The Differences and Comparative Risk of Arthroscopic and Open Surgery

Arthroscopy can be simply defined as ‘viewing the joint’ using a specialized instrument known as the ‘arthroscope.’ As modern-day surgeons get accustomed to using this instrument, it is being used for more and more diagnostic and surgical procedures related to major joints, which earlier indicated ‘open’ surgical techniques. It has made some of the orthopedic surgeries less messy and highly successful with reduced complications and risks that were usually associated with such surgeries.

How is an arthroscopy performed?

Most often, it is an outpatient procedure and the patient can expect to arrive home the same day. However, they will receive anesthesia, which can be general, spinal, or regional, depending on the site and the procedures performed.

Arthroscope is a flexible tube-like instrument, which has its own light source and a tiny camera to visualize its path, and it has wires to transmit its signals to a television monitor. Surgeons will insert the instrument into a joint through a small incision of 1 to 2 cm made in the overlying skin.

Apart from the main arthroscope, two more thin tubes inserted through even smaller incisions into the joint will facilitate better visualization through continuous irrigation, and there will be more functionality through introduction of various instruments. Thus, the surgeons will be able to perform visual diagnosis, removal of foreign bodies and particles, aspiration of fluids, washing of the joints, repair of ligaments and torn cartilages, obtaining a biopsy specimen, etc, without needing to open the joint.

Following the procedure, surgeons will pull out the tubes and will place sutures, staples, or surgical glue in order to close the remaining incisions.

How is an open surgery performed?

An open surgery is also performed under anesthesia as described above, although stronger anesthesia would be necessary when considering the amount of damage to the tissues during such a procedure as opposed to arthroscopic procedures.

The term ‘open’ refers to the direct visualization of the surgical field by the surgeon during a surgical procedure. Thus, in order to perform a procedure carried out through an arthroscope as an ‘open’ surgery, the surgeon has to make a wider incision over the joint.

In most instances, application of pressure is required in order to keep the edges of the incision apart. Such ‘open’ surgeries will give more flexibility to the surgeon and will be useful in performing major surgeries, which require complex reconstruction that is difficult to perform using an arthroscopic technique.

Following the surgery, the wound edges have to oppose each other and in most instances, several sutures may be necessary in order to close the wound.

What are the advantages of arthroscopic surgery?

Due to the smaller incisions, the procedure does not do much harm to the surrounding structures and is therefore more likely to heal faster than the wound of an ‘open’ surgical procedure. Less tissue trauma will also lessen the pain following such procedures, and therefore, the necessity of using painkillers. Smaller incisions made during an arthroscopic procedure will minimize scar formation and therefore have a good cosmetic outcome.

As described earlier, these patients can go home on the same day, and they may spend less time before mobilizing the joint than their counterparts undergoing ‘open’ surgery. Smaller incisions and tissue damage also means that chances for infection will be smaller. This will further reduce the recovery time and the possibility of complications.

During joint surgery, there is a risk of exposing the surface cartilages of the bones to the outside air and this can lead to dehydration of these structures, which can cause long-term complications. Nevertheless, following arthroscopic surgeries, such exposure is either minimal or almost nil, which makes it a safer procedure than an open surgical approach.

What are the advantages of ‘open’ surgical procedures?

Such procedures will allow the surgeon enough space to manipulate instruments and to perform certain techniques which arthroscopy may not allow. Furthermore, a 3D view gained through open surgery will enable a surgeon to access complicated joints or ones with multiple damages. At the same time, open surgery can alleviate the necessity for a second surgery, which may be the case when arthroscopic surgeries are attempted in some instances.

What are the risks associated with each technique?

The anesthetic risks and the possibility of deep vein thrombosis following joint surgeries would be present with both procedures. These risks can range from minor complications to death, although the incidence is rather low. However, ongoing pain in the calf, swelling, and sudden onset shortness of breath needs urgent evaluation to avoid fatal complications.

As described earlier, risk of infection is higher with open surgeries although arthroscopy could also have an infection risk to a certain degree.

Arthroscopic procedures will have an increased risk of damaging nearby blood vessels or nerves as it enters the joint blindly. However, a careful approach and expertise will largely reduce such risks.

At the same time, when considering the relative tissue damage, open surgery would have a higher risk of bleeding than an arthroscopic technique.