- 1 What is arthroscopy?
- 2 What is it for?
- 3 What is the arthroscope?
- 4 How is it done?
- 5 Knee Arthroscopy
- 6 Hip arthroscopy
- 7 Shoulder arthroscopy
- 8 When should it be done?
- 9 Contraindications
- 10 Pre-surgery care
- 11 Post-surgery care
- 11.1 Dressings
- 11.2 Ice and compression bandages
- 11.3 Adaptation to crutches
- 11.4 Physiotherapy
- 11.5 Physical exercises
- 11.6 Withdrawal of stitches
- 11.7 Avoid directing
- 11.8 For shoulder arthroscopy
- 12 Arthroscopy results
- 13 What are the risks?
- 14 Arthroscopy price
What is arthroscopy?
Arthroscopy, also known as arthroscopic surgery, is a minimally invasive surgical procedure that acts in the diagnosis and treatment of diseases and injuries in the joints.
It can be performed on the shoulders, elbows, ankles, hips, hands, wrists and, most commonly, on the knees.
The name arthroscopy comes from two Greek words, arthro (joint) and scopia (look), which describes the main objective of this surgery very well.
Through the arthroscope, an instrument used during the procedure, orthopedic surgeons are able to observe the joints in detail, which an image examination does not allow.
In surgery, the doctor makes incisions in the region to be treated and introduces the arthroscope through these small cuts. Normally, it lasts from 45 minutes to 1 hour. However, it may vary depending on the case.
The possibilities of using arthroscopy are diverse. It is a common treatment in traumatic injuries of athletes, for example.
Because it is minimally invasive, recovery is faster. The pain is also less when compared to open surgery.
Continue reading and find out how this procedure is performed and on what occasions it is indicated.
Arthroscopy is a surgical procedure that allows you to analyze or treat problems in the joints of the body such as those of the knee, shoulders, hips and small joints such as the elbow, ankle and wrist.
The most common is its use in the treatment of problems related to knee and shoulder joints.
Through the use of the arthroscope, equipment used during the procedure, the doctor will be able to investigate possible causes of pain and see if there is any damage to the joint structures such as cartilage and ligaments.
It can also be used as a complement to other tests, such as X-rays, as a treatment or for diagnosis. During arthroscopy, the doctor can take the opportunity to make minor repairs.
The arthroscope is the equipment used during this surgical procedure. It is a kind of endoscopic instrument, as it allows the doctor to visualize inside the patient, through small incisions.
There are different sizes of arthroscopes, as they vary according to the region to be treated. Basically, the arthroscope is a thin rod, composed of a microcamera on the tip and a light source, so that it is possible to see the structures of the joints and, together, a monitor is used to reproduce the image.
Arthroscopy can be done both for the treatment and for the diagnosis of any disease in the joints. Its duration varies from 45 minutes to 1 hour, where the patient can be discharged on the same day.
During surgery, the doctor drills two to three holes in the patient’s joint. These small incisions are also called portals.
One of the incisions is used for the introduction of the arthroscope and the other is used for cases in which it is necessary to operate the patient, not just diagnose it. Thus, the incisions allow the use of other instruments that are necessary.
To make visualization better, an amount of saline can be introduced into the joint. Its presence inflates the joint structures and makes them clearer, facilitating the procedure.
Thus, with the arthroscope on the patient, it is possible to understand the damage in the region and proceed with the immediate treatment or the orientation of other treatments, varying according to the patient’s need.
In general, arthroscopy is not considered a complex procedure, but it still requires specific care. Because the incisions are minimal, the patient should not experience severe pain after the procedure.
During arthroscopy, however, he will have to receive anesthesia, which can be local, regional or general, varying according to the case.
The knee was the first part of the human body to experiment with arthroscopy in 1918, when surgeon Kenji Takagi created it.
The technique, initially used and widespread in Europe, took time to gain popularity. In the USA, for example, it only started to be practiced after the 1960s.
From the knee arthroscopy, the techniques were developed and applied to the other joints.
What started out as a form of diagnosis has now also become a form of treatment. This facility in observing inside the joints contributed to making this assessment more systematic, accurate and agile.
It also allows you to create a more complete patient record, with the archiving of images and recording of pathologies and treatment. This practice is recommended among all doctors, being for the evaluation of the knee or any part of the body.
