Arthrotomy
Arthrotomy is a surgical procedure that opens a joint for direct inspection, drainage of infection or blood, removal of foreign bodies, or repair of internal joint structures — providing access and diagnosis that is not achievable through less invasive techniques.
Overview
Arthrotomy is the surgical opening of a joint through a formal incision to allow direct visual inspection of joint surfaces, cartilage, ligaments, and synovium, and to perform procedures not achievable arthroscopically — including drainage of septic arthritis, evacuation of haemarthrosis, removal of foreign bodies, or repair of complex intra-articular injuries. In the era of arthroscopy, open arthrotomy is reserved for situations requiring more extensive access, direct tissue manipulation, or management of infectious joint disease where thorough washout demands open access. Performed by an experienced orthopaedic surgeon, arthrotomy provides definitive diagnosis and treatment of challenging intra-articular pathology.
Types of Arthrotomy
Arthrotomy can be performed on any joint in the body, with the specific approach tailored to the joint, the pathology, and the required surgical intervention.
- Knee Arthrotomy (parapatellar, medial, or lateral approach depending on pathology)
- Hip Arthrotomy (anterior, posterior, or lateral approach for hip joint exploration)
- Shoulder Arthrotomy (deltopectoral approach for shoulder joint access)
- Ankle Arthrotomy (anterior or posterior approach for ankle joint surgery)
- Elbow Arthrotomy (medial, lateral, or posterior approach for elbow joint procedures)
Risk Factors for Conditions Requiring Arthrotomy
Several conditions predispose joints to pathology requiring open arthrotomy when less invasive approaches are insufficient.
- Septic arthritis — bacterial joint infection from haematogenous spread or direct inoculation
- Intra-articular fracture with complex joint surface disruption requiring open reduction
- Haemarthrosis from coagulopathy or anticoagulation causing progressive joint damage
- Foreign body penetrating injury entering the joint space
- Failed arthroscopic management requiring conversion to open surgery
- Synovial disorders including pigmented villonodular synovitis requiring complete synovectomy
Arthrotomy Indications and Symptoms
These symptoms and clinical findings indicate the need for open joint surgery when less invasive management has failed or is not appropriate.
- Hot, swollen, acutely painful joint with fever suggesting septic arthritis
- Tense haemarthrosis following trauma causing severe pain and limited joint movement
- Visible or palpable foreign body in or around the joint confirmed on imaging
- Intra-articular fracture with displaced joint surface fragments on CT imaging
- Locking or mechanical block to joint movement from intra-articular pathology
- Failed aspiration or arthroscopic drainage of an infected joint
- Rapidly progressive joint destruction on serial imaging requiring urgent intervention
- Chronic synovitis with failure of all conservative and arthroscopic treatments
Key Benefits
Discover the advantages of choosing our arthrotomy services.
Provides direct access to the joint for definitive diagnosis and treatment in one procedure
Thorough joint washout eliminates all infected material that aspiration alone cannot achieve
Direct inspection allows identification and treatment of unexpected intra-articular pathology
Immediate source control of joint infection prevents progressive articular cartilage destruction
Early physiotherapy after arthrotomy prevents long-term joint stiffness and functional restriction
Clinical Features
The technology, techniques and clinical approach behind our arthrotomy.
Direct surgical access provides complete visualisation of all intra-articular structures
Copious joint washout with warm saline achieves thorough source control in septic arthritis
Drain placement allows continued monitoring and drainage of joint fluid post-operatively
Specimens sent for microbiological and histological analysis to guide ongoing treatment
Physiotherapy begins within 24 hours to prevent joint stiffness after open arthrotomy
Preparation Instructions
- Complete X-ray, CT, and MRI of the affected joint to characterise the pathology and plan the surgical approach
- Blood tests including CBC, inflammatory markers, coagulation, and blood culture in cases of suspected septic arthritis
- Joint aspiration for microscopy, culture, and crystal analysis in cases of infection or crystal arthropathy
- Stop anticoagulants 5 to 7 days before elective surgery under supervision
- Fast for 6 to 8 hours before surgery
- Arrange home support and appropriate mobility aids for the post-operative period
- Physiotherapy assessment before surgery to plan the post-operative rehabilitation programme
- Inform the orthopaedic team of all medications, allergies, and relevant joint history
The Procedure
Step-by-step guide to what you can expect during your arthrotomy procedure.
Diagnostic Imaging and Surgical Planning
Your orthopaedic surgeon reviews plain X-rays, CT, and MRI of the affected joint to understand the anatomy of the pathology — whether infected fluid, haematoma, foreign body, or intra-articular fracture — and plans the safest surgical approach that provides the best access with minimal disruption of normal joint structures.
Anaesthesia and Joint Preparation
General, spinal, or regional anaesthesia is administered based on the joint being explored and the patient's health. The joint and surrounding skin are prepared with antiseptic solution over a wide area and draped in a fully sterile manner. A tourniquet is applied to the limb for bloodless field access where appropriate.
Surgical Approach and Joint Capsule Opening
A precisely planned incision is made over the affected joint following the anatomically established approach for that specific joint. Each tissue layer is divided carefully and the joint capsule is opened in a controlled manner, allowing immediate assessment of the joint contents under direct surgical vision.
Joint Inspection and Treatment
The entire joint interior is systematically inspected under direct vision and copious irrigation with warm saline. The specific treatment is performed — whether thorough washout for septic arthritis, haematoma evacuation, foreign body removal, intra-articular fracture reduction and fixation, or synovial tissue biopsy — based on the intraoperative findings.
Drain Placement and Capsule Closure
A surgical drain may be placed within the joint to allow continued post-operative drainage and monitoring of joint fluid. The joint capsule is closed in meticulous layers with strong absorbable sutures to restore joint stability and prevent post-operative fluid collection under the repair.
Physiotherapy from Day One
Your physiotherapist begins joint mobilisation and range-of-motion exercises from the first post-operative day — preventing joint stiffness, promoting synovial fluid circulation, and beginning the rehabilitation programme that will restore full joint function. Early physiotherapy is one of the most important determinants of functional joint recovery after arthrotomy.
What to Expect
Arthrotomy is performed under general, spinal, or regional anaesthesia and takes 60 to 120 minutes depending on the joint and pathology. A formal incision is made over the joint, the capsule opened under direct vision, and the required procedure performed — washout, removal of foreign body, fracture fixation, or tissue excision — under optimal lighting and access. Most patients are discharged within 2 to 5 days with physiotherapy and progressive joint mobilisation beginning within 24 to 48 hours.
Recovery
After Arthrotomy, follow the prescribed physiotherapy and joint mobilisation programme faithfully from the earliest permitted stage to prevent joint stiffness and restore range of motion. Keep the wound clean and dry and monitor for signs of infection — redness, warmth, swelling, or discharge — throughout the healing period. Take all prescribed antibiotics for the full prescribed duration in cases of septic arthritis — incomplete courses lead to recurrence. Contact your orthopaedic team immediately for fever, increasing joint pain, swelling, or any wound complications.
Frequently Asked Questions
Common questions about arthrotomy.
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