Arthrotomy is a surgical procedure that involves making an incision directly into a joint to access its internal structures. This technique allows orthopedic specialists to directly view and treat various conditions affecting the joint. It provides a wide view of the joint space for diagnostic or therapeutic purposes.
Reasons for Arthrotomy
Arthrotomy is performed for a variety of reasons, including diagnosing complex joint issues and repairing significant damage. One common indication is joint exploration for diagnostic purposes, allowing surgeons to visually inspect the joint when other imaging techniques may not provide sufficient detail. This direct visualization helps identify the cause of persistent pain, swelling, or limited movement.
The procedure is also used to remove foreign bodies from the joint, such as bone fragments, loose cartilage, or other debris. Repair of damaged cartilage or ligaments, and treatment of severe joint infections, particularly septic arthritis, are additional reasons for arthrotomy. For deep joint infections, especially in larger joints, arthrotomy ensures thorough drainage and debridement of infected tissue.
How Arthrotomy is Performed
The arthrotomy procedure begins with the administration of anesthesia, which can be general, regional, or local. Once the anesthesia takes effect, the surgeon prepares the surgical site. A precise incision is then made over the joint, providing direct access to the joint capsule and its internal components.
The size and location of the incision depend on the specific joint being operated on and the nature of the condition being addressed. The joint capsule is carefully opened, allowing the surgeon to directly visualize the joint space. This direct view enables the surgeon to assess the extent of any damage, remove foreign bodies, repair torn structures like ligaments or cartilage, or drain infected fluid. After the necessary repairs or interventions are completed, the joint capsule and overlying tissues are closed with sutures. A sterile dressing is then applied to the incision site, and in some cases, a brace or cast may be used to immobilize the joint.
What to Expect During Recovery
Recovery following an arthrotomy involves several phases. Immediately after surgery, patients experience pain and swelling, which is managed with prescribed pain medication and anti-inflammatory drugs. Applying ice packs to the surgical site and elevating the limb help minimize swelling and pain.
Physical therapy is essential for recovery, often starting within a few days to two weeks post-surgery. Early exercises may include gentle movements like ankle pumps and heel slides to improve circulation and restore range of motion. As healing progresses, a physical therapist guides the patient through exercises designed to strengthen the muscles around the joint and improve flexibility. Weight-bearing restrictions vary depending on the joint and the extent of the surgery, with some patients gradually increasing weight-bearing over several weeks, while others may be non-weight-bearing for a longer period. The full recovery timeline can range from several weeks to a few months, with individual progress influenced by the specific procedure and overall health.
Potential Risks
As with any surgical procedure, arthrotomy carries potential risks, though serious complications are uncommon. One concern is the risk of infection, which can be severe if it affects the joint directly (septic arthritis). Symptoms like severe pain, warmth, redness, and fever after surgery require immediate medical attention.
Other potential risks include bleeding and damage to surrounding nerves or blood vessels. Stiffness in the joint post-surgery can occur, sometimes requiring additional physical therapy. Scar tissue formation can occur, potentially limiting joint movement. Complications related to anesthesia, though rare, can also arise. Studies comparing arthrotomy to less invasive procedures, such as arthroscopy, indicate similar rates of major complications, including deep surgical site infection, with minor complications like peripheral nerve issues also occurring.