Arthroscopy

An arthroscopy is a type of keyhole surgery used both to diagnose and treat problems with joints.

It's most commonly used on the:

knees
ankles
shoulders
elbows
wrists
hips

What happens in an arthroscopy

An arthroscopy involves the use of a device called an arthroscope to examine the joints. This is a thin, metal tube about the length and width of a drinking straw. It contains a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece, so the surgeon is able to see inside the joint.

It's also possible for tiny surgical instruments to be used alongside an arthroscope. These allow the surgeon to treat certain joint conditions.

An arthroscopy procedure usually lasts between 30 minutes and 2 hours. You can normally go home the same day or the following morning.

Preparing for surgery

Before having an arthroscopy, you'll usually be given an appointment to attend a pre-admission clinic.

During your appointment, your general health will be assessed to make sure you're ready for surgery. You'll also be given information about issues like:

what and when you are allowed to eat and drink on the day of surgery
whether you should stop or start any medications before surgery
how long it'll take for you to recover from surgery
whether you'll need to do rehabilitation exercises after surgery

The surgical team will explain the benefits and risks associated with having an arthroscopy.

You'll be asked to sign a consent form. This confirms that you agree to have the operation and that you understand what's involved, including the risks and benefits.

Anaesthetic

An arthroscopy is usually carried out under general anaesthetic. But, occasionally it can be performed under spinal anaesthesia, or with local anaesthetic. Your anaesthetist will explain which type of anaesthetic is most suitable for you. In some cases, you may be able to say which one you'd prefer.

If you have a local anaesthetic, your joint will be numbed so you do not feel any pain. But, you may still feel some sensations during the procedure, like a mild tugging, as the surgeon works on the joint.

The arthroscopy operation

Antibacterial fluid is used to clean the skin over the affected joint. A small incision, a few millimetres long, is then made so the arthroscope can be inserted. Additional incisions will be made so that an examining probe or other fine surgical instruments can be inserted.

The surgeon may fill the joint with a sterile fluid to expand it and make it easier to view. They'll be able to see inside your joint using an eyepiece or a video screen. If possible, during the procedure, they'll repair any damaged areas and remove any unwanted tissue.

Your surgeon will then examine the inside of the joint using the arthroscope. If necessary, they'll remove or repair any problem areas using surgical instruments inserted through the additional incisions.

After the procedure, the arthroscope and any attachments are removed, along with any excess fluid from the joint. The incisions are usually closed using special tape or stitches and covered with a sterile dressing.

When arthroscopy may be used

An arthroscopy can be carried out to help diagnose and treat many joint problems and conditions.

Diagnosing joint problems

An arthroscopy can be used to help investigate:

joint pain
joint stiffness
swelling of the joint
the joint giving way or "popping" out of position

These problems are usually first investigated using:

If these scans don't find anything, it may be necessary to take a direct look at the inside of the joint.

An arthroscopy can also be used to assess the level of joint damage resulting from an injury. For example, a sports injury, or from underlying conditions that can cause joint damage like osteoarthritis.

Treating joint problems

Fine surgical instruments can be used along with an arthroscope to allow a surgeon to treat a range of joint problems and conditions. For example, an arthroscopy can be used to:

repair damaged cartilage, tendons and ligaments (for example, in knee ligament surgery)
remove inflamed tissue
remove small sections of bone and cartilage that have broken off and are loose within the joint
drain away an excess build-up of synovial fluid (which lubricates the joint)

Treating conditions in the joint

Conditions that can be treated with arthroscopy include:

arthritis – a common condition that causes pain and inflammation within a joint
Baker's cyst – a build-up of synovial fluid inside a joint, leading to stiffness and swelling
frozen shoulder – pain and stiffness in the shoulder that tends to get gradually worse
carpal tunnel syndrome – a tingling sensation, numbness and sometimes pain in the hand and fingers
arthrofibrosis – excess scar tissue caused by a previous injury that disrupts the normal workings of the joint
bone spurs – abnormal bone growths that can cause persistent pain
synovitis – inflammation of the joint lining
temporomandibular disorder (TMD) – a problem that affects the joint between the lower jaw and the base of the skull

How long does it take to recover?

