Many orthopaedic procedures on joints are performed using an arthroscope, where a fibre optic telescope is used to look inside the joint. Through this type of keyhole surgery, fine instruments can be introduced through small incisions (portals) to allow surgery to be performed without the need for large cuts. This allows many procedures to be performed as a day stay and allows quicker return to normal function of the joint. Arthroscopic surgery is less painful than open surgery and decreases the risk of healing problems. Arthroscopy allows access to parts of the joints which can not be accessed by other types of surgery. Arthroscopy Arthroscopy (ahr-THROS-skuh-pee) is a procedure for diagnosing and treating joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor. Arthroscopy allows the surgeon to see inside your joint without making a large incision. Surgeons can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions. Doctors use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the: Knee Shoulder Elbow Ankle Hip Wrist Diagnostic procedures Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered. Surgical procedures Conditions treated with arthroscopy include: Loose bone fragments Damaged or torn cartilage Inflamed joint linings Joint infections Torn ligaments Scarring within joints Complications, though uncommon, may include: Tissue damage. The placement and movement of the instruments within the joint can damage the joint's structures. Infection. Any type of invasive surgery carries a risk of infection. Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs. Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should: Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding. Fast beforehand. Depending on the type of anesthesia you'll have, your doctor may want you to avoid eating solid foods eight hours before your procedure. Arrange for a ride. You won't be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day. Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure. Although the experience varies depending on why you're having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard. You'll remove your street clothes and jewelry and put on a hospital gown or shorts. The anaesthetist will place an intravenous catheter in your hand or forearm and inject a mild sedative. During the procedure The type of anesthesia used varies by procedure. Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint. Regional anesthesia. The most common form of regional anesthesia is delivered through a small tube placed between two of your spine's lumbar vertebrae. This numbs the bottom half of your body, but you remain awake. General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure. General anesthesia is delivered through a vein (intravenously). You'll be placed in the best position for the procedure you're having. This may be on your back, on your abdomen or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet might be used to decrease blood loss and make it easier to see inside the joint. Another technique to improve the view inside your joint is to fill it with a sterile fluid, which helps distend the area and provide more room. One small incision will admit the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair. Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape. After the procedure Arthroscopic surgery usually takes between 30 minutes and two hours, depending on the procedure. After that, you'll be taken to a separate room to recover for a few hours before going home. Your aftercare may include: Medications. Your doctor will prescribe medication to relieve pain and inflammation. R.I.C.E. At home, you'll need to rest, ice, compress and elevate the joint for several days to reduce swelling and pain. Protection. You might need to use temporary splints — slings or crutches for comfort and protection. Exercises. Your doctor might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint. In general, you should be able to resume desk work and light activity in a week, and more strenuous activity in about four weeks. However, your situation might dictate a longer recovery period and rehabilitation. Your surgeon will review the findings of the arthroscopy with you as soon as possible. You might also receive a written report. After arthroscopic surgery to treat a joint injury or disease, healing may take several weeks. Your surgeon will monitor your progress in follow-up visits and address problems. For more information about arthroscopy please click here.

For elderly patients joint replacement surgery is commonly required to treat damaged joints from wearing out, arthritis or other forms of joint disease including rheumatoid arthritis. In these procedures the damaged joint surface is removed and replaced with artificial surfaces normally made from metal (chromium cobalt alloy, titanium), plastic (high density polyethylene) or ceramic which act as alternate bearing surfaces for the damaged joint. These operations are major procedures which require the patient to be in hospital for several days and followed by a significant period of rehabilitation. The hospital has several ways of approaching the procedure for replacement and the specifics for the procedure will be covered at the time of assessment and booking of surgery. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation. For more information about joint replacement please click here

Common surgical procedures on the shoulder are: Rotator Cuff Repair Several small incisions (cuts) are made in the shoulder through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope). The surgeon is then able to remove any bony spurs or inflamed tissue and mend torn tendons of the rotator cuff group. Shoulder Arthroscopy This surgery involves making several small incisions (cuts) on the shoulder through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope). This allows the surgeon to look inside the shoulder, identify problems and, in some cases, make repairs to damaged tissue. For more information about shoulder and elbow conditions and treatments please click here

Common surgical procedures on the knee are: Knee Arthroscopy Several small incisions (cuts) are made on the knee through which is inserted a small telescopic instrument with a tiny camera attached (arthroscope). This allows the surgeon to look inside the joint, identify problems and, in some cases, make repairs to damaged tissue. Total Knee Replacement This is a surgical procedure performed on a knee joint that has become painful and/or impaired because of disease, injury or wear and tear. In total knee replacement, artificial materials (metal and plastic) are used to replace the following damaged surfaces within the knee joint: the end of the thigh bone (femur) the end of the shin bone (tibia) the back of the kneecap (patella) This operation is a major procedure which requires you to be in hospital for several days and will be followed by a significant period of rehabilitation. Occasionally blood transfusions are required; if you have some concerns raise this with your surgeon during consultation. For more information about total knee replacement please click here. Anterior Cruciate Ligament (ACL) Reconstruction The anterior cruciate ligament (ACL) is a strong, stabilising ligament running through the centre of the knee between the femur (thigh bone) and tibia (shin bone). When the ACL is torn, frequently as the result of a sporting injury, arthroscopic surgery known as ACL Reconstruction is performed. The procedure involves replacement of the damaged ligament with tissue grafted from elsewhere, usually the patellar or hamstring tendon. The ends of the grafted tendon are attached to the femur at one end and the tibia at the other using screws or staples. For more information about ACL Reconstruction please click here. Meniscal Surgery The menisci are two circular strips of cartilage that form a cushioning layer between the ends of the femur (thigh bone) and tibia (shin bone) in the knee joint. Together the medial and lateral menisci, on the inside and outside of the knee, respectively, act as shock absorbers and distribute the weight of the body across the knee joint. The menisci can become torn through injury or damaged from age-related wear and tear and may require surgery. The most common meniscal surgery is partial meniscectomy in which the torn portion of the meniscus is cut away so that the cartilage surface is smooth again. In some cases meniscal repair is carried out, in this case the torn edges of the meniscus are sutured together. Both procedures are performed arthroscopically. For more information please click here for meniscal tears and click here for meniscal transplant surgery.

Common hand & wrist surgical procedures are: Carpal Tunnel Release Surgery to relieve carpal tunnel syndrome involves making an incision (cut) from the middle of the palm of your hand to your wrist. Tissue that is pressing on the nerve is then cut to release the pressure. Arthritis Arthritis is a condition in which a joint and the surrounding tissue become swollen and painful. If surgery is necessary, it may involve replacement of the joint with an artificial joint or removal or repair of swollen or damaged tissue. For more information about hand and wrist conditions and treatments please click here

For information about sport- and exercise-related injuries and treatments please click here

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In many cases tendons will be lengthened to improve the muscle balance around a joint or tendons will be transferred to give overall better joint function. This occurs in children with neuromuscular conditions but also applies to a number of other conditions. Most of these procedures involve some sort of splintage after the surgery followed by a period of rehabilitation, normally supervised by a physiotherapist.

The division of a crooked or bent bone to improve alignment of the limb. These procedures normally involve some form of internal fixation, such as rods or plates, or external fixation which involves external wires and pins to hold the bone. The type of procedure for fixation will be explained when the surgery is planned.