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 and hips.

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 that 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 to allow the surgeon to treat certain joint conditions.

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

Why it's used

An arthroscopy might be recommended if you have problems such as persistent joint pain, swelling or stiffness, and scans have not been able to identify the cause.

An arthroscopy can also be used to treat a range of joint problems and conditions. For example, it can be used to:

• repair damaged cartilage
• remove fragments of loose bone or cartilage
• drain away any excess fluid
• treat conditions such as arthritis, frozen shoulder or carpal tunnel syndrome

Read more about when an arthroscopy may be used.

What happens during an arthroscopy?

The arthroscope is inserted through a small cut in the skin made next to the joint. Further small incisions may also be made to allow an examining probe or surgical instruments to be inserted.

Your surgeon will then examine the inside of the joint using the arthroscope and, if necessary, remove or repair any problem areas.

This will usually be done under general anaesthetic, although sometimes a spinal or local anaesthetic is used.

The procedure is usually performed as a day case, which means you'll normally be able to go home on the same day as the surgery.

Read more about how an arthroscopy is performed.

Recovering from an arthroscopy

The time it takes to recover from an arthroscopy can vary, depending on the joint involved and the specific procedure you had.

It's often possible to return to work and light, physical activities within a few weeks, but more demanding physical activities such as lifting and sport may not be possible for several months.

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

While you're recovering, you should contact your surgical team or GP for advice if you think you may have developed one of the complications mentioned below.

Read more about recovering from an arthroscopy.

What are the risks?

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 such as swelling, bruising, stiffness and discomfort after an arthroscopy. 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.

An arthroscopy can be carried out to help diagnose and treat a number of 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 X-rays, computerised tomography (CT) scans or magnetic resonance imaging (MRI) scans. 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, such as a sports injury, or from underlying conditions that can cause joint damage, such as osteoarthritis.

Treating joint problems and conditions

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)

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

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 such as:

• 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 will take for you to recover from surgery
• whether you will need to do rehabilitation exercises after surgery

The surgical team will explain the benefits and risks associated with having an arthroscopy. You will also be asked to sign a consent form to confirm that you agree to have the operation and that you understand what's involved, including the risks and benefits. 

The arthroscopy operation

An arthroscopy is usually carried out under general anaesthetic, although 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 express a preference.

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

Antibacterial fluid is used to clean the skin over the affected joint and a small incision, a few millimetres long, is made so the arthroscope can be inserted. One or more additional incisions will also 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 will be able to see inside your joint using an eyepiece or a video screen. If possible, during the procedure, they will repair any damaged areas and remove any unwanted tissue.

Your surgeon will then examine the inside of the joint using the arthroscope and, if necessary, remove or repair any problems 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.

Read more about recovering from an arthroscopy.

How long it takes to recover after an arthroscopy can vary, depending on the type of surgery you had, your general health and 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 had, you may need a temporary sling, splint or crutches to support and protect the joint while you recover. 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, so you'll need to ask a responsible adult to take you home and to stay with you for the first 24 hours following surgery. Most people will recover from the effects of the anaesthetic within 48 hours.

Make sure you elevate the joint and apply ice packs to help with swelling when you get home, if advised to do so. You should also carry out any joint exercises that have been recommended for you.

Any dressings will need to be kept as dry as possible, so you'll need to cover them with a plastic bag when having a bath or shower. If your dressings do get wet or fall off, they will 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 surgery.

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

Returning to normal activities

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

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 will largely depend on whether your job involves strenuous activity that could damage the joint.

You'll be able to drive again once you're able to do so without experiencing any pain and you can 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.

Your surgeon can advise you on how long it will 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.

When to seek medical advice

You should contact your GP or the clinic where you had your operation if you experience:

• 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, such as an infection or nerve damage.