Arthroscopy – An Invaluable Addition to the Orthopaedic Surgeon’s Toolkit
Since their discovery by Wilhelm Conrad Röntgen in 1895, and until comparatively recently, the form of electromagnetic radiation known as X-rays has provided doctors with the primary means with which to investigate the internal structures of the body. Because bone, unlike soft tissue, is quite resistant to the passage of this energetic form of radiation, one of the most effective applications for it has long been its use in the detection of fractures. X-rays have since been adapted to produce 3D images of parts or the whole of the body, but there are occasions when even the detail provided by a CAT scan is no substitute for a live view.
Arthroscopy, a procedure now widely adopted by orthopaedic specialists, offers the surgeon precisely that.
For orthopaedic purposes, the instrument used is based upon the design of the endoscope. The term is used generically to describe a range of similar devices used for the non-surgical investigation of internal anomalies via various bodily orifices. The latter includes the upper and lower gastrointestinal tract, the bronchi, vagina, and urethra. Variants of this instrument have since been adapted for a number of minimally invasive surgical procedures, including laparoscopy – the examination of organs within the abdominal cavity, as an alternative to performing a more radical laparotomy.
Generally regarded as the father of arthroscopy, in 1919, Professor Kenji Takagi inserted a cystoscope, an instrument normally used to view the interior of the bladder, into the knee joint of a patient in order to examine its internal structure more closely. Since then, there have been various modifications to the original design that have resulted in an instrument better adapted for orthopaedic use. Others continued the pioneering work, and over time, a growing number of orthopaedic specialists chose to adopt the use of these instruments as an aid to diagnoses prior to proceeding with open surgery on the affected joint.
The next breakthrough in the field of arthroscopy came, once again, from a Japanese surgeon. A student of Takagi, Masaki Watanabe was the first to use the instrument to perform keyhole surgery and thereby avoid the more radical procedure involving its complete exposure. By the mid-1960s, Watanabe’s arthroscopic, surgical techniques had been adopted by orthopaedic surgeons in Canada, and were soon to gain acceptance by fellow specialists throughout the Western world.
With the development of fibre-optic technology, the performance of these instruments has been enhanced considerably. This, in turn, has opened up further possibilities for the use of arthroscopy to perform minimally-invasive surgical interventions on the hip, shoulder, and knee joints. One of the more common problems affecting the knee joint is a torn meniscus. This is a pad of cartilage shaped like the letter “C” and which acts rather like a shock absorber. Each knee has a pair located between the femur and the tibia. Athletes often experience torn menisci due to the twisting of the upper leg whilst the knee is bent.
In some cases, a combination of pain medication and a regimen of exercises designed to strengthen the local musculature may result in recovery, but surgery will frequently be necessary. Arthroscopy has made it possible for most of these repairs to be undertaken via a pair of keyhole incisions: one for the scope and the other for instruments. In this way, much of the trauma, pain, and recovery time inherent in a more radical surgical procedure can be eliminated, whilst avoiding the need to delay the repair and the additional use of theatre time this would entail.
The same procedure is also used for irrigating joints to remove bone fragments and other foreign bodies that may impede their normally smooth operation. Without doubt, however, the most impressive advance in the surgical application of arthroscopy has been its adaptation to provide an alternative approach when performing a joint replacement. In this type of procedure, the cartilage that normally forms the protective articulating surfaces to shield the underlining bone has become badly damaged and must be is replaced with prosthetic implants. The latter are fabricated from suitably tough materials, including a variety of metals, plastics, and ceramics in various combinations.
Where once this would have meant full exposure of the affected joints, in many instances, surgeons at the Life Wilgers Hospital in Pretoria and worldwide, now prefer to use the less-invasive option of arthroscopy instead.