Arthroscopy offers several advantages over such extended open arthrotomies. Compared with minimally invasive arthroscopic procedures, the extended exposure of joints prolongs recovery and increases pain and risk of complications, such as infection and arthrofibrosis. Minimally invasive surgeries, in general, result in less pain and postoperative swelling than open techniques. As a result, arthroscopically treated patients tend to heal faster and begin rehabilitation earlier and, subsequently, return to normal activity and work sooner. As techniques and indications for treatment have expanded, injuries, particularly those in athletes that at one time would have been career ending, can now be addressed with arthroscopy allowing patients to return to full function. Examples include anterior cruciate knee ligament injuries in running athletes and intra-articular shoulder pathology in throwing athletes. While these problems can be addressed with extended open techniques, the comorbidity associated with open procedures often prevents such patients from returning to their pre-injury functional status. For professional athletes, these types of injuries more often led to the end of their paying careers. Another socioeconomic benefit of arthroscopy is that almost all arthroscopic procedures can be performed in an outpatient setting. Some arthroscopists even have the facilities to perform procedures in an office setting, further reducing costs. Arthroscopy can be performed under many options of anesthesia ranging from local to general. Choice of anesthesia varies depending on the nature of the procedure and preferences of the patient and physician.
Procedures
Arthroscopic & Minimally Invasive Surgery
Arthroscopic and minimally invasive surgery allows an orthopedic surgeon to see inside a joint and treat problems through very small incisions rather than a large open exposure. Dr. Nikolaj Wolfson discusses and performs these techniques at Wolfson Orthopedics in San Francisco.
Arthroscopy, a minimally invasive alternative to standard open surgical techniques and now the most commonly performed orthopedic surgical procedure, was one of the greatest advances in orthopedic surgery of the 20th century. Minimally invasive surgeries result in less postoperative swelling than open techniques and reduce pain, risk of complications, and recovery times. Arthroscopy has evolved from a diagnostic tool to a therapeutic tool capable of treating a wide range of injuries and disorders. Many injuries, particularly those that at one time would have been career ending for athletes, can now be addressed with arthroscopy allowing a quicker return to full function. While arthroscopy has resulted in an overall decrease in morbidity compared with open techniques, it is still an invasive procedure and inherently involves risks.
History of Arthroscopic Procedures
Almost all arthroscopic procedures can be performed in an outpatient setting. In 1999, 211 arthroscopic procedures were performed at Ochsner. Orthopedic surgery, like all fields of medicine, experienced tremendous progress in the 20th century. Along with an improved understanding of basic molecular, cellular, genetic, and biomechanical factors of the musculoskeletal system, joint replacement surgery and arthroscopic surgery were the two most important innovations in orthopedic surgery in the last 100 years. These innovations, made possible by advances in technology, will continue to improve outcomes of treatment and expand the indications for usage as technology advances. Prior to the widespread clinical use of arthroscopy and its specialized instrumentation, joint surgery required extended incisions and arthrotomies for exposure and treatment of joint pathology.
Advantages of Arthroscopy
Risks of Arthoscopic Procedures
As with any invasive procedure, complications can occur with arthroscopy, now the most commonly performed orthopedic procedure. A 1983 national survey of 118,590 procedures reported 930 complications—an incidence of 0.8% (7). In this survey, equipment failure accounted for 17% of complications reported while vascular injuries accounted for 1%. Arthroscopy is a technical procedure requiring a wide range of equipment (camera and monitor, surgical equipment, pump, tourniquet, etc.) that can malfunction or break during a procedure. The surgeon should be familiar with the equipment and use it only for its intended purposes. Anesthesia problems can also occur, but this is not unique to arthroscopic surgery. When arthroscopic surgery is performed in an office setting, the surgeon must be prepared for any potential anesthesia problems that might arise. Other complications include hemarthrosis, thrombophlebitis, arterial injury, nerve injury, compartment syndrome, and infection and metabolic complications in patients with metabolic diseases (diabetes, gout) or those using steroids. While arthroscopy has resulted in an overall decrease in morbidity compared with open techniques, it is still an invasive procedure and inherently involves risks.
Which joints and problems are involved
Arthroscopy is used most often in the knee and shoulder, and it may also be applied to the hip, ankle, elbow and wrist. A thin camera is placed into the joint through one small portal and slender instruments are passed through one or more additional portals. The surgeon views the inside of the joint on a monitor while working.
The kinds of problems that may be addressed this way include meniscus and cartilage injuries, loose fragments within a joint, inflamed joint lining, scar tissue and contracture, ligament injuries, and some tendon problems around the shoulder. Minimally invasive principles also apply outside the joint, in techniques that aim to limit the amount of muscle and soft tissue disturbed during an operation. Whether a given problem can be treated arthroscopically depends on the specific diagnosis, the condition of the tissues and the individual patient, and that judgement can only be made after examination and imaging.
Symptoms that often bring people in
- Joint pain that persists despite rest, activity change or physical therapy
- Catching, locking, clicking or a sense that the joint gives way
- Swelling in a joint that keeps returning
- Loss of motion, stiffness or difficulty straightening or bending a joint
- A joint injury from sport or an accident that has not settled
How it is evaluated
Evaluation usually begins with your history and an examination of the joint, looking at motion, stability, alignment, strength and the points that reproduce your pain. X-rays are commonly obtained, and MRI or other imaging may be requested when a soft tissue problem such as a cartilage, meniscus, ligament or tendon injury is suspected. Any prior imaging, operative reports and therapy notes you can bring are helpful. Surgery is considered only after the diagnosis is understood and non-surgical options have been discussed.
What to expect when you consult Dr. Wolfson
Dr. Wolfson, MD, FRCSC, FACS, is board certified in the United States and Canada. At a consultation he will review your history, examine the joint, look at your imaging with you and explain what he believes is going on in plain language. Non-surgical measures are discussed first wherever they are reasonable. If an arthroscopic or minimally invasive procedure is a sensible option for your situation, he will explain what the procedure is intended to accomplish, what its limitations and risks are, and what rehabilitation would involve, so that you can make the decision together. Second opinions are welcome, and telemedicine visits are available for people who want to begin the conversation remotely.
Schedule a consultation in San Francisco
Dr. Nikolaj Wolfson evaluates joint problems and discusses arthroscopic and minimally invasive options at Wolfson Orthopedics, 2300 Sutter Street, Suite 207, San Francisco. New patients are welcome, and telemedicine visits are available.
This page provides general information about arthroscopic and minimally invasive surgery and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.
Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.
If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.
Common questions
Is arthroscopy the same as minimally invasive surgery?
Arthroscopy is one form of minimally invasive surgery, specifically the kind performed inside a joint with a camera and small instruments. Minimally invasive is a broader term for techniques that aim to accomplish an operation through smaller exposures and with less disturbance of surrounding tissue.
Does arthroscopy treat arthritis?
Arthroscopy is not a treatment for arthritis itself. In some situations it may be used to address a specific mechanical problem within an arthritic joint, and in others it may not be appropriate at all. Whether it has any role in a particular case is a judgement your surgeon makes after examining you and reviewing your imaging.
Will I need physical therapy afterwards?
Rehabilitation is usually an important part of recovery after joint surgery, and the plan is tailored to the procedure performed and to you. Dr. Wolfson will discuss what therapy would be expected in your case before any procedure is scheduled.
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