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Osteoarthritis
Surgical Options
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
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