Surgical Options for Osteoarthritis

When medicines, physical therapy and other treatments fail to relieve the pain of osteoarthritis, surgical intervention may be needed. Surgery usually comes at the point in time when the pain and limited function are causing a decrease in a person’s quality of life.

There are many different surgical procedures available to those with osteoarthritis. The choice of surgery depends on many factors; the joint involved, the degree of degeneration of the joint, and perhaps most importantly the amount of pain the person is in.

The following is a brief discussion of some of the more common types of surgery used to treat osteoarthritis. It is in no way a complete list, you need to discuss your treatment options with a qualified orthopedic surgeon.

Joint replacement surgery has been the single biggest advance in the treatment of osteoarthritis in the past half century. When osteoarthritis becomes so severe that pain and immobility make normal functioning impossible, many people become candidates for this surgery. Hip replacement is the most established and successful replacement procedure, followed by knee replacement. Other replaceable joints include shoulders, elbows, wrists, and fingers. Recently the ankle replacement has become an option also. The primary guidelines should be pain and significant limitations, however some surgeons also use age as a guideline. The younger a replacement candidate is, the more likely it is that the replacement joint will wear out over time and need removed or revised. We feel that if the pain and limitations have a significant affect on the person’s quality of life, that age should not be taken into consideration.

Osteotomies may serve as alternatives to joint replacement in younger people since it may delay progression of disease. But, only 50% of patients with knee osteotomies have satisfactory results at 10 years, hip osteotomies have a lower satisfaction rate. It is done by opening the joint and reshaping the bones to bring the joint back into alignment, loose particles or torn fragments are removed from the joint.

An arthroscopy is performed to clean out bone and cartilage fragments that cause pain and inflammation. It is usually performed on the knee but may also be done on other joints. Minor repairs to joint tissues can also be done via arthroscopy.

Joints that cannot be easily replaced may be fused in a procedure called arthrodesis. It does eliminate movement of the joint, but by doing so it relieves the pain caused by movement.

A fairly new technique called autologous chondrocyte implantation, or chondroplasty is being used to treat OA of the knees. It involves taking a small amount of healthy tissue out using an arthroscope and growing it in the laboratory for about two weeks. It is then put back into the joint, where it stimulates the regrowth of damaged tissue.

Again, there are just a few of the many surgical options available to those with OA. If you think you might benefit from orthopedic surgery, a consult with a surgeon is in order. You can find more information on some of these procedures in our Surgery Index.

References:
Goroll: Primary Care Medicine, 3rd ed., Copyright ? 1995 Lippincott-Raven Publishers
Osteoarthritis Well-Connected
Copyright ? Nidus Information Services 2000
Koopman: Arthritis and Allied Conditions, 13th ed., Copyright ? 1997 Williams & Wilkins