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Antibiotics for Arthroscopic Surgery


Arthroscopic Surgery Antibiotics

Arthroscopy is a way for a surgeon to look into your joint with a camera. The most common type of arthroscopy is arthroscopic knee surgery. Other common arthroscopic surgeries include shoulder, elbow, wrist, ankle, and hip arthroscopy. A small camera is inserted into a joint such as a knee, shoulder, elbow, wrist or ankle joint. The internal structures and problems within the joint can then be seen without opening the joint so that a diagnosis can be made.

The diagnosis and treatment of shoulder joint problems have improved greatly since a minimally invasive procedure called arthroscopy was developed. Arthroscopy allows your surgeon to see inside your shoulder and to carry out procedures through tiny incisions. Arthroscopic surgery can be used to diagnose and treat shoulder injuries.

Types of Arthroscopic Surgery

Arthroscopic surgery could potentially be performed on any joint, and as time passes, more and more different joints are being arthroscopically treated. Common types of arthroscopic surgery include:

  • Knee Arthroscopy
  • Shoulder Arthroscopy
  • Hip Arthroscopy
  • Ankle Arthroscopy
  • Elbow Arthroscopy
  • Wrist Arthroscopy

Knee and shoulder arthroscopy are by far the most common arthroscopic procedures performed. These joints are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments.

Technically speaking, any joint can be arthroscoped. However, the practicality and the instrumentation available limit our ability to arthroscope every joint for all types of problems. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and repairing rotator cuff tears in the shoulder.

Performing Arthroscopic Surgery

When an arthroscopy is performed, a camera is inserted into the joint through a small incision (about one centimeter). The arthroscopic surgery camera is attached to a fiberoptic light source and shows a picture of the inside of the joint on a television monitor. The surgeon uses fluid pumped through the joint to aid in visibility and clear debris from the joint. One or more other incisions are made to insert instruments that can treat a variety of conditions. For example, a shaver can be inserted to trim torn cartilage from a joint.

Is arthroscopic surgery safe?

Understand that arthroscopic surgery is a surgical procedure and involves risks. These may include infection, blood clots, problems with anesthesia, etc. These are serious risks and the decision to undergo arthroscopic surgery should be taken seriously. That said, arthroscopic surgery is a "less invasive" procedure, and when performed for the right problem it is often very successful. Ask your doctor for more information about arthroscopic surgery, and talk about the possible risks of undergoing the procedure.

Is arthroscopic surgery safe?

Understand that arthroscopic surgery is a surgical procedure and involves risks. These may include infection, blood clots, problems with anesthesia, etc. These are serious risks and the decision to undergo arthroscopic surgery should be taken seriously. That said, arthroscopic surgery is a "less invasive" procedure, and when performed for the right problem it is often very successful. Ask your doctor for more information about arthroscopic surgery, and talk about the possible risks of undergoing the procedure.

Antibiotic prophylaxis for arthroscopic surgery.

Because the incidence of infection in arthroscopic surgery is very low, one can argue both for and against the use of prophylactic antibiotics. Administering antibiotics adds expense and introduces the potential for both exposure to allergic reactions and selection of resistant organisms. Antibiotics are given to prevent deep infection; such treatment may require further surgery, prolonged use of intravenous antibiotics, high costs, and outcomes that may be less than satisfactory. An answer to this controversial issue would require a study that includes large numbers of patients to make it adequately statistically powered because the incidence of infection is so low. No such research has yet been performed, and the American Academy of Orthopaedic Surgeons (AAOS) has not produced an advisory statement addressing this issue. It is the opinion of this author that antibiotic prophylaxis is indicated for arthroscopic surgery. Despite surgical team best practices, mistakes can occur. This has led the AAOS to issue an advisory statement to prevent wrong-site surgery. Similarly, complacency with repetition may produce breaks in sterility that may occasionally go undetected. Antibiotic usage may help to reduce infection in such circumstances. Arthroscopic procedures are not always performed in healthy patients. The risk of infection in "high-risk" patients, such as those with diabetes, immune problems, and skin disorders, may be reduced by prophylactic antibiotics. How one defines a case as arthroscopic can be debated. If small incisions are made, or if the scope is used for only a portion of the procedure, many would still consider the case to be arthroscopic. Surgeries are becoming more complex, which adds to their duration. Some cases also involve the use of implants such as interference screws and suture anchors. It is my opinion that antibiotics should be used in these situations. The potential exists for litigation in cases of infection. Medicolegally, it is easier to argue that all measures were taken to prevent infection if prophylactic antibiotics were given, although patient care issues supersede defensive medicine. Risk of infection in arthroscopic surgery is multifactorial, and antibiotic prophylaxis is only one facet of the issue. Although it is my opinion that antibiotics are recommended, others could be justified in supporting the opposite opinion, pending appropriately designed and adequately powered future investigations.

Are Antibiotics Needed Routinely for Arthroscopic Surgery?

Patients who have arthroscopic surgery on any joint are at increased risk for infection. Those who have joint replacements could be in danger of implant failure from infection. The use of antibiotics to prevent infection is called prophylaxis. Prophylactic use of antibiotics is a form of ?defensive medicine.?

The over use of antibiotics has led to bacteria that are resistant to antibiotics. Should everyone get antibiotics to keep this from happening?

In this report, Dr. P. R. Kurzweil from the Southern California Center for Sports Medicine offers his opinions about the use of antibiotics for arthroscopic surgery. His arguments are all in favor of prophylactic antibiotics. He gives the following reasons: Prevents infection from mistakes made in sterile procedures (human error) Prevents deep infection that would require more surgery Helps high-risk patients who are at increased risk of infection from other problems such as diabetes, immune disorders, or skin problems Protects the surgeon in case of a lawsuit over infection; use of antibiotics shows the doctor took every step to avoid this problem Offsets the risk of infection for some of today's arthroscopic operations that are long and complex

Some experts argue against the routine use of antibiotics. For one thing it's expensive. And the actual risk of infection with arthroscopic surgery is very low. Patients are exposed to something they may be allergic to or that could result in resistant bacteria if an infection does occur.

Prophylactic antibiotics don't prevent all infections but they do reduce the risk. The author advises use whenever any incision is made no matter how small. It's less expensive to give everyone a prophylactic antiobiotic than to treat the small number of patients with infection using intravenous antibiotics.

Pricing for Arthroscopy

Price Range for Arthroscopy in India ($): 1890 - 2310

Estimated UK Price for comparison ($): $7200

Percentage Saving India to UK: 71%

Athroscopic Sugery
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Antibiotics for Arthroscopic Surgery
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