ArthroscopyArthroscopy is a technique that allows to visualize the inside of joints for a diagnosis and also to carry out a treatment if necessary. So are small incisuras around the joint by where are introduced cameras, clamps and other very small tools that allow you to manipulate the joint inside without having to open it completely. Arthroscopy is part of the techniques of minimally invasive such as eRCP, laparoscopy or neuroendoscopy surgery among many others. Despite this, it should be in an operating room with adequate asepsis measures and under regional or general anesthesia.
First Arthroscopic interventions were carried out only in the knee, since it is the largest human body joint and which suffers from more ailments and diseases. Soon began to perform other joints such as the shoulder and hip arthroscopy, today almost all joints, even of the smallest arthroscopies are done.
Minimally invasive techniques have allowed that postoperative patients is shorter and less painful, also save health care costs. Arthroscopy reduces even the risk of surgical wound infections, which in turn helps to reduce the number of septic arthritis.
When Arthroscopy is doneArthroscopy is performed when you want to see the inside of the joint to confirm a specific diagnosis. It also allows to take samples and biopsies from the inside of the joint. But most importantly the arthroscopy is to carry out joint treatments. The most frequent are:
· Meniscus repair (sutures, transplant removal, etc).
· Reconstruction of the cruciate ligaments of the knee.
· Removal of loose bodies extra joint.
· Suture of tendon of the rotator cuff in the shoulder sleeve.
· The shoulder restraint to avoid repeated dislocations.
· Treatment of subacromial shoulder syndrome.
· Wash intra-articular in septic arthritis.
· Excision of ganglion of the wrist.
· Repair of acetabular hip labrum.
· Repair of some bone fractures.
· Treatment of inflammation of the synovial membrane, which is the layer that lines the joints.
· Realignment of the ball after a dislocation.
· (Common in rheumatoid arthritis) Baker's cyst removal.
How the arthroscopyBefore arthroscopy, firstly are you you numb eye so you don't feel any pain throughout the procedure. The anesthesia can be of three types: general, regional or local. The most common is that you carry out with regional anaesthesia wherever possible. To do so will be back a small puncture to anesthetize the nerve roots in the spinal cord directly. In this way the joint to intervene will not have sensitivity and you will keep awake all the time, although you can sedate yourself so that you are more relaxed.
Then be disinfected the outside of the joint and is covered with a surgical sheet which limited the area. Sometimes are placed a sleeve before joint to carry out pressure and limit the blood flow in the joint.
It is then when the orthopedic surgeon makes three or four incisuras in the joint to introduce them the camera, serum pump and other instruments. The camera allows you to see the inside of the joint, serum pump introduces saline within the joint to increase the space between bone and bone.
Instruments that are inserted into the joint are very varied: forceps, scissors, files, sutures, etc. With them the orthopedic surgeon will get solve the problem presented by the joint. Any intervention is recorded on video to view it later by the physician or by yourself.
When the intervention is completed all instruments are removed and the knee incisions are closed with stitches, leaving a very small wounds. After 24 hours you can begin exercises recommended by your health care provider to mobilize the joint.
Preparation for ArthroscopyIf they are going to perform an arthroscopic surgery these are the issues that you must consider when ready to test:
Duration: Arthroscopy has a variable duration according to the surgical technique that is going to be done. It will generally last two to three hours if there are no complications and treatment is simple.
Entry: Arthroscopy can be done on an outpatient basis. You can undergo the operation in the morning and in the evening you can go to your House. However it is frequent that the orthopedic surgeon prefer entering the patient for a minimum of 24 hours to observe their initial evolution.
Is necessary to be accompanied?: Yes, it is recommended to carry a passenger. After Arthroscopy joint should not support an excessive weight or carry large or sudden movements. This can make it difficult to drive or walk.
Drugs: is not necessary to take any prior medication. You should tell your doctor all the medicines taken regularly and will decide which suspend or maintain. You should avoid taking medications that hamper the clotting of blood two weeks prior to arthroscopy, such as aspirin, ibuprofen and other NSAIDs.
Food: must remain in fasting between 6 and 12 hours prior to Arthroscopy.
Clothing: once the street clothes enters hospital is changed by a gown more comfortable and suitable for the operating room. If you enter at least one night it is recommended to wear clothes to sleep and comfortable shoes.
Documents: it is advisable to take the medical history on the joint is going to intervene, although the doctor will already have it with him. Before undergoing intervention sign informed consent that agree to make him the technique and know the potential risks.
Contraindications: Arthroscopy does not have any specific contraindication.
Pregnancy and lactation: Arthroscopy is not contraindicated in these situations, but should only be performed on pregnant women and nursing mothers in emergency situations or when joint damage more difficult day by day in a remarkable way. If it doesn't, it is best to wait until later.
Arthroscopy resultsArthroscopy treatment outcomes are very positive in general. Depending on the technique that is done will require more or less time to recover.
When ligaments or fractures are repaired it is frequent that joint is immobilized for several weeks and crutches for the joints of the leg should be. If the intervention has been minimal or has only been diagnostic, movements can be 24 hours later.
In any case it is advisable to perform simple exercises to prevent stiffness in the joint. If needed the doctor will tell you how to perform them before you get high. Rarely needed rehabilitation, and when not needed is because Arthroscopy itself, but to the previous injury.
When performing a diagnostic Arthroscopy results can be offered to the patient shortly after making it, since there is the joint direct. If biopsy or microbiological samples taken results may take several days because they depend on the analysis in the laboratory.
A few days later one will quote the patient to remove stitches from injuries and check that they heal properly.
Arthroscopy complicationsArthroscopy complications are very rare. Some that can ever occur are:
· Articular cartilage damage, ligaments, tendons, or other structures that are within the knee. They may be due to a mistake by the surgeon or by anatomical abnormalities of the patient.
· Infection of surgical wounds or the inside of the knee. When it happens the intravenous antibiotic treatment is necessary to prevent the destruction of the joint.
· Injury of arteries, veins or nerves that pass around the joint. In general, they are unimportant.
· Limitation of motion of the joint after arthroscopy, can be temporary or permanent.
· Thrombosis of the veins, more frequent when hips, knees and ankles are involved.
· Pulmonary thromboembolism by immobility
· Complications of anesthesia (respiratory depression, sedation allergies, nerve paralysis, etc).
However, remember that these complications occur in rare cases.