Arthoscopic versus open surgery

Typical arthroscopic incisions in the knee. Source: Wikimedia, Tim1965

Surgery is often thought of as a procedure in which the body is opened up, but for certain types of surgery, such as joint operations, traditional open surgery is becoming the last resort. Arthroscopic surgery utilizes small fiber optic instruments to see inside and around the joint. Major differences exist in both the procedures and risks of open and arthroscopic surgery. Read more about the differences and comparative risks of these types of surgeries after the jump.

 

 

According to the American Academy of Orthopaedic Surgeons (AAOS), arthroscopy aids in both treatment and diagnosis. However, other more complicated treatments require more access to the area than endoscopic instruments can provide, such as joint replacement, so open surgery (arthroplasty) is still common. The most common joints to be examined and repaired by arthroscopy, according to a 2006 study from the National Center for Health Statistics reported by the Washington Post, are the knee, shoulder, and wrist.

Major differences exist in both the procedures and risks of open and arthroscopic surgery. One difference is that arthroscopic procedures allow the surgeons to see the natural state of the joint with minimal disruption, unlike the more complicated open surgical procedures that disrupt the tissue to obtain a clear view of the connective tissues and bones making up the joint of interest. Arthroscopy is minimally invasive, requiring only small incisions for the endoscopic instruments to be inserted near the joint. As such, the incisions can be covered with a simple dressing and the procedure done as outpatient surgery. Open surgery almost always requires a hospital stay and is considered as being harder on the patient, with longer healing and recovery times, as noted by the Weill Cornell Medical College Department of Surgery and the MayoClinic in the context of surgery on the temporomandibular joint.

Open and arthroscopic procedures also share some risks, as they both require invasion into the body and anesthesia. According to the AAOS, approximately 1 percent of arthroscopy patients can expect complications, including infection, blood clots, instrument breakage, excessive swelling, and damage to the blood vessels or nerves. Open surgery carries higher risks of infection due to the increased exposure of the tissues to the external environment for the procedure. According to Emerging Infectious Diseases from the CDC in 2001, out of 27 million surgeries, half a million experience post-surgical infection. Diabetics also have a more difficult and prolonged healing period, so benefit from the minimally invasive nature of arthroscopy.

The risks from anesthesia depend on the type used. The effects of anesthesia are related to age, other medical conditions, and lifestyle factors (such as smoking, drinking, and drug use.) Some arthroscopic procedures can be performed with local or regional anesthesia that does not put the patient to sleep, according to New York Times Health. Open surgery is usually performed under general anesthesia for pain management, which is more likely to have adverse effects. According to WebMD, all anesthetics carry some risk, though such complications are not common.