Do I Need Surgery For Osteoarthritis?
Any good doctor will tell you that surgeries are the last resort, when all other methods, medicines and maneuvers have failed to control the disease. In cases of symptomatic patients, with a worsening picture which is evaluated to be further damaging to surrounding muscles and nerves, the surgical options are offered.
Surgery can be conservative or radical. Conservative surgeries conserve the joint and involve minimal remodeling of the affected area. Radical is an aggressive approach, but is often called for in case of total joint involvement. It involves removing and replacement of the whole joint. Both types have their own indications and contraindications.
Arthroscopy
It is a simple procedure and can be carried out in an OPD. It involves a camera guided probe, entered through small incisions in the skin of the affected joint. The probes can then be used to see into the joint and get a clear picture of the features. The same procedure can be used therapeutically in the following ways:
- To debride the bony outgrowths and smooth out the roughened edges of the bone and joint surfaces, and clean the joint afterwards with a sterile solution
- To repair any torn cartilage.
- The proliferating synovium under inflammatory mediators can be resected helping in reducing the symptoms and disease progression.
- To repair the meniscal tears caused by the increased load on the affected joint.
- To tend to any bony-cartilage proliferation around the joint.
This surgical technique is minimally invasive, with a very short recovery time. However, it will not be successful in dealing with severe joint involvement for which a more radical approach is used.
Osteotomies
This surgery is a little more aggressive than Arthroscopy. In most patients this surgery is proposed to buy time for hip and knee total replacement. This can provide pain relief by using the conservative surgical approach.
This surgery involves opening up the joint area and basically realign the bones together at the joints. In osteoarthritis bones get deformed, which may lead to abnormal deviation like in OA of the big toe or knee. This procedure uses surgical saws to cut down the excess of the bony outgrowths that might be causing the bone to deviate. It also uses surgical screws to hold the bone in the new position. The entire procedure is done after anesthetizing the surgical site.
The recovery time is a bit longer in this case, and may be associated with pain. The joint also needs rest so the physical mobility might be restricted till complete healing. Pain meds and antibiotics are to be used in post-operative period
Joint replacement
The last technique to deal with joints aching due to OA is joint replacement. Osteoarthritis is the most common indication of this procedure. It is a radical surgery, which involves cutting, debriding and removing the old joint surfaces. Prosthesis made up of metal or plastic are then put in the place of the original. These are kept in place with surgical cement.
The recovery requires a hospital stay and close monitoring. Physical therapy is highly encouraged to engage the new joint.