For the treatment of pathologies that occur in the knee joints, the possible resources are:
- Diagnostic arthroscopy;
- Partial meniscectomy;
- Free body removal;
- Reparo meniscal;
- Transfer of osteochondral plug;
- Autologous chondrocyte implantation;
- Reconstitution of the anterior cruciate ligament.
Knee arthroscopy is not indicated in some cases, such as when the patient has some type of skin infection, close to where a cut would be necessary to introduce the arthroscope.
It is also not recommended in cases of patients who do not collaborate with postoperative procedures, which can cause complications.
Knee arthroscopy is recommended in the following cases:
Synovitis is an inflammation of the synovial membrane, a very thin layer of connective tissue responsible for covering the tendons. This membrane and its functioning are fundamental for the health of the joints, because it is the one that produces the synovial fluid, responsible for lubricating and reducing the friction between the structures of the knee.
This inflammation occurs for different causes, such as trauma, overexertion of the joints, infection or metabolic reaction.
The main symptoms of synovitis are swelling, pain and difficulty in moving the joint.
Meniscal rupture is an injury that occurs in the meniscus, one of the main structures for the proper functioning of the knee. On each of our knees there are 2 menisci. They act as buffers for all the impact suffered by the joint.
When, for reasons that can vary, these menisci suffer some kind of rupture, the patient is harmed. In addition to pain, the patient when he breaks a meniscus suffers from swelling and stiffness of the knee.
In this condition, the patient may end up losing total movement of the joint. Failure to treat this type of injury can be dangerous, as the meniscus can detach and “float” through the joint.
Arthroscopy helps to diagnose and also helps in the treatment of this lesion, in a non-invasive way.
Septic arthritis of the knee
The arthritis , septic infection is caused by the invasion of joints of a type of pathogenic microorganism, which may be caused by a bacterium, virus or fungus.
Arthroscopy, in this case, is indicated so that it is possible to perform a joint wash.
In this joint wash, the doctor uses a large amount of saline to remove what is damaging the joint, in this case, it will depend on the cause of septic arthritis.
In this pathology, arthroscopy is not the first procedure used to treat the problem. The doctor in charge must analyze the need, as the treatment of septic arthritis is usually based on the use of antibiotics .
Each case, in particular, requires a specific diagnosis and treatment. Arthroscopy is a resource that can assist in this process, but it is up to the orthopedist to make this assessment.
Arthroscopy assists in the removal of free bodies, such as fragments of cartilage or bones.
Hip arthroscopy is a procedure that helps preserve the region, seeking to reduce pain and preventing the patient from having to resort to the use of prostheses, in cases where there are more serious complications to the joint.
This type of surgery assists in the treatment of several pathologies, being more common to treat problems such as femoroacetabular impingement, lesions of the acetabular labrum, cartilage lesions, to saturate or repair fibrocartilage lesions, labral lesions and to smooth out bony prominences.
In addition to these functions, arthroscopy can help remove damaged tissues, fragments of cartilage and other free bodies.
During this surgery, the use of saline can also be done, as it causes a strain in the joint and creates a space necessary for the doctor to be able to see all the structures.
Lesions treated by hip arthroscopy include the following cases:
Labral injuries are usually caused by changes in the shape of the hip bones. It is common in people who practice sports activities or perform more intense movements, as in heavier work.
Arthroscopy has good results in the treatment of most types of labral lesions, preventing these changes from causing other complications.
The treatment of a femoroacetabular impingement is the main indication for hip arthroscopy. The name is unfamiliar, but the condition is one of the most frequent causes of pain at the site.
The femoroacetabular impingement is a wear and tear caused by a condition in which the femur (thigh bone) and the acetabulum (pelvic bone) have bony prominences that come into contact.
This constant friction, in addition to causing pain, causes damage to the cartilage of the joint.
External hip shoulder
This injury, also known as hip cracking, is a condition that does not cause pain in the patient. These crackles happen in specific movements of the hips, they can often be heard even by close people.
They are usually caused by a friction between the tendons and the bones. In many cases, these snaps are not considered serious and do not even need specific treatment.
However, it can become painful and aesthetically uncomfortable. In some cases, these crackles appear as a symptom of other, more serious types of damage to the cartilage or due to the presence of free bodies, that is, fragments of bones or cartilage.
In such cases, it is common for the patient to feel pain or a sensation of the joint more tightly.
Arthroscopy can be used to help orthopedists investigate the causes of pain in the gluteal region. However, in these cases the instrument used is different. Instead of the arthroscopic, an endoscope is used.
