Understanding Joint Lavage: Procedure, Indications, and Benefits

Introduction

Joint lavage, also known as arthroscopic lavage or joint irrigation, is a medical procedure used to clean and treat certain joint conditions. It involves flushing out a joint with sterile saline solution, typically saline, to remove debris, inflammatory byproducts, and loose tissue fragments within the joint space. It is typically performed arthroscopically; a small camera is inserted into the joint to view and guide the procedure. This minimally invasive technique is commonly performed in orthopedics to address various joint-related issues, particularly in the knees and shoulders.

How Is Joint Lavage Done?

Joint lavage is most often performed under regional or general anesthesia. The patient lies still while the surgeon makes small incisions around the joint. The surgeon inserts an arthroscope through one incision, which is a tiny camera and light system. This allows the surgeon to view the inside of the joint on a video monitor. Through another incision, the surgeon inserts the lavage system, typically cannulas or tubes attached to a saline bag or pump.

Once the instruments are in place, the surgeon uses the arthroscope to survey the joint for injury and disease. The saline solution is then pumped into the joint, flushing out any blood, loose debris, bacteria, or irritating enzymes. It also stops inflammation and delivers nutrients to promote healing. The saline will drain out through another cannula, carrying away unwanted materials.

This pumping out and flushing process may be repeated several times to clean the space thoroughly. Once the lavage is complete, the instruments are removed, and the small incisions are closed with a few stitches or bandages. The anesthesia then wears off as the patient comes out of sedation. The procedure typically takes less than 90 minutes.

What Are the Benefits of Joint Lavage?

The potential benefits of joint lavage include:

• Pain Relief: One of the most significant benefits is often rapid pain relief. Flushing out inflammation, debris, loose cartilage, or scar tissue can eliminate a source of major discomfort. Pain relief starts quickly as numbing fluid fills the joint during the procedure.

• Restore Function: Along with pain relief comes an improvement in function in many cases. Removing debris, draining infection, and delivering medication directly into the joint space are all actions that reduce impediments to normal joint mechanics. Ankle motion may be restored after flushing out scar tissue. Catching and locking from cartilage fragments ceases after they are washed out.

• Avoid Replacement Surgery: In some younger patients with early joint arthritis, lavage can delay advanced reconstructive procedures. Removing debris and inflammation provides a better environment for the remaining cartilage. Healthier cartilage results in preserved joint function for months to years longer.

• Minimally Invasive: Joint lavage spares patients from open arthrotomy procedures, which require long incisions through the joint. Small puncture incisions leave less scarring and allow for same-day surgery in many cases. Overall, less surgical trauma means faster recovery times.

• Diagnostic Information: The surgeon gains direct visualization of the inner joint with an arthroscope camera. This allows for the assessment of injuries, detection of loose bodies, evaluation of cartilage wear, and discovery of infection or crystal deposits. Diagnostic findings may guide further nonsurgical or surgical treatment.

• Temporary Relief Option: For some elderly patients with end-stage arthritis, joint replacement may be a high-risk surgery. Undergoing joint lavage provides significant symptom relief for six to 12 months until joint replacement is safer. It serves as a lower-risk option to buy more time.

What Are the Indications of Joint Lavage?

Joint lavage is used to treat multiple orthopedic conditions. Common indications include:

• Septic Arthritis: It is the infection of joints causing severe pain, fever, and swelling. Joint lavage can flush out bacteria causing this infection and thereby provide relief.

• Loose Bodies: In cases where loose bodies or fragments are present within the joint, such as cartilage or bone fragments, joint lavage can be used to remove this debris, reducing the risk of joint locking or impingement.

• Post-traumatic Arthritis: Acute injury to the joints may lead to the inflammation and accumulation of debris, scar tissue, and inflammatory cells. Joint lavage can flush out this debris.

• Synovitis: Joint lavage can be beneficial in managing certain synovial joint conditions associated with inflammation, such as synovitis or inflammatory arthritis. Flushing out the inflammatory byproducts and debris from the joint space can alleviate symptoms and improve joint function.

• Adhesive Capsulitis (Frozen Shoulder): It is a condition where the shoulder capsule becomes inflamed and stiff, greatly restricting motion and causing chronic pain. Breaking up the scar tissue formed by joint lavage is indicated, along with delivering anti-inflammatories.

• Adjunct to Other Treatments: It might be used as part of a comprehensive treatment plan, complementing other interventions such as corticosteroid injections, physical therapy, or oral medications. Combining joint lavage with these therapies may enhance overall outcomes in managing certain joint conditions.

• Hemarthrosis: It is a condition where there is bleeding into a joint, causing pain and swelling. Lavage evacuates the blood accumulated.

• Chronic Inflammatory Arthritis: Lavage is used to wash out inflammatory proteins that drive disease progression in chronic inflammatory arthritis (long-term joint inflammation).

What Are the Potential Risks of Joint Lavage?

Here are some of the potential risks and complications associated with joint lavage:

• Infection - There is always a small risk of introducing infection into the joint during the procedure. The sterile technique is used to minimize this risk. Signs of infection after lavage may include persistent fever, chills, increasing pain, and swelling. Additional surgery or IV (intravenous) antibiotics may be needed to treat infected joints.

• Bleeding - Bleeding can occur from the portals or incisions or inside the joint. Hemarthrosis or bleeding within the joint can cause pain and swelling after surgery. Additional lavage may drain the blood; rarely, a transfusion or additional surgery is required for uncontrolled bleeding.

• Nerve Injury - Small sensory nerves around the joint may be stretched or compressed during instrumentation. This can result in numbness, tingling, or even complex regional pain syndrome as a complication. Nerve symptoms usually resolve over time.

• Clot Formation - In rare cases, loose debris or tissue can form clots inside the joint following lavage. This causes recurrent swelling, pain, and catching. Additional arthroscopic surgery may be needed to remove clots.

• Stiffness - Some loss of motion can occur after surgery due to swelling or scar tissue. Physical therapy helps regain flexibility over the first few postoperative months.

• Instrument Breakage - Rarely during arthroscopic procedures, part of an instrument, like a tip, could break off inside the joint. Additional surgery may be needed to retrieve the loose fragment.

• Anesthesia Risks - Anytime anesthesia is used, even in regional blocks, there are risks of breathing issues, arrhythmias (irregular heartbeat), blood pressure changes, and allergic reactions. Fortunately, serious complications are relatively uncommon with modern anesthetics and monitoring.

Conclusion

Joint lavage often provides rapid pain relief and restored function. It can eliminate the need for joint replacement in some younger patients. In the knee and shoulder, studies show lavage paired with debridement can significantly delay time to eventual replacement. Overall, joint lavage serves as an indispensable tool for the orthopedic treatment of multiple joint disorders.