Arthroscopic Surgery – Dr. R. A. Purnachandra Tejaswi

1. What is Arthroscopic surgery?

Arthroscopic surgery commonly called as keyhole surgery or minimally invasive surgery is a type of orthopedic surgery of specific joints like shoulder, knee, hip etc. Small incisions or poco holes are made in the skin and insert thin long tube or reflect which is called an arthroscope into the joint. This is in turn connected to a camera which relays the images and video onto a monitor which makes the surgeon assess all the structures in the joint and can deal with specific problems through additional 102.05 centimeter incisions by the use of high precision and specific instrumentation. The surgery is highly precise and also limits the damage to the surrounding structures to a bare minimum this is called arthroscopic or keyhole surgery.

2. What are the indications for Arthroscopic surgery? 

There are many indications for arthroscopic  surgery previously it was done mainly for joints like the knee & shoulder and very few problems were treated by this excellent technique but as the technology advanced along with increased surgeon expertise the scope and the indications for this procedure have increased.

3. What is the benefit of Arthroscopic surgery compared to open or conventional surgery? 

More and more procedures that were being done by conventional long incisions are being done by this technique. The classical example is the hip joint previously even a minor surgery like a biopsy from the hip associated 5 to 10 inch incision to access the joint but now this can be achieved with two small 0.5 centimeter incisions through this technique but unfortunately there are only two or three centers in the entire nation with properly trained surgeons to do this  procedure these days we are treating even some fractures with the aid of this excellent technique this helps us in getting good reduction of the fracture especially at the ends of the bone and around the joint which helps in better healing and beneficial to the patient with right training and good equipment keyhole surgery can be done for almost all major joints in the body including shoulder elbow and wrist joints in the upper limb and starting from hip till the ankle joint in the lower limb. if you consider some very common problems in the younger population that is below 40 or 45 years of age most of the problems that are addressed by arthroscopy include problems related to ligament test damage to many sky or what we call as shock absorbing structures in the joints dislocations of the joints are multiple dislocations or involving shoulder joint elbow etc also problems related to cartilage can be treated by this technique in older individuals the commonly treated problems are due to degenerative conditions such as rotator cuff tears meniscal tears and mild osteoarthritis.

4. How is the post-operative pain and recovery from Arthroscopic surgery as compared to an Open surgery?

There are several advantages of arthroscopic surgery compared to open surgery in the period before surgery the amount of  preparation to be done by the patient is generally lower and the pre-operative investigations are generally less during the surgery per se we use minute incision and there is no need for blood transfusions the surgical time is usually reduced which limits the anesthetic drugs required due to less soft tissue dissection and damage to the surrounding structures the post-operative pain is less and the recovery is quicker due to three-dimensional assessment of the structures and pathology the level of precision and treatment is usually higher the arthroscope can be guided into type spaces which allows the surgeon to tackle even those problems which are usually not visible to the naked eye this makes the treatment complete and the benefit of which can be transferred to the patient after the operation this reduces the hospital stay and there is less postoperative pain there is decreased chance for infections also the patient has faster recovery.

5. How many days should a patient  stay in the hospital after an Arthroscopic surgery?

Since we go directly into the DC site with minimal disturbance to the normal  structures and there is minimal dissection of the tissues, pain is usually less and recovery after surgery is usually faster when compared to open surgery.

6.  After how many days can the patient go back to doing normal activities?

Most of the patients in fact are treated on day care basis as most of these procedures are done on an elective basis the patient is evaluated in advance by the surgeon and the anesthetist and is advised to come to the hospital on the day of surgery with six hours of fasting the surgery is usually done on the same day morning and most of the patients are discharged on the day of surgery this is called as decay surgery few patients especially the elder people and those from outside the city are discharged the following day for most of the procedures the patient can start walking the next day and doing all day to day activities within a day or two  these people those people who have desk jobs or office jobs can usually return to work by 10 to 12 days activities like choking or cycling can be started by three weeks usually.

7. What is the average time required to return to sports?

Usually, the patient is gradually trained to take increasing stress on the operated joint and progressively introduced to sports it may take anywhere between six months to one year to fully return to sports at the same level of activity before the injury or surgery which again depends on the severity of the initial problem and the progress of the rehabilitation program.

8. What is the average time required to return to sports?

Since arthroscopy involves special equipment and there is a lot of equipment needed for which investment goes into initial cost is usually higher than open surgery which is usually around 10 to 20 percent expensive than the conventional surgery but the cost of surgery cannot be seen in isolation and we consider the total cost involved for the patient the pre-operative investigations needed the amount of physical rehabilitation needed for surgery and the total rest from work needed all the above are less in arthroscopic surgery when compared to open or conventional surgeries in fact many studies have been conducted to study this aspect and have found that even though arthroscopic surgery is expensive initially. But, when we add all the costs combined that is including the pre-operative expenses the increased hospital stay the postoperative rest required and the absence from work the cost-effective analysis or the cost benefit study shows that arthroscopy surgery is much more beneficial to the patient  further there are that the studies have shown less number of complications or like decreased chances of infection decreased stiffness of the joint in arthroscopic surgery compared to conventional surgery all these things taken into account make arthroscopic surgery much more beneficial to the patient in general.