Surgery an Option – But Not the First – For Arthritis

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Surgery often provides relief of arthritis pain, but it’s typically not considered until after other treatment options are tried without success or, over time, lose their effectiveness.

“Surgery is often a very good option for patients to relieve arthritic pain after they have been through an extensive course of conservative, nonsurgical treatment options,” says orthopedic surgeon Michael Raab, MD.

Dr. Michael Raab explains how conservative, nonsurgical treatment techniques are typically tried before surgery to relieve arthritis pain.

Click play to watch the video or read video transcript.

He adds, “The first question many patients have in the office is, ‘Do I need surgery?’” Most of the time, he answers no. “Many, many arthritic problems can be treated without surgery.”

Nonsurgical options include:

  • Exercise and physical therapy. “Exercise and motion of the joint nourishes the cartilage, helps strengthen the joint, increases the flexibility of the joint,” Dr. Raab explains. Physical therapy can also strengthen muscles around the joint to lessen joint stress.
  • Medication. Over-the-counter medications such as acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve), can control mild pain. Prescription medications also are available for stronger pain.
  • Heat or ice. Heat may help relax muscles around the affected joint. Ice can relieve pain and swelling after activity or exercise. Your doctor may give you a gel or cream to help your joint pain.
  • Weight loss. Losing weight, if you’re overweight, can reduce stress on joints and contribute to relieving pain. Each pound lost can take 3 to 5 pounds of pressure off lower extremity joints.
  • Wearing braces. External braces or supports can also help reduce joint pressure.
  • Cortisone injections. If pain medications don’t bring you relief, your physician may recommend injecting cortisone into a joint. This may temporarily help relieve pain and swelling. Patients react differently to cortisone, so the length of relief varies, usually from six weeks to six months. 
  • Gel injection. Injection of a gel, typically in the knee, can help cushion the joint to relieve pain.

If nonsurgical measures prove ineffective, your physician will talk with you about surgical options for treating your arthritis. Dr. Raab says that surgical options available to treat pain that results from the wearing down of a joint fall in four general categories:

  • Joint replacement (arthroplasty). This procedure, used most commonly in the hip, knee, and shoulder, involves removing the damaged, arthritic parts of the bone and replacing them with a new covering of metal or plastic that provides the same flexibility and mobility as a natural joint.
  • Joint fusion (arthrodesis). Typically used in smaller joints, in the hand, wrist, and feet, this procedure is performed by scrapping off damaged cartilage from each side of the joint and screwing the two bones together “so that a painful joint becomes one solid, painless, stable, functional joint,” Dr. Raab explains.
  • Ligament reconstruction and tendon interposition (LRTI). In this procedure for thumb arthritis, damaged surfaces at the base of the thumb are removed. This leaves space in which a tendon is rolled up and placed to provide cushioning. LRTI helps alleviate problems with gripping and grasping, Dr. Raab explains.
  • Joint realignment (osteotomy). This involves removing bone above or below the joint to redirect force in the joint, creating a wedge of bone that realigns the joint. “This is not done as commonly, but may be an option for younger patients,” Dr. Raab says.
  • Dr. Michael Raab discusses surgical options for patients to treat arthritic pain after first trying conservative, nonsurgical treatment options.

    Click play to watch the video or read video transcript.

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See a Premier Physician Network provider near you.