How long it takes to recover after an arthroscopy can vary, depending on:

the type of surgery you had
your general health
the type of work that you do

Some people feel better after a few days, while others may not be back to normal for several months.

After the operation

After your arthroscopy, you'll be taken to a room to recover from the effects of the general anaesthetic, if it was used during the procedure.

You may experience some pain in the joint. If you do, tell a member of the hospital staff, who will be able to give you painkillers.

Most people who have an arthroscopy are able to leave hospital either on the day of the surgery or the following morning. Before leaving hospital, you may have an appointment with a physiotherapist to discuss exercises for you to do at home.

Depending on the type of procedure you've had, you may need to support and protect the joint while you recover with a temporary:

sling
splint
crutch

Some people are given special pumps or compression bandages to help improve their blood flow.

Recovery advice

It's likely that you'll feel tired and light-headed after having a general anaesthetic. This means you'll need to ask a responsible adult to take you home and stay with you for the first 24 hours after surgery. Most people will recover from the effects of the anaesthetic within 48 hours.

Do

elevate the joint, if told to do so
apply ice packs to help with the swelling when you get home, if you're advised to do so
carry out any joint exercises that have been recommended for you
keep dressings as dry as possible – cover them with a plastic bag when having a shower or bath

If your dressings do get wet or fall off, they'll need to be replaced. The dressings can usually be removed after 5 to 10 days.

Your wounds should start to heal within a few days. If non-dissolvable stiches were used to close them, these will need to be removed after a week or two. This will usually be done by a practice nurse at your local GP practice.

You'll normally be asked to attend a follow-up appointment a few weeks after the operation. Here you'll discuss the results of the surgery, your recovery, and any additional treatment you may need.

Returning to normal activities

Your surgeon or care team will advise you how long it's likely to take to fully recover. They'll also tell you what activities you should avoid until you're feeling better.

Work

You'll probably need at least a week or two off work, although this varies from person to person. Some need more, while others need less. This'll largely depend on whether your job involves strenuous activity that could damage the joint.

Driving

You'll be able to drive again once you can do so without experiencing any pain. You also have to be able to safely perform an emergency stop. This may not be for a few weeks or several months after surgery. Your surgeon can give you more specific advice.

Exercise

Your surgeon can advise you on how long it'll be before you can undertake strenuous physical activities, such as heavy lifting and sport. For many people, this will be around 6 weeks after surgery, but in some cases it may not be for several months.

Non-urgent advice: Speak to your GP or the clinic where you had your operation if you have:

a high temperature (fever)
severe or increasing pain
severe or increasing redness or swelling
discoloured or foul-smelling discharge from your wounds
numbness or tingling

These problems could be a sign of a complication of surgery, like an infection or nerve damage.

Benefits of arthroscopy

As the equipment used during an arthroscopy is so small, only minor cuts need to be made in the skin. This means the procedure has some potential advantages over traditional, 'open' surgery, including:

less pain after the operation
faster healing time
lower risk of infection
you can often go home the same day
you may be able to return to normal activities more quickly

Risks of an arthroscopy

An arthroscopy is generally considered to be a safe procedure, but like all types of surgery it does carry some risks.

It's normal to experience short-lived problems after an arthroscopy like:

swelling
bruising
stiffness
discomfort

These will usually improve during the days or weeks following the procedure.

More serious problems are much less common, occurring in less than 1 in 100 cases. They include:

a blood clot that develops in one of the limbs – this is known as deep vein thrombosis (DVT) and it can cause pain and swelling in the affected limb
infection inside the joint – this is known as septic arthritis and it can cause a high temperature (fever), pain and swelling in the joint
bleeding inside the joint – which often causes severe pain and swelling
accidental damage to the nerves that are near the joint – this can lead to numbness and some loss of sensation, which may be temporary or permanent

Speak to your surgeon about the possible risks before agreeing to have an arthroscopy.