The main indication for surgery is to investigate whether there is compression of the sciatic nerve, one of the main causes of pain in that location.
The bursitis trochanteric is an inflammation that occurs in the bursa, one synovial tissue located in the hip region.
Bursae are like a kind of bags or empty bags that perform the function of protecting the joints. They help the tendons and muscle fascias to slide over the bone.
Each person has 4 or more bursae on each side of the hip. Inflammation of one of them is already characterized as trochanteric bursitis. The patient has pain and faces some limitations with this pathology, having difficulty performing physical activities and sleeping, for example.
Arthroscopy in this region of the body is also a recurrent procedure. Usually, it is requested when there are chronic pains that have not responded well to treatments done with medication or physical therapy.
As it is a surgery that allows you to look inside, in a less invasive way, it becomes an option for these patients.
Like all surgery, shoulder arthroscopy can also cause some complications. However, it is not common for them to occur. Usually, the associated risks are possible bleeding, infections or injuries to the nerves or ligaments.
Recovery time is usually much shorter than other types of open surgery, averaging approximately 1 to 2 months.
Because the cuts made are minimal, the patient will have no problems with the healing of the site and no concern with extensive scarring.
Shoulder arthroscopy is indicated for the treatment and diagnosis of various pathologies. However, in more severe cases, such as a fracture or rupture of ligaments, arthroscopy may be insufficient.
It is up to the doctor to assess which procedure will be ideal for the patient. In the case of fractures, for example, arthroscopy can be used only as a diagnosis.
Some shoulder joint diseases that arthroscopy helps to treat and diagnose are:
Rotator cuff repair
Rotator cuff is the name used for the group of muscles and tendons of the shoulder joint, helping to keep it in position and allowing the arms to make greater movements.
When damage to these muscles and tendons occurs, the patient experiences pain, limited movement and weakness. It is common for such damage to the rotator cuff to make sleeping on your side uncomfortable.
Bone spur removal
The bone spur, also known as osteophyte, is a kind of bone lump that forms at the edges of bones. When these spurs appear on the spine, they are popularly known as the parrot’s beak .
These spurs can cause symptoms such as pain in the site, limited movement, swelling or inflammation. In this case, arthroscopy is used as a treatment.
Removing free bodies
Shoulder arthroscopy, as well as other parts of the body, can be used to remove free bodies, such as loose cartilage or inflamed tissue.
Arthroscopy is indicated for different types of injuries and in different regions of the body, such as knees, shoulders, hips and ankles.
In more delicate regions, such as fingers, the temporomandibular joints (TMJ), wrists and elbows, arthroscopy can also be performed, but in these cases, the use of much smaller cameras is necessary.
This procedure is also recommended in cases of inconclusive previous examinations, such as those of X-ray, MRI or tomography.
It can be indicated in cases of inflammation, tendon rupture and ligament injuries. Some commonly treated problems are:
The tendinitis is an inflammation that occurs in the tendon. It usually occurs as a consequence of a Repetitive Strain Injury (RSI).
This inflammation can affect different parts of the body such as the shoulders, hands, heels, knees, elbows and wrist.
Calcification occurs when a very large amount of calcium accumulates in the soft tissues, such as in arteries, heart valves and in the cartilages themselves.
Arthroscopy, in this case, can help treat possible damage caused by this calcification, which ends up making these tissues more rigid and which can trigger various injuries in the patient.
The meniscus is a fibrocartilage structure located on the knee. In each knee there are two menisci responsible for the proper functioning of this joint.
They are located in the center of our knees and perform a series of fundamental functions, such as shock absorbers, lubricants, distributors of the loads that pass inside the joint and stabilizers.
They also make the fit between the femur and tibia better, that is, the menisci are fundamental pieces and need to be in perfect condition. However, there are injuries.
Meniscus injuries are quite recurrent and happen to people of both genders and in different age groups. The causes can vary, and can be of traumatic or degenerative origin.
The symptoms are knee pain and joint effusion, also known as water in the knee , since there is an excessive production of synovial fluid, responsible for lubricating the joints.
Knee arthroscopy can be recommended to diagnose or to help treat the injury.
Loose fragments of cartilage or bone
Some injuries can cause loosening of cartilage or bone fragments in the joints.
An example is osteochondritis dissecans, a condition in which a piece of cartilage, together with a very thin layer of bone, comes off. It usually occurs near the end of a bone.
