow, and wrist.

During arthroscopy, the arthroscope is put into your joint through a small cut (incision) in the skin. The scope has a light source and a video camera attached to it. Images from the camera can be seen on a video screen. These magnified images provide a clear picture of your joint. During the procedure, a sample of joint tissue can be collected to be tested. This is called a biopsy. If needed, more tools will be put into your joint through other small incisions.

Like open surgery (which is done using a larger incision), arthroscopy allows your doctor to see what is wrong with your joint. But compared to open surgery, arthroscopy usually:

  • Is less painful.
  • Costs less.
  • Lets you recover sooner, depending on what is done.
  • Can be done on an outpatient basis without the need for an overnight stay in a hospital. An inpatient stay is often needed with open surgery.

Why It Is Done

Arthroscopy is used to:

  • Evaluate and diagnose a joint problem when a physical exam and other tests don't give a clear result. These tests may include X-rays, blood tests, CT scans, or magnetic resonance imaging (MRI).
  • Do surgery to repair a joint problem.

It may be used during surgery to:

  • Shave bone tissue to remove calcium deposits or bone spurs.
  • Repair or trim soft tissues, such as ligaments, tendons, or cartilage.
  • Cut ligaments to help relieve tightness in a stiff joint. They can also be repaired or rebuilt.
  • Collect a sample of joint tissue or joint fluid (synovial fluid) for testing (biopsy).
  • Remove scar tissue or an area of joint lining (synovium) that is swollen.

Some joint problems may be repaired using arthroscopy with open surgery.

How To Prepare

Arthroscopy is often done on an outpatient basis without the need for an overnight stay in a hospital.

Tell your doctor if you:

  • Are allergic to any medicines, including anesthetics.
  • Are taking any medicines, including aspirin or some other blood thinner.
  • Have had any bleeding problems, including blood clots in a vein (deep vein thrombosis, or DVT).
  • Are or might be pregnant.
  • Have a history of joint stiffness or arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
  • Have had an X-ray of your joint that used contrast material (arthrogram) within the last 10 days. The contrast material may cause swelling within your joint that makes doing arthroscopy hard. This swelling can also prevent a clear picture of your joint during the procedure.
  • Have a history of infection, such as septic arthritis, in the affected joint.
  • Have a history of a broken bone (fracture) or injury to the affected joint.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).

You may have more tests, such as blood tests or urine tests, before your arthroscopy.

Arrange to have someone drive you home after the procedure.

If you have arthroscopy of your ankle, knee, or hip, your doctor will talk to you about using crutches after the procedure. If you have arthroscopy of a joint in your arm, you will likely wear a sling or splint afterward.

How It Is Done

Arthroscopy is usually done by a doctor who specializes in bone, muscle, and joint surgery (orthopedic surgeon).

You will be asked to remove any jewelry and to wear a hospital gown. You may be given a sedative shortly before the procedure to help you relax. The skin around your joint may be shaved.

During the procedure

If general or regional anesthesia is used, an anesthesia specialist will give the medicine. A general anesthetic will make you sleep during the procedure. Your heart rate and rhythm, blood pressure, and breathing will be watched closely during the procedure. If a local anesthetic is used, it will be injected into the skin and joint space. If a local or regional anesthetic is used, your limb will be numb. You will be relaxed and drowsy but will be awake.

You probably will lie on your back. Depending on which joint is being looked at, an inflatable band (tourniquet) may be used to briefly restrict blood flow to your joint. This allows your doctor to see all the parts inside your joint. Your joint is scrubbed with an antiseptic solution and draped with sterile towels. Before the tourniquet is inflated, the joint will be raised. It may also be wrapped with an elastic bandage to reduce blood flow to the joint.

A small incision about 0.25 in. (0.6 cm) will be made near your joint. Before the doctor inserts the arthroscope, an irrigation fluid (usually saline) will be used to flush the joint space. This gives the doctor a better view of the entire joint. A steady low flow of fluid is usually used during the procedure. This clears out any debris or blood in the joint so your doctor can evaluate your joint.

After the scope is put in, your doctor will be able to see inside the joint by viewing a video screen attached to the scope. Your doctor or the surgical assistants may bend, extend, and change the position of the joint to see it from different angles. Videotapes or photos of the joint may also be taken.

If more surgery is needed to repair your joint problem, more small incisions will be made. Other thin tools will be put into your joint. When the arthroscope and any other tools are taken out, any blood and debris will be flushed with saline and drained. To reduce swelling or pain, local anesthetics or corticosteroids may be injected into your joint.

The small incision is closed with stitches. Depending on which joint was looked at, you may need to use splints, slings, or crutches while you recover from surgery.

How long the procedure takes depends on what is done. It may take only about 15 minutes, but it could take an hour or longer.

After the procedure

After the procedure, you may need to rest your joint for several days. You may not be able to drive for 24 hours. This will depend on which joint was looked at and what type of anesthetic you had. If your stitches aren't the type that dissolve over time, they will be removed in 7 to 10 days. You can use ice, elevation, and a compression bandage to reduce any swelling. And you can take pain relievers to relieve any pain or discomfort. Ask your doctor for advice on strengthening your joint with exercise and when you can do your normal activities.

How It Feels

If you get a local anesthetic before the procedure, you will feel a brief burning or stinging in your skin. As the arthroscope is put into the joint, you will notice a thumping feeling. You may feel slight pulling in the joint area as your doctor moves joint structures around.

