Is surgery needed for arthritis?

Surgery is often a very good option for patients to relieve their arthritic pain after they have been through an extensive course of conservative non-surgical treatment options, which includes anti-inflammatories, weight loss, exercise, therapy, external braces or supports, and possibly injections.  If the patient continues to have pain despite going through extensive appropriate conservative measures, then we can have a surgical discussion about what options may be available to relieve the patient’s joint pain.

And in general, arthritis being wear and tear or wearing out of the joint for whatever reason, the different strategies that are available to address that joint pain fall into about four different surgical categories.  Probably the most common category that everybody is aware of is joint replacement as with the hip, the knee, and the shoulder being the most commonly replaced joints.  And in this operation, we remove the arthritic portions of the bones and replace them with a new covering of metal and plastic to create a much less painful situation for the patient.  So, joint replacement or total knee arthroplasty, total hip arthroplasty, shoulder arthroplasty, are all the means of replacing the worn out joint with a new joint made of metal and plastic.  This is what we’re most familiar with, what lots of patients are familiar with.  There are other options other than replacing the joint that may be helpful, particularly in the hand or some of the smaller joints rather than replacing the joint we may fuse the joint by scraping off the bad cartilage from each side of the joint and then screwing those two bones together solidly so that the painful joint becomes one solid painless stable functional joint.  This is most often done in the hands, in the feet, and in the wrist.  And joint fusion or joint arthrodesis can very helpful as well.  One other option rather than replacing the joint or fusing the joint, is to simply remove the joint and leave a space with a cushion, a rolled up tendon cushion to replace the arthritic area.  And this is commonly done at the base of the thumb.  Many times patients have arthritis of the knee, will also have pain at the bottom of the thumb with gripping and grasping, and it’s surprising how many patients don’t realize that arthritis can occur at the base of the thumb as well as the major joints throughout the body.  So removing the joint and replacing it with a rolled up cushion is another option as well.  Lastly, not done as commonly, is realigning the joint or performing an osteotomy, in other words, cutting the bone above or below the joint to redirect the force by making a wedge of bone to realign the joint.  This is not done as commonly but maybe an option for younger patients.