It occurs more often in young men, usually as a response to an injury or after a sports trauma, such as a sprain during a run.
Despite being more common in the knee, these loose fragments can also appear in other regions, such as the ankle and elbow.
During treatment, arthroscopy is useful because it allows greater visibility of the fragment to be removed.
Arthroscopy is not indicated for patients who have an infection of the skin or a wound close to the insertion site.
It is also not a recommended procedure for people who suffer from a severe bleeding disorder.
Who should decide if the patient has conditions or if he really needs an arthroscopy is the doctor responsible for the case, considering the risks and benefits of the surgery.
Arthroscopy, like other surgical procedures, requires some important care before it is performed.
Before an arthroscopy, it is recommended that the patient fast for 8 hours, for food and liquids.
He can still consume water up to 4 hours before surgery, after that time no more. It is also recommended that the patient avoid very heavy foods at his last meal, such as fatty meats, feijoada and pasta in large quantities.
Another recommendation is in relation to the consumption of alcoholic beverages, which should be avoided in this pre-surgery preparation.
Do not use drugs
A recommendation from doctors is that the patient should not use any type of drug in the week before surgery, as there is a risk of interaction with anesthetics.
Beware of medications
People who need to take medication for continuous use such as hypertension, diabetes and thyroid do not need to stop using it.
Other medications must be informed in advance to the doctor, to check if there is any risk of drug interaction during surgery.
The use of anticoagulant drugs should be discontinued as they present a risk of causing bleeding during surgery.
Usually, arthroscopy is not a surgery that requires hospitalization of patients, nor does it even require that they stay for a long period of observation.
Certainly, this can vary from case to case, since arthroscopy addresses several problems related to the joints. It is also a procedure that depends a lot on the Hospital where the surgery will be performed.
In general, hospitalization is done on the day of surgery, 3 hours before the procedure, or the day before.
Some patients may need the use of crutches after the procedure, for example, when it is done on the knee and ankle.
It is important to check with the doctor if it is going to be necessary and take them to the hospital for later use.
For shoulder arthroscopy
Pre-surgery care in a shoulder arthroscopy is basic. The patient should keep his hygiene up to date, especially in the shoulder and armpit regions.
It is also necessary to take greater care not to be exposed to too much sun, to avoid burns on the skin.
Even though it is difficult to predict what will happen, doctors advise the patient to take care not to suffer scratches or cuts on the skin close to where it will be operated, as this can influence the performance of the surgery.
It is not necessary to remove hair, as this, if necessary, will be done during surgery and by doctors.
In the post-surgery period, the patient must take a series of precautions to achieve a good recovery and not run the risk of suffering any type of complication.
As it is a less invasive surgery, this process is usually less painful than open surgery. Usually, the patient is discharged on the same day and can be released for daily activities, such as study and work, in a few days after arthroscopy.
However, people who work in heavy activities may need a longer rest period, as wear and tear can prolong recovery time.
Other precautions or procedures to be performed are:
The patient must take care of the dressing to avoid the risk of infection. To do this, you must follow the doctor’s recommendations regarding hygiene and dressing changes.
In some cases, the patient receives an impermeable dressing, which makes bathing easier. These dressings can last up to a week, during which time the patient must return to the doctor’s office to evaluate the surgery.
On this visit to the doctor, the dressing should be changed and a new one replaced. The dressings are removed along with the stitches, 14 days after surgery.
Ice and compression bandages
The use of ice and compression bandages can be done to help decrease possible pain, swelling and infections at the surgery site.
Adaptation to crutches
Crutches are generally used within 1 to 2 weeks after arthroscopy is performed. They serve to help the patient to walk more safely, avoiding falls and reducing possible effort in the operated area.
In most cases, the use of crutches is not necessary for longer than 2 weeks. During the first week, the use of 2 crutches is recommended, after the second week, the patient can use only one.
If the doctor agrees and the patient is safe to walk without the support of crutches, they can be dispensed after the seventh day of surgery.
Physiotherapy contributes to a more efficient recovery of the treated region and must be done by a physiotherapist with experience in strengthening exercises and limb mobility after surgery.
In the first weeks, physiotherapy should start with lighter activities and intensify the movements according to the patient’s evolution.
For athlete patients, for example, within 4 to 6 weeks after surgery, with physiotherapy and strengthening exercises done correctly, they will be able to return to sports.