If you get a general anesthetic, you will be asleep and will not feel anything. If you get a regional anesthetic, your arm or leg will be numb for several hours.

You may have some soreness and pain after the procedure. Your doctor will give you instructions on using pain medicine and applying ice to your joint to reduce swelling and pain. You may also need to prop it up on pillows. You will have bandages to cover your incision. Keep them clean and dry.

After the procedure, you may notice bruises around the incision. This will not last long and should disappear within 2 weeks. It is normal for your joint to feel tender for about a week. Ask your doctor how much bleeding, drainage, or swelling from the incision site to expect. If you needed more extensive joint surgery, you may have more bleeding, drainage, pain, and swelling than if you had a simpler surgery.

Risks

Problems during arthroscopy are not common. Sometimes there is joint stiffness or long-lasting joint pain. Bleeding inside the joint can occur, especially if surgery is done during the procedure.

There is a small chance of infection, getting a blood clot in the affected limb, or nerve or joint damage. Also, there is a small risk of damage to the structures within the joint.

In rare cases, a serious condition called compartment syndrome can occur. This happens if pressure builds inside a muscle compartment (most commonly in the front of the calf or forearm). When this occurs, medical treatment is needed right away to release the pressure.

In very rare cases, death can occur from problems with general anesthesia.

After the test

Contact your doctor right away if:

  • Your pain or swelling (or both) continue or get worse.
  • Your incision site bleeds more than expected.
  • You have redness, swelling, pain, or a feeling of heat in your calf or arm. These may be signs of a blood clot in a vein. This condition is called thrombophlebitis. If you have these symptoms, do not massage the area.
  • You develop signs of infection. These signs may include:
    • Increased pain, swelling, redness, or warmth around the affected area.
    • Red streaks extending from the affected area.
    • Drainage of pus from the area.
    • Swollen lymph nodes in the neck, armpit, or groin.
    • Fever or chills with no other known cause.

Results

Arthroscopy is a surgical procedure that lets your doctor look inside your joints. The doctor uses a thin viewing tool called an arthroscope, or scope. Your doctor can see if your joint is normal by looking at it through the scope. Usually your doctor will be able to discuss the results with you right after the test.

Arthroscopy
Normal:

In a normal, healthy joint, the ligaments look like white cables. The cartilage is smooth and white. The joint fluid is clear, and there are no loose pieces of tissue in the joint. If there is no damage or disease seen in the joint, your doctor may conclude that your joint is normal and is not the cause of your symptoms.

Abnormal:

In a damaged or diseased joint, the ligaments and cartilage are abnormal in color and shape. If there is damage or disease in the joint, your doctor may identify the condition. Your doctor may even do surgery during the arthroscopy to repair the joint problem. Examples of damage or disease in the joint include:

  • Torn, displaced, or loose fragments of soft tissues (such as ligaments or cartilage).
  • Abnormal growths, cysts, or ganglions.
  • Signs of joint or cartilage damage caused by injury or diseases such as arthritis.
  • Infection.

After your doctor has evaluated your joint, you may need more treatment. This could be medicine, physical therapy, or surgery.

What Affects the Test

You may not be able to have the test, or the results may not be helpful, if:

  • You had an X-ray of the joint that used contrast material (arthrogram) within the previous 10 days. The contrast material may cause swelling inside the joint. The swelling can prevent a clear picture of the joint during arthroscopy.
  • You have arthritis. Joint damage caused by arthritis may make it difficult or impossible to do this procedure.
  • You have some other medical condition, such as a thickening of tissue (fibrosis) in the joint area or widespread infection (sepsis).

What To Think About

  • Surgical procedures done by arthroscopy usually result in shorter hospital stays and faster recovery times than open joint surgery.
  • Arthroscopy usually is not done if:
    • You have a skin or wound infection near the joint to be looked at. But it may be done to clean out an infected joint.
    • You have ankylosis. This is a condition that causes stiffness and poor flexibility of a joint. It may be caused by a disease (such as ankylosing spondylitis), a joint injury, or surgery.
    • Joint destruction is severe (for example, with severe arthritis).
    • You have a severe bleeding disorder. But arthroscopy may be done if clotting factor medicines are used.
  • It may take several weeks for your joint to heal. If extensive surgery is done during your arthroscopy, it may take longer than a few weeks to recover. Your doctor will give you pain medicine and recommend exercises or physical therapy for you to do while you recover. Depending on which joint was examined, you may need to use splints, slings, or crutches to support movement of your joint during recovery.
  • Many doctors use ultrasound, CT scans, or MRI scans before doing an arthroscopy. This is to make sure that any problems that need surgery can be done at the same time.

References

Other Works Consulted

  • Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
  • Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise Staff

Primary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine

E. Gregory Thompson, MD - Internal Medicine

Adam Husney, MD - Family Medicine

Specialist Medical ReviewerRobert B. Keller, MD - Orthopedics

Current as ofMarch 21, 2017

Current as of: March 21, 2017

Author: Healthwise Staff

Medical Review: William H. Blahd, Jr., MD, FACEP - Emergency Medicine & E. Gregory Thompson, MD - Internal Medicine & Adam Husney, MD - Family Medicine & Robert B. Keller, MD - Orthopedics