Arthroscopy is a form of minimally invasive surgery that is performed on joints that have been injured through accident or disease. Arthroscopic procedures can be performed without opening the joint. These types of procedures have a lower risk of surgical complications than more invasive surgeries, reduce the amount of time you must spend in the hospital, and are associated with a quicker return to normal activity.
In arthroscopy, a specially trained surgeon passes a tube, known as an arthroscope, into the joint. The arthroscope contains both a light and a camera. It allows the surgeon to visualize structures inside the joint through a very small hole in the skin. Using another small hole, the surgeon can insert surgical instruments into the joint to repair injured structures. Sometimes a third incision is made so that the surgeon can insert additional surgical instruments or remove pieces of cartilage or bone that are causing pain and inflammation.
More than 500,000 arthroscopic procedures are performed each year in the United States. Approximately half of those patients report an improvement in pain and function after undergoing this type of surgery. The most common joint that arthroscopy is used on is the knee, and the most commonly performed arthroscopic procedures are tidal lavage and chondroplasty.
In tidal lavage, the surgeon removes small pieces of cartilage and other debris from the inside of the joint. After anesthetizing the patient, the surgeon injects sterile salt water into the joint several times. This fluid is allowed to wash out of another small hole in the joint. Many patients experience decreased pain and increased function following this procedure, with the improvements lasting several weeks or months.
A treatment for osteoarthritis of the knee in which a saline solution is repeatedly injected, then withdrawn from the joint space to remove debris from the joint and help break up the synovial membrane, which has adhered to itself.
In chondroplasty, the surgeon removes damaged cartilage from the joint and replaces it with new cartilage. The surgeon shaves off damaged cartilage from the inside of the joint and then removes some healthy cartilage from a part of the joint that does not bear weight or come in contact with other bones. The healthy cartilage is sent to a laboratory, which removes the healthy cartilage cells (called chondrocytes) from the cartilage.
These new chondrocytes are placed back in the joint during a second surgical procedure. Some patients experience improvement in pain and function in their joints after this procedure. Chondroplasty is currently recommended for younger patients with joint injuries who want to prevent OA by repairing defective joint surfaces.
A study conducted in 2002 examined the effectiveness of arthroscopy in patients with OA of the knees. In half of the patients, an actual arthroscopic procedure was performed. In the other half, incisions were made in the skin of the knees of the anesthetized patients to make them think they had undergone surgery.
When the physicians examined the patients and followed their progress over two years, they discovered that arthroscopic knee surgery was no more effective than sham surgery for relief of pain or stiffness from OA.
While this study doesn't mean that arthroscopy does not offer any benefit to any patient, its results should prompt debate on which procedure to perform and who is most likely to benefit. If you are considering arthroscopic surgery, discuss the likely risks and benefits with your rheumatologist and your orthopedist. Acting collaboratively, you should decide whether you are the best candidate for this procedure.