What are risks inherent in open surgery that are avoided by doing procedures arthoscopically?
Open surgery involves a larger incision and often detachment of one or more muscles or tendons. Visualization in open surgery is often not as good as with arthroscopic surgery which makes it difficult to identify and address all potential pain generators. Additionally, during the post-operative period, prolonged immobilization may be required to allow healing of additional muscle or tendon trauma necessary to perform the open surgery.
Does the arthroscopic camera really provide a better field of vision than being able to see directly into an open incision?
During an arthroscopic procedure a high-definition fiber optic camera is placed into the joint and by gently moving the camera around, every part of the inside of the joint can be seen. Because of the small size of the tip of the camera and the fact that it has a light attached to it, the camera fit into areas that would be difficult, if not impossible, to see with open surgery.
In my experience, MRI scans are very helpful in confirming a diagnosis and generating a treatment plan. They are not 100 percent, however. Occasionally, I will find an injury that was not picked up on the MRI. In these circumstances, if you did not have the ability to visualize all of the structures inside the joint, an injury may be overlooked with open surgery.
Finally, arthroscopic procedures allow me to take pictures and movies of the inside of my patient’s knee or shoulder showing them injury and then how I repaired it. I have found this to be a great tool when I am discussing my patients the nature of their injury and exactly what I did to help them.
How much time in hospital for arthroscopy vs. open procedures? How much recovery time at home after arthroscopy vs. open surgery?
Arthroscopy is an alternative to “open” surgery. All of my patients that have an arthroscopic procedure go home the same day. The recovery is based largely on the type of procedure that is done and how much work had to be done. I routinely ask the anesthesiologist to attempt a nerve block prior to the procedure. When successful, you will require less medication during the surgery and will often be discharged home with minimal discomfort.
Arthroscopy generally results in less pain and stiffness, fewer complications, and faster recovery times. The results are most predictable in the hands of a highly-specialized surgical team that is familiar with the various techniques and instruments and who perform this surgery often. Such a team will maximize the benefits of the surgery and minimize the risks.