Arthroscopy: Surgery, Meaning, Procedure, Treatment

Arthroscopy is typically an out-patient invasive procedure and usually takes about 30 to 45 mins to complete. The procedure is done under anaesthesia (medication used to reduce the sensation in a specific body part). The type of anaesthesia used varies depending on where and for what procedure is being used.

1. Local Anaesthesia: The drug is injected below the skin to block sensation in a limited area (e.g. knee). The patient is awake and may feel some pressure or sensation of movement within the joint but no pain.
2. Regional Anaesthesia: The drug is injected using a small needle placed between 2 of the spine's lumbar vertebrae. This numbs the bottom half of the body. The patient is conscious, but nothing is felt below the waist.
3. General Anaesthesia: The drug is injected intravenously. The patient is unconscious (asleep) and does not feel anything.

The steps involved in the arthroscopy procedure may vary depending on the condition. During an arthroscopy, an orthopaedic surgeon:

1. Makes a small incision (one which can be closed with 1 or 2 stitches or sterile adhesive tape) in the skin after appropriately positioning the area to be examined (Positioning may involve fixing the area with a tourniquet and managing the blood flow to the area using pressure cuffs. Sometimes a sterile liquid may also be injected into the area to improve visibility). 
2. Inserts an arthroscope (a small, thin pencil-sized instrument attached to a camera and light source). This instrument helps magnify and illuminate the structures inside the joint. 
3. Views the inside of the joint, cartilage, ligaments or tendons by images sent from the arthroscope on a video monitor. The extent or type of injury is then determined.
4. If possible, the problem is corrected by making additional small incisions around the joint to insert surgical tools to grasp, cut, grind and provide suction as needed for repairing the joint. 
5. Removes the arthroscope and other instruments.
6. Closes the incision (either with sutures or sterile adhesive tape), and the patient is moved to a recovery room to monitor vitals and post-operative recovery.
7. Will monitor the patient’s vitals throughout the procedure.

Prior to the arthroscopy, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Arthroscopy

1. The patient should discuss any allergies with the doctor.
2. While taking instructions about the medications, the patient should ensure that he/she has discussed his/her full medical history, including any supplements or medications the patient takes.
3. The patient will be advised to avoid taking certain medications or dietary supplements before the procedure.
4. The patient may also be advised to avoid eating solid food 8 hours before the procedure.
5. The patient will also be instructed about medications, recovery time and the exercises that the patient needs to do after the arthroscopy.

On the day of Arthroscopy

1. The patient will be asked to sign the consent form in the presence of his/her family.
2. The patient will be asked to remove his/her street clothes and jewellery and wear a hospital gown or shorts.
3. A nurse will place an intravenous catheter in the patient’s hand or forearm and inject a mild sedative.
4. Vitals will be monitored.
5. The patient will then be shifted to the operation theatre.

Usually, arthroscopic surgery doesn’t take long. The patient can go home within a couple of hours after the procedure. The patient may expect the following after the surgery:

The recovery process at the hospital

1. Usually, the operating surgeon will remove the dressing the next day of surgery. 
2. The surgeon may prescribe medication to relieve pain and inflammation. Most patients need very little to no pain medication post the arthroscopy. 
3. For most patients, daily activities may be resumed within a few days of arthroscopy. 
4. The puncture wounds (small incisions) and complete joint recovery take several weeks to heal, although arthroscopy is a minimally invasive procedure. 
5. Physical therapy/rehabilitation and specific exercises may help speed up the recovery and protect future joint function.
6. The patient should ensure that someone is available to pick him/her up after discharge as he/she won’t be allowed to drive home alone. 

Recovery process/expectation after hospital discharge

1. The surgeon may prescribe R.I.C.E. (R=Rest, I=Ice, C=Compression, and E=Elevation) for several days to reduce swelling and pain.
2. The patient should use temporary splints, slings, or crutches for comfort and protection. 
3. Physical therapy/rehabilitation and exercises recommended by the surgeon should be done to regain muscle strength and improve joint function.
4. The patient should wear loose clothing for ease and comfort.

First follow-up appointment

1. The first follow-up will be scheduled within 2 to 3 weeks after the surgery.
2. The doctor will also change the dressing from the incision site.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area. 
4. The doctor will advise the patient for further timely follow-ups as well.

Generally, arthroscopic surgery is a minimally invasive procedure as it occurs through small incisions. The benefits of arthroscopy include:

1. Faster recovery
2. Less pain
3. Minimal blood loss and scarring

Arthroscopy is a relatively safe procedure, but it is a surgical procedure, and just like any other surgical procedure, arthroscopy has few complications associated with it. The risks and complications of arthroscopy include:

1. Bleeding or swelling
2. Infections
3. Tissue or nerve damage
4. Blood clots
5. Allergic reactions to anaesthesia

When is consultation with the doctor needed?

The patient can consult the doctor if he/she develops:

1. Fever
2. Pain not helped by medication
3. Drainage from the incision
4. Redness or swelling
5. New numbness or tingling

Delaying an arthroscopy procedure can increase the severity of the pain leading to reduced quality of life. Below mentioned are some the common risks of delayed arthroscopy.

1. Severe pain in joints
2. Inflammation in the joints
3. Infections
4. Stiffness in joints
5. Tenderness of the joints
6. Osteoarthritis
7. Rheumatoid arthritis
8. Frailty in elderly

The cost of arthroscopy ranges from ₹30,000 to ₹80,000. The cost varies based on the following factors:

1. Type of arthroscopy surgery
2. Age of the patient
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.