Surgical Procedures for Osteoarthritis

Surgical and Medical Procedures for Osteoarthritis

Medical Procedures

If medications and other comfort measures are ineffective, there are some invasive procedures that are used to temporarily reduce joint pain and inflammation. These procedures may have to be repeated to maintain effectiveness. Injections may not be advised for all types of osteoarthritis (OA).
Intra-articular Corticosteroid Injections
Corticosteroids can be directly injected into the joint with a needle. Steroids can help decrease inflammation and pain in the joint. Sometimes, your doctor will remove excess joint fluid from the joint just before injecting the steroid medication.
Steroid injections often have to be repeated every several months but are generally limited to no more than 3-4 such injections in a year. Frequent use of steroids in the joint can cause deterioration of tissue in the joint.
Viscosupplementation Injections
Viscosupplementation involves injecting the affected joint with a fluid containing a substance called hyaluronic acid. Hyaluronic acid is a chemical found in normal cartilage and joint fluid. The injections are believed to help lubricate the joint, allow better gliding, and decrease pain and stiffness.

Surgical Procedures

Surgery can not treat OA itself, but may be needed to repair, rebuild, or replace damaged joints. It may help to reduce or eliminate pain, correct joint deformities, and restore mobility. Surgical procedures are generally only recommended for those who don't have relief with other treatment methods.
Arthroscopy
During an arthroscopy, several tiny incisions are made on or near the joint. A small lighted camera is inserted through one incision. Small surgical instruments are passed through a second incision. These instruments are used to clean out shards of bone and cartilage that might be causing pain and interfering with movement.
Osteotomy
In this procedure, a deformed joint, usually of the knee, thigh bone, or leg bone (femur and tibia), is realigned to redistribute body weight on the joint. By doing this, the healthy joint cartilage, usually on the outside of the knee, is aligned to bear more weight and thus alleviate pressure on the damaged tissue.
Arthroplasty
Arthroplasty replaces part or all of the damaged joint. It is more commonly referred to as a joint replacement surgery. A synthetic joint or devices, often made of a chromium alloy and plastic, will be used. The replacement is done to decrease pain and improve function.
The knee and hip are the most common joints replaced.
Hip Replacement
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Knee Prosthesis
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Arthrodesis
Arthrodesis is a last resort for those who have not had good pain relief from other efforts. In this procedure, the 2 bones making up a joint are permanently fused together. While this can greatly improve pain, it also means that the joint is no longer able to function and movement is limited.

References

ACR issues recommendations on therapies for osteoarthritis of the hand, hip, and knee. Am Fam Physician. 2013;87(7):515-516.

Degenerative joint disease of the hip. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 17, 2014. Accessed December 1, 2014.

Degenerative joint disease of the knee. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated November 25, 2014. Accessed December 1, 2014.

Osteoarthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at: http://www.niams.nih.gov/Health%5FInfo/Osteoarthritis/default.asp. Updated August 2013. Accessed December 1, 2014.

Sinusas, K. Osteoarthritis: Diagnosis and treatment. Am Fam Physician. 2012;85(1):49-56.

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