There are few rheumatologists who now use the technique of arthroscopy; in most centers, referral is made to an orthopedic surgeon who specializes in this technique. It has become clear in recent years that the synovium is the primary site of inflammation and the major effecter organ in a variety of joint diseases including rheumatoid arthritis . The present retrospective study was primarily carried out to assess the safety of this procedure in the hands of a rheumatologist and also to assess the utility of the procedure in various joint diseases.
To evaluate the safety and diagnostic value of medical arthroscopy performed by a rheumatologist.
Decisions for performing arthroscopy were taken when a detailed clinical history and relevant rheumatological investigations failed to arrive at a definite diagnosis. Initial assessment included detailed clinical history and relevant diagnostic tests for rheumatic diseases. Routine blood count, bleeding time, clotting time and biochemical parameters were also determined. After obtaining written consent, arthroscopies were performed as an outpatient department procedure using a 4 mm arthroscope with 0° and 30° viewing. All the procedures of arthroscopy were performed by a single rheumatologist. Procedures were done in a minor operating theatre under local anesthesia using strict aseptic precautions. Xylocaine 2% and bupivacaine 0.5% were used as local anesthetic agents for skin portal and intraarticular anesthesia, respectively. A tourniquet was not used during the procedures and the skin portal was not stitched. Synovial biopsies taken during procedures were subjected to only histopathological examination. All the procedures were recorded on a video-cassette.
See Tables 1 and 2. None of the patients developed any complications during the procedure or after 6 months of follow-up. None of the patients experienced any discomfort during the procedure except for a mild stretching sensation experienced by male patients. Females tolerated the procedure better than males.
Arthroscopy using a 4 mm scope in the hands of rheumatologists is a safe daycare procedure. It can be performed without a tourniquet. The local anesthetic agent bupivacaine provides an excellent local anesthesia. Females tolerate the procedure better than males. In a few cases arthroscopy helped in arriving at a final diagnosis but many patients remained undiagnosed. Both the rheumatologists and the pathologists require further experience in this field.