After 4 to 6 weeks of surgery, with the musculature similar to the other limb and the proprioception (balance) restored, the patient will be able to return to his sports practice.
Practicing physical exercises can help recovery by strengthening the treated region. However, these exercises must be done with the accompaniment of a physical education professional.
It can be dangerous for the patient to perform exercises without this support, as there is a risk of suffering an injury or end up impairing the recovery from arthroscopy.
Withdrawal of stitches
The removal of the stitches from the surgery should be done between 7 to 14 days after the procedure.
After undergoing an arthroscopy, depending on the region in which the patient was operated, the ideal is that he avoids driving for at least 1 to 2 weeks.
Driving is not an activity that will interfere with the results of the surgery, however, because it is a surgical procedure that causes discomfort and pain in the area, it can cause some difficulty for the patient, running the risk of an accident.
For shoulder arthroscopy
After performing a shoulder arthroscopy, the patient must follow some basic precautions to have a good recovery of the site, such as the following items:
Immobilize the arm
Patients are instructed to immobilize the arm after arthroscopy for 1 to 4 weeks. For this, it is possible to make use of orthopedic slings.
In addition to leaving the arm of the operated side immobilized, it is important that the patient avoids physical efforts.
Analgesic and anti-inflammatory drugs
The patient must correctly follow the medical guidelines related to the use of analgesic and anti-inflammatory drugs, to relieve possible pain. In addition, if there is any complication or if the pain does not go away with the medication, the patient must return to the doctor’s office.
Sleeping with the headboard elevated
Sleeping with the head of the bed raised helps prevent the patient from stretching the tendons, which can cause greater discomfort or pain in the area.
Apply ice on the shoulder
Applying ice to the operated area helps to reduce swelling. The indicated is that the patient put ice packs during the first week.
After 2 to 3 weeks of arthroscopy, if the doctor understands that it is possible, the patient can already begin to undergo physical therapy. This treatment helps in the total recovery of the shoulder, strengthening the musculature and helping to recover the movements of the joint.
The results obtained through arthroscopy vary widely, as it is a procedure that can be performed for the diagnosis and treatment of various diseases and in different joints.
A difference is the fact that the doctor can look in great detail at what is happening in the patient’s joint, which is sometimes not possible in exams such as X-ray, MRI or tomography.
Usually, the procedure has positive responses for treatment and also for diagnosis. Because it is minimally invasive, patients demonstrate good recovery.
For sports practices, arthroscopy is an extremely relevant procedure, as it is often used to treat injuries sustained in training and competitions.
Other characteristics that influence the positive results of arthroscopy are:
- Little bleeding during surgery;
- Smaller incisions and, consequently, smaller scars;
- Quick recovery;
- Quick return to day-to-day activities;
- It causes less pain than open surgery;
- Rehabilitation does not require much effort;
- Discharged the same day.
The risks that surgery such as arthroscopy presents are considered relatively small. However, there is still the possibility of having some complications.
Some risks are common to any surgery, such as the chance of internal bleeding, infection at the cut site or allergic reaction to anesthesia.
Other risks include:
- Knee stiffness;
- Injuries to healthy knee structures;
- Opening of the stitches, which can cause infections;
- Dores not local;
- Nerve damage;
- Feeling of heat in the place;
- Phlebitis (inflammation in a vein).
Regarding the risks of the surgical procedure itself, there is a chance that the arthroscopic or other instrument used will break. This, in general, should not happen, as the materials used are resistant.
The break may be more related to the misuse of the instrument by the surgeon, which is rare.
In the event that an instrument breaks inside the joint, during surgery, the doctor can remove it by making a small incision.
The price of arthroscopy varies according to the purpose of the procedure. When used as a diagnosis, for example, its value is usually lower, something of approximately 200 reais.
The cost for surgical arthroscopy, in which the patient is submitted to corrections of injuries, the price is higher, ranging from 400 to 800 reais. These prices can certainly fluctuate according to the chosen clinic.
However, as of 2008, private health plans adopted the procedure as health care coverage, with the minimum coverage for the procedure being mandatory. In SUS it is also possible to perform the procedure, free of charge.
Arthroscopy is an important procedure for the health of our joints. Despite being a surgery, it is considered minimally invasive and helps in the diagnosis and treatment of several diseases.
If you have had this surgery, leave in the comments how was the recovery and the results obtained. If one day it is necessary to undergo an arthroscopy, I hope this article has helped to clarify your doubts. Thanks for reading!