Surgical Treatment For Osteoarthritis - Osteoarthritis: Arthritis

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Surgical treatment for osteoarthritis

Sometimes surgical intervention is necessary to relieve extremely painful or badly misaligned joints. The option your doctor recommends will depend on your age, activity level, and overall health. Surgical options are usually recommended only when drug therapies and other strategies have failed.

Arthroscopy

Arthroscopy is considered minor surgery because the surgical incisions are small and the procedure generally does not require an overnight stay in the hospital. An arthroscope is an instrument with a tiny light, a camera, and a variety of surgical attachments. The surgeon inserts the instrument into the joint and performs minor surgery using the attachments. The camera enables the surgeon to see and smooth over any ragged joint edges and to locate and remove debris and loose material. Depending on the condition of the joint, this can result in mild to moderate improvement that may last several months or perhaps a few years. However, for someone with severe osteoarthritis, this approach is unlikely to offer much benefit. Studies have called into question whether this type of surgery should be routinely employed. Unless there is a specific finding or abnormality that can be addressed with this technique (such as a tear in the cartilage), arthroscopy for osteoarthritis may not be helpful.

Joint reconstruction or replacement

Doctors recommend joint reconstruction or replacement in cases of severe osteoarthritis in which the joint shows significant deterioration. Surgery can be used to correct joint deformity, to reconstruct a diseased joint, or to completely replace a diseased joint with a prosthetic device. This surgery is most often recommended for osteoarthritis of the hip or knee, because severe disease of these joints can impede movement.

Hip replacement and knee replacement are among the most common surgeries performed in the United States. A replaced joint will last an average of 10 to 15 years (or even longer, because such estimates are based on operations performed at least 10 years ago). But joint replacement is not an option for everyone; the ideal surgical candidate is in good general health and not overweight. However, as surgical and anesthesia techniques have improved, more and more people are becoming good candidates for surgery. Surgeons may encourage young, physically active people to delay joint replacement because artificial joints usually need to be replaced after a decade or two. The younger the patient, the more the joints are used, and the greater the number of replacements that may be necessary.

It's also important to have realistic expectations about what joint replacement surgery can and cannot do. Joint replacement doesn't guarantee that you will be able to move or use the joint in a normal way. Still, many people do experience great functional improvement. The major consistent benefit is substantial relief from pain. To maximize the chances of good results, it's important to participate in physical therapy after surgery.

Many artificial joints are attached to bone with pins and acrylic cement (see Figure 6). Over time, these components may loosen or break, requiring repairs. Researchers believe some design improvements that have been made may make the implants last longer. For example, cementless components are now widely used. Their metallic surfaces are roughened until they become semi-porous, allowing bone to grow into the surfaces, which may reduce the likelihood of loosening. However, such designs must be tested for 10–20 years to determine how well they perform. These components haven't yet been shown to perform significantly better than a well-cemented pin.

Figure 6: Artificial hip joint Artificial hip joints have metal shafts that are inserted into bone and anchored. At weight-bearing points, slick, high-density polyethylene is used to reduce friction (like cartilage in natural joints). Cement fastens the artificial joint to the skeleton in many joint replacement operations. Cementless implants have a porous surface that bone tissue penetrates, thereby holding the prosthesis in place.

Cartilage transplant

Cartilage transplant is a method to replace damaged cartilage with healthy cartilage transplanted from elsewhere in the body or from donated tissue from someone who has died. Cartilage cells may be removed from a joint or some other area and grown outside the body to form a biological patch. The patch is then inserted in an area of damaged or missing cartilage with an arthroscope. So far, these approaches have been used primarily in young people with small, sports-related cartilage injuries in the knee. But many experts believe that the time is coming when cartilage transplant will be a more common treatment for osteoarthritis.

Last updated:	September 05, 2008