Arthroscopy of Knee: Surgery for Joints, Arthritis


Arthroscopy is the surgical procedure used on joints using an endoscope. This would make the procedure much less invasive than open surgery. The procedure has been practiced since 1920 and has evolved into a successful alternative for minor and even major joint problems.

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Arthroscopy comes from two Greek words, “Arthro” which means joint and “Skopein” which means to look. Literally it means “looking into the joint”. This procedure is used to either evaluate or treat orthopedic conditions concerning the bones, cartilages, meniscus, and ligaments.

History

The first known attempt for arthroscopy on live patients was done by Eugen Bircher. He is considered the inventor of knee arthroscopy although he did not have the primary credit for it. At that time, he only used arthroscopy to diagnose the problem and still use open surgery. He first used thoracolaparoscope to evaluate tissue damages. Later on, he adapted a double-contrast method which provides more visibility.

Arthroscopy has been reported to be done since 1912 by Dr. Severin Nordentoft. He was a Danish surgeon who shared his ideas on the procedure to the German Society of Surgeons at Berlin. It was not clear though if his studies were done with live or deceased patients.

It was not until in 1919 that Professor Kenji Takagi published his work on arthroscopy. He used a cytoscope measuring 7.3 millimeters to examine a knee joint of a cadaver. This was continued on by his student, Dr. Masaki Watanabe. However, recent publications suggest that medical arthroscopy have been introduced in the early 1800’s.

Pros

The endoscope used is more commonly known as arthroscope. It is a thin, straw-like tube containing optical fibers and lenses attached to a video camera. It provides light and visualization on the target site. This has a diameter from 0.5 to 5 millimeter. Arthroscopy is considered as the best option for people who frequently need operation and less recovery period.

Arthroscopy was popularized in early 1960’s. Although knowledge and instruments were still limited at that time, it proved to be quite a good alternative treatment. Patients undergoing arthroscopy suffers from less tissue trauma, scarring and requires lesser recovery time. Also, it can be done as an out-patient procedure. This means hospitalization after the procedure would only take 1 to 2 hours and patients can recuperate at the comfort of their own homes.


Cons

There are little known complications with arthroscopy. However, it is still best to assess and prepare for the procedure. Infection which is normal in all operative procedures could also set in after arthroscopy. This can easily be counteracted through anti-bacterial medications. Phlebitis which is the formation of blood clots in the vein can also occur.

Blood vessels and nerves damage can also arise. This is because joints have thriving blood vessels and nerves near it. As with most surgery, swelling and bleeding is also considered. Lastly, there is also a risk for breakage of instruments. Again these complications are quite uncommon. It occurs in less than 1 percent of all procedures done.

Arthroscopy Applications

Arthroscopy can be used in any joint of the body. It is most commonly used for knees, shoulders, wrists, ankles and hip joint surgery. The process is quite similar for all joints, the number and width of incisions made and arthroscope size used will vary though.

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Knee arthroscopy is used to diagnose extent of tissue damage, withdraw sample tissue for biopsies and perform corrective surgery. Sometimes knee problems can be treated through physiotherapy and medications alone. This is the reason that radiologic examinations such as X-ray and MRI are utilized.

After the procedure, weight bearing and deep knee bending activities should be avoided. This is to ensure that no further trauma or stress is added. Also, knees can be swollen especially with arthritis. Raising the foot for some time to avoid pooling of blood on the lower extremities is recommended.

• This used for non-inflammatory and inflammatory joint problems such as degenerative arthritis and rheumatoid arthritis. It can also be used for synovial fluid diagnosis and treatment. Overall it is considered as one of the safest orthopedic procedure, although sometimes it would need to be repeated.

Shoulder arthroscopy is used for problems with the rotator cuff. This is a group of tendons and muscles which aids in the movement of your arm that can be easily damaged by overuse and injury. This is done for three main purposes: repair the rotator cuff, clean off damage or inflamed tissues, and provide shoulder stability.

Wrist arthroscopy is done to repair damaged and torn cartilages due to trauma or infection of arthritis.

Spinal arthroscopy is generally used for spinal deformity, disc herniation and spinal tumors. This is becoming more popular over the years and can ultimately replace open surgery with more medical advancements.


Nursing Care

Arthroscopy still follows the general guidelines for surgical procedure. Assessment of the lungs and heart is emphasized especially for those within the extreme ages. Physical examination, blood works and radiologic tests are done. Certain medications are ordered to be regulated before the surgery. Anti-coagulants are cut off 2 weeks before surgery to decrease risk of bleeding. Diabetes and hypertension medications are also monitored weeks before and after the procedure.

During the surgery, anesthesia is used. General anesthesia is commonly used, although spinal, epidural and block would also suffice. This would depend on the extent of surgery and discretion of the surgeon. An intravenous line is established for fluid and medications.

Anesthesia can wear off minutes after the procedure is done. However, this can still cause problems with balance and reasoning skills. It is best to avoid activities that require coordination like driving and operating machineries. Alcohol intake would enhance the side effects of anesthesia, hence, no alcohol intake should be done within 24 hours of the procedure.

Swelling can lasts for 5 to 15 days. Within those days, it’s important to follow RICE. Rest, Ice, Compression and Elevation. Rest the affected area to avoid further strain. Put in ice pack to reduce inflammation. While, compression helps in blood flow circulation. And finally, elevation prevents accumulation of blood in the lower area.

Of course, proper hygiene is required. Keep the bandage and incision area dry and clean the whole time. Assess for progressive pain, edema, warmth and redness as these can be signs of infection or reduced blood flow. Consult a physician right away if any of the aforementioned symptoms occur.

Arthroscopy video

Check out this video where arthroscopy of the knee is done.

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