Osteoarthritis
Surgery
Surgery is reserved for people with severe osteoarthritis who do not get pain relief from medicine, home treatment, or other treatments and who have significant loss of cartilage.
Surgery relieves severe, disabling pain and may restore joint function and mobility. Some surgical procedures, such as osteotomy or arthroscopy, may postpone total joint replacement.
Surgery Choices
Surgeries to treat osteoarthritis may include:
- Osteotomy of the knee or hip, used in cases of hip deformity and abnormality of the legs in active people younger than 60 with mild osteoarthritis.
- Joint replacement surgery, considered when pain and disability have not been controlled by conservative treatment such as exercise and medicine, and joint damage is visible on X-rays.
- Hip resurfacing surgery, which doctors use primarily for younger, more active people who have pain and disability from hip deterioration. No long-term results are available yet, but short-term results are positive up to about 8 years after surgery.11 One large study suggests that this surgery works well. But the study also says that the risk of needing the surgery redone is slightly higher than with a standard hip replacement.12
- Arthroscopy, which can provide temporary (and sometimes long-term) pain relief and improved joint movement in some people. But arthroscopy does not seem to help osteoarthritis itself.13 It may work best for people who have pain or trouble moving when their joints become “locked” or stuck because of loose cartilage or bone fragments.
- Arthrodesis, surgery that joins (fuses) two bones in a diseased joint so that the joint can no longer move. Doctors may use it for the spine, ankles, hands, and feet, but rarely for the knees and hips.
- Small joint surgery, used if the joints of the hands or feet are so disabled that function is impossible. Severe finger deformity is more commonly seen in rheumatoid arthritis than in osteoarthritis. Doctors replace toe joints sometimes, in cases of severe pain and disability, but rarely in younger or more active people.
What To Think About
Surgery for osteoarthritis is considered a choice (elective surgery). Surgery may not be appropriate for some people who are in poor health or who have other diseases that would make surgery less successful.
You will need several months of rehabilitation following surgery.
An artificial joint may only last for 10 to 20 years. You may need repeat surgery if an implanted joint wears out. Shoulder replacement for osteoarthritis is less common, and in general less successful, than hip or knee replacement.
Many people with arthritis have symptoms and degeneration in the inner knee. A new procedure inserts a small C-shaped cup in the joint space of the inner knee. The intent is to cushion the joint to delay the need for a knee replacement. This procedure is still being studied.
If you decide to have surgery: Before you go to the hospital, it's a good idea to make sure your home is ready for your return. Be sure you have someone to help you for a few days after you come home. And put a telephone and important phone numbers near where you will be spending time. If your surgery will be on your leg or foot, you may need to avoid stairs for a while. Be sure there's a bed for you to sleep in without having to go up or down stairs. If your bed is low, consider raising it with extensions under the legs or even an extra mattress on top. Finally, clear away any extra furniture and clutter, small rugs, or cords on the floor. You need a safe walking surface with plenty of space to move around safely.
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| Author: | Shannon Erstad, MBA/MPH | Last Updated: April 17, 2009 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Richa Dhawan, MD - Rheumatology | |
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