Norm of Arthroscopy
Internal anatomy of the joint space is undisturbed. Synovial fluid is clear. Synovial membranes are not erythematous. There are no free-floating materials within the joint space.
Usage of Arthroscopy
Diagnostic use of the procedure is mainly to determine the cause of chronic arthritic complaints that cannot be established with serologic tests. The therapeutic use of the procedure involves the treatment of various acute and chronic arthritic conditions (including the management of septic arthritis and the treatment of torn ligaments) that would otherwise require arthrotomy.
Description of Arthroscopy
A diagnostic and therapeutic procedure involving the insertion of an arthroscope into a joint that provides direct visualization of the joint space to the physician without the requirement of surgical exposure of the joint (arthrotomy). In addition to the arthroscope, an irrigation cannula and various small resection instruments can be introduced into the joint space during the procedure. Total intravenous anesthesia with propofol and alfentanil or remifentanil does not affect the risk of postoperative nausea and vomiting. Joints that are frequently studied with this procedure include the knee, shoulder, wrist, and (occasionally) the temporomandibular joint. Neurovascular complications are the most serious and devastating complications of this procedure.
Professional Considerations of Arthroscopy
Consent form IS required.
Bleeding (hemarthrosis), infection, allergic reaction to the local or general anesthetic agent(s) to be used during the procedure.
History of bleeding diathesis, history of allergic reaction to anesthetic agents to be used during the procedure, severe arthritis resulting in narrowing of the joint space that would preclude insertion of the required instruments, cellulitis over the joint to be studied.
- Preoperative determination of the vital signs is indicated.
- The surface over the joint to be studied is shaved and prepped with an iodine solution.
- If the procedure is to be performed with the client under general anesthesia, anesthetic premedication may be given and the client is taken to the operating room where a general anesthetic agent is administered.
- If the procedure is to be performed with the client under local anesthesia, the client may need to be properly positioned. (As an example, arthroscopy of the knee is at times performed with the client in a sitting position.)
- Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.
- If the procedure is to be performed with the client under local anesthesia, infiltration of the skin over the joint is performed with a local anesthetic agent (lidocaine).
- The joint space is infiltrated with the local anesthetic agent.
- If the joint to be studied is located in an extremity, a proximal tourniquet is occasionally applied.
- A small incision is made, and the irrigation cannula is passed into the joint space. The joint space is irrigated and distended with irrigation solution (saline).
- The arthroscope is placed into the joint space through a second incision. The internal structures of the joint are visualized.
- If arthroscopic surgery is to be performed, insertion of various arthroscopic surgical cannulae can be performed through a third incision.
- At the end of the procedure the instruments are removed from the joint, and the incisions are closed with sutures or Steri-strip tape.
- Various dressings are applied. In the case of knee arthroscopy, an Ace wrap is often used.
- The pneumatic cuff is then deflated.
- Postoperative determination of the vital signs and a dressing check are indicated.
- Frequent reevaluation of the dressing and the joint may be needed. The physician supervising the care of the client should be informed if bleeding, swelling of the joint, or leakage of synovial fluid is noted.
- Postoperative analgesic medications and antibiotic agents may be ordered by the physician supervising the test.
- A program of physical therapy may be required, although frequently the client may resume normal activity within 24 hours of the procedure.
Client and Family Teaching
- A general preoperative orientation to the procedure and postoperative care plan is indicated.
- The client and family will need instruction in any physical therapy routines or mobility limitations imposed by the procedure.
- Orientation as to the nature and prognosis of the disease process diagnosed by the arthroscopy may be indicated.
- An ice pack may help ease postprocedure pain. Use a towel between the ice pack and the joint.
- Use crutches for 5–7 days when walking.
- Do not exercise the joint more than normal activity for 5–6 weeks after the procedure if surgery was performed.
- Contact the physician if edema continues more than 3 days or if fever over 101 degrees F (38.3 degrees C) or increased knee pain develops.
Factors That Affect Results
- Client cooperation during arthroscopy performed with the client under local anesthesia is essential.
- Severe arthritis-producing deformity of the joint space may limit the effectiveness of the procedure.
- Postoperative complications such as bleeding or infection may limit the effectiveness of arthroscopic surgical procedures.
- Wrist arthroscopy is ideal for evaluating intra-articular soft tissue injuries.
- The cause of various types of chronic arthritis can frequently be determined with radiographic or serologic tests without the need to perform arthroscopy.
- The increasing availability of smaller arthroscopic instruments has resulted in a growing trend to perform these procedures with the client under local anesthesia and in an office (rather than a hospital) setting.