Bones, joints, and muscles

Treating arthritis: orthopedic surgery

Although arthritis can be successfully managed through physical or occupational therapy, acupuncture, and medications, in severe cases, doctors may recommend surgery. The decision to have surgery should never be taken lightly; it's important to discuss the risks and benefits with your surgeon, rheumatologist, or physician. He or she will be able to answer any questions you may have. You may be well advised to seek a second or even a third opinion.

Table 1. Benefits and risks of surgery.¹

Benefits of surgery

Risks of surgery

Improved movement and use of joints: surgery can help stabilize a joint, allowing for a greater range of motion. You will be able to function more easily. Pain relief: surgery may provide pain relief where medications have failed. Improved alignment of deformed joints: realigning joints can improve their function.

If you have pre-existing medical conditions such as heart disease or lung problems, surgery may be too risky. If you have an infection, it must clear up before you can undergo surgery in order to avoid serious complications. You may develop blood clots. You can reduce this risk by discussing blood thinning medications and leg exercises with your doctor prior to surgery. Leg exercises after surgery help increase blood circulation, thereby reducing the risk of clots. If you are overweight, you add to the stress on your heart and lungs during surgery. Being overweight may also slow your recovery. You may want to consider losing weight prior to surgery.

Your doctor will discuss the type of surgery you need and will also explain what the procedure entails. There are several types of surgery for arthritis, including:²

Arthodesis

In arthodesis, bones are fused or joined together. This procedure stops the progress of arthritis at the point of fusion and also helps reduce or eliminate pain. Although arthodesis impairs flexibility, it does help stabilize joints, allowing them to bear weight more easily.

Arthroplasty

In arthroplasty, an entire joint, such as a hip, is rebuilt or replaced. Despite the best treatment and medical managment, your doctor may feel arthroplasty necessary to relieve pain and loss of function. A number of different approaches are available and your doctor will let you know what you can expect from surgery.

Arthroscopy

Arthroscopy uses tiny instruments inserted into the joint through small incisions. Closed-circuit television allows the surgeon to see the damage to the joint, and he or she will be able to remove loose growths that may be causing pain. This type of procedure is often performed as day surgery and involves a shorter recovery period than open surgery.

Osteotomy

Meaning a "cut in the bone," osteotomy is usually performed to correct knee or hip deformities in younger patients. Osteotomy can improve alignment and increase stability while relieving pain of a deformed joint.

Synovectomy

Synovectomy involves the removal of diseased synovium, the tissue lining the joints. Changes in this tissue that occur as a result of arthritis are progressive. Such changes can lead to the eventual destruction of cartilage. Synovectomy is usually performed arthroscopically and can help alleviate pain and swelling.

Once you decide to move ahead with surgery, ensure you adequately prepare for the procedure and that you follow the advice of your health team to ensure a full and fast recovery. Aftercare is as important as proper preparation; don't be afraid to ask for help and support from your family and friends while you recuperate. Follow instructions and keep positive and optimistic.

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1. Treating Arthritis Arthritis.com (2003)
2. Treating Arthritis Arthritis.com (2003)