Today our topic of discussion is Arthroscopy of Medical Surgical Procedures.
Arthroscopy of Medical Surgical Procedures
ARTHROSCOPY
Arthroscopy is an endoscopic examination of the interior aspect of a joint (usually the knee) using a fiberoptic endoscope. Normally, an arthrography is performed prior to arthroscopy. Arthroscopy may be used to diagnose meniscal, patellar, extrasynovial and synovial diseases;
To perform joint surgery, and to monitor disease process or the effects of medical or surgical therapeutic regimen. Frequently biopsy or surgery is performed during the test procedure. Spinal or general anesthesia is used and for visualization of the interior joint space, a local anesthetic.
Purposes
- To diagnosis meniscal, patellar, extrasynovial and synovial diseases
- To perform joint surgery.
Abnormal Findings
- Meniscal disease with torn lateral or medial meniscus
- Patellar disease
- Chondromalacia
- Patellar fracture
- Osteochondritis
- Dissecans
- Osteochondromatosis
- Torn ligaments.
- Baker’s cysts
- Synovitis
- Rheumatoid and degenerative arthritis.
Client Preparation
- Check on the type of anesthesia to be used.
- If general or spinal anesthesia is ordered, inform the client to remain NPO after midnight prior to the test.
- Assess the involved area for possible skin lesion or infection
- Determine the client’s anxiety level, and be available to answer questions.
- Be prepared to repeat information .
- if the level of anxiety or fear is determined to be high
- Use aseptic technique throughout the procedure.
- Sepsis can cause severe complications to the joint and tissues.
Factors Affecting Diagnostic Results
Septic technique used during test procedure could cause pain and discomfort and could further complicate the joint disease.
Procedure (Fig. 29.121)
- A consent form should be signed
- There is no food or fluid restriction for local anesthetic.
- NPO after midnight for spinal and general anesthesia
- Local, spinal or general anesthesia is used, depending on the purpose, and procedure for the test
- Ace bandage and/or tourniquet may be applied to decrease blood volume in the leg
- The arthroscopy is inserted into the interior joint for visualization, for draining fluid from the joint, for biopsy, and/or for surgery
- A dressing is applied to the insertion site of the affected joint.
Contraindication
- Severe skin infection
- Severe fibrous ankylosis.
Post-procedural Care
- Assess the client before, during and after procedure, including vital signs, bleeding, and swelling.
- Report abnormal finding to the health care providers
- Apply an ice bag with cover to the area as indicated
- Administer an analgesic for pain or discomfort as ordered
- Answer the client’s and family member’s question
- Instruct the client to avoid excessive use of joint for 2 to 3 days or as ordered.
- Walking should be minimized.