Joint Prosthesis Surgery
Spinal Curvature - Scoliosis
Hand And Finger İnjuries
• Prof. Erdal CİLA, MD
• Assoc. Prof. İbrahim AKEL, MD
• Levent TAD, MD
• Serdar SÖYLEV, MD
Athroscopy is a minimal surgical method used for diagnosis and treatment of joint diseases. “Arthroscopy” which is the term by combining arthro (joint) and scopy (looking-examining) words is the procedure of diagnosis and treatment by examining joints with a lens system and light source called scope. A camera is inserted in the tip of the scope and image is transferred to TV screen and images can be seen bigger and clearly. Moreover, it is recorded and photos can be taken.
Arthroscopic procedures applied to only knee joint before is now applied to shoulder, ankle, wrist, elbow and hip joint as technological advances increased.
Arthroscopic surgery is a method damaging the normal tissues in the least degree since it is applied from very small lacerations. It can be applied to every patient having the proper diagnosis and treatment opportunity. However, a limit is applicable to arthroscopic treatments. Arthroscopic surgery having a number of advantages compared to open surgery should be replaced by open surgery if necessary.
To whom is arthroscopy applied?
Special age group and patient group are not applicable. It can be applied to every patient with proper diagnosis and treatment chance. However, a limit is applicable to arthroscopic treatments. Arthroscopic surgery having a number of advantages compared to open surgery should be replaced by open surgery if necessary.
How is arthroscopy applied?
The procedure is initiated by general anesthesia or proper local anesthesia. Firstly, laceration in the diameter of scope of the camera system (0,5 cm) is done in the skin. The camera is inserted and joint will be inflated with sterile liquid (serum physiologic) and joint is viewed. Firstly, all visible points of joint are examined for diagnosis and then treatment is initiated. Holes 2 and 3 are opened for instruments to be used in treatment and the procedure is carried out. Damages of tissue are examined and necessary treatment is administered.
What’s the advantage and disadvantage of arthroscopy compared to open surgery?
1 cm of 2 or 3 pieces small incisions are sufficient for arthroscopy. Bigger lacerations are necessary to see the joint easily in open surgery. The bigger laceration is, the longer the wound improves and physical therapy process gets difficult and term of hospitalization extends. Moreover, big laceration increases the risk of inflammation.
The image is seen 5-6 times bigger than normal when looked with lens system in arthroscopy. More detailed and clear image than seen with the naked eye allows more sensitive and detailed treatment.
While washing is limited in open surgery in inflammation cases requiring wash of joint, more detailed and effective washing is possible with athroscopy.
Pain control is generally problem after operation in case of open surgery however, post-op process is comfortable in arthroscopy. Arthroscopic procedures are daily procedures. Term of hospitalization may extend for a few days by the procedure. Term of hospitalization is generally longer in open procedures.
The disadvantage of arthroscopy it is not sufficient for treatment of certain lesions due to anatomic structure of some joints. Moreover, small intrarticular fractures can be treated arthroscopically, open surgery will be necessary to dominate the entire fracture in bigger fractures.
For which joints and diseases is arthroscopy applied?
Knee: the joint that arthroscopy procedure is applied most frequently today is knee joint. Almost all intrarticular pathologies can be treated with arthroscopy. Internal and external meniscus tears, anterior cruciate ligament injuries, posterior cruciate ligament injuries, joint cartilage problems, patella integrity problems, small intrarticular cartilage can be treated with arthroscopy easily.
Shoulder: Shoulder is the joint that arthroscopy is applied frequently. The rate of preference of open surgery and arthroscopic surgery changed in favor of arthroscopy clearly. In some open procedures, almost completely arthroscopic procedures are performed. Rotator cuff lacerations, impingement syndrome, repeated dislocations, cartilage problems, frozen shoulder and intrarticular fractures can be treated with arthroscopy.
Ankle: It is applied for a number of disorders successfully in spite of some technical problems due to anatomic structure and sizes of ankle joint. It is used for intra articular cartilage crush and breaking, front and rear impingement syndrome, intra articular cartilage observation.
Wrist: Intra articular fractures, intra articular free object removal, laceration and painful conditions of cartilaginous tissue inside of wrist called as TFCC (Triangular fibrocartilage complex) can be treated athroscopically. Smaller instruments than usual scope and instruments should be used due to size of joint.
Hip: Hip joint arthroscopy has been applied more frequently recently. FAS (femoroacetabular impingement) disproportion problem of hip, intraarticular free cartilage lesions, tumoral formations, labrum (Thick tissue on the side of joint) tears are the diseases that can be treated by arthroscopy methods. Longer and stronger instruments are necessary due to special condition of hip joint, moreover, traction table is necessary to view the joint.
Elbow: removal of parka from cartilage, free object, shaving osteophyte preventing acting, treatment of joint membrane thickening in rheumatismal diseases and removal of intraarticular benign tumors can be performed arthroscopically.
Today term of hospitalization should be shortened and early return to work is necessary. Arthroscopic treatments make it convenient as the best method meeting this requirement. Innovations of technology will enable us to access regions we can’t access in time.