Arthroscopy (keyhole joint surgery)

What is arthroscopy?

“Arthroscopy” means looking inside a joint with a thin camera and treating the problem at the same time. The surgeon makes a few very small cuts (about a centimetre or less) in the skin. The camera goes in through one and shows the picture on a screen, and tiny instruments go in through the others. Because the cuts are small, pain and stiffness after the operation are usually less than with open surgery.

Arthroscopy is done mostly on the knee, but it is also used for the shoulder, hip, ankle and other joints. On this page the examples are mostly about the knee.

Who is it for?

A doctor may suggest arthroscopy in these situations, usually when non-surgical treatments (rest, physiotherapy, anti-inflammatory medicine and injections) have not solved the problem:

• A torn meniscus (the meniscus is a pair of cartilage pads between the thigh bone and the shin bone that act as the knee’s shock absorbers): removing the torn part, repairing it, or sometimes a graft
• A torn cruciate ligament that needs reconstruction (ligaments are bands that hold bones together)
• Smoothing or repairing damaged cartilage
• Removing loose pieces of bone or cartilage that catch inside the joint
• Removing inflamed tissue from the lining of the joint
• Some kneecap problems
• Treating a joint infection

Arthroscopy is not suitable for everyone. If your pain is more from widespread wear of the cartilage (osteoarthritis), this method may not help much. The doctor tells you this after examining you and reviewing the imaging. If you are not sure, you can ask why he suggests this method for you and what happens if you do not have the operation.

How is the operation done?

Before the operation a general doctor may check your overall health and ask for a blood test or ECG. Be sure to give the surgeon a list of all your medicines and supplements, because some must be stopped before the operation. Follow the fasting instructions exactly.

The general steps:

1. The skin is disinfected and the leg is covered. A device may be used to hold the knee still.
2. Small cuts are made and the joint is washed with sterile fluid to give a clearer view.
3. The surgeon first looks at the problem with the camera. Then, with tiny instruments, he can cut, shave, remove or repair tissue.
4. The cuts are closed with stitches or glue and a soft dressing is applied. After a repair or reconstruction, a knee brace may be given.

For most operations sources give under one hour, but it may take longer depending on what the surgeon finds. What is done depends on the findings inside the joint.

After the operation

• The same day. Most patients go home a few hours later. Someone must take you home.
• First days. Keep the leg raised and apply ice as your doctor directs (never directly on the skin). Most patients need crutches at first. The doctor will say when you can put weight on the leg.
• Pain. Some pain is normal. The doctor decides the type and duration of painkillers. If the pain does not start to improve after a few days, let the doctor know.
• Exercise and physiotherapy. A few weeks of regular exercise are needed to get movement back and strengthen the muscles. A physiotherapy programme usually gives a better result.
• Driving and sport. In sources, driving after a minor operation is given as about one to three weeks and a return to most activities as about six to eight weeks. If a meniscus was repaired or a ligament reconstructed, the return is later (for rehabilitation after a meniscus repair, sources give about three to six months, and after removal of part of the meniscus, recovery of about three to six weeks).
• Changing the type of sport. Some people need to change their sport to protect the joint, for example swapping running for swimming or cycling.

The times are only general ranges. The surgeon will set your programme.

Risks

Complications of arthroscopy are usually few and mild. These may occur:

• Infection
• Blood clot in the leg veins
• Stiff knee
• Bleeding inside the joint
• Bruising and swelling

Sometimes recovery is not complete, or wider treatment is needed later. The doctor will tell you your personal risk based on your situation.

When to call

Contact your doctor if:

• You have a temperature of about 38 degrees or higher, or chills
• The area around the cuts is red, hot, swollen, or has discharge or pus
• Knee pain or swelling gets worse or does not improve after a few days
• You have cramp-like pain, tenderness or new swelling in the calf

If leg swelling or pain comes with sudden shortness of breath or chest pain, call 115 (the emergency number in Iran) at once or go to the emergency department.

Every patient’s treatment plan is different; ask your doctor about your own situation.