Understanding Your Joint Procedure Options
Here’s a guide to the most common joint surgeries.
If you maintain a healthy weight and exercise regularly, but joint pain from your osteoarthritis (OA) or other type of arthritis is still debilitating, surgery may be in your future.
This guide to common surgical options can help you have an informed discussion with your doctor about which type is best for you.
What is it? Surgeons use this technique -- which involves small incisions, specialized instruments and a tiny camera -- to fix tears in soft tissues around the knee, hip, shoulder and other joints; repair damaged cartilage; and remove broken, free-floating cartilage pieces.
Best candidates: Active people younger than 40 years.
Pros: Often immediately reduces pain and improves range of motion and other symptoms. May delay or eliminate the need for an artificial joint
Cons:. “The jury is still out as to whether [arthroscopy] can actually stop the further deterioration of the joint,” says Mathias P. Bostrom, MD, an orthopaedic surgeon at the Hospital for Special Surgery in New York. “Right now, there are no long-term studies to support that idea.”
What is it? In the knee, this may also be called unicompartmental or partial knee replacement. In this procedure, surgeons replace with an implant only one of the three compartments of the knee, the medial (inside), lateral (outside) or patellofemoral (front) compartment. In the hip, surgeons replace the hip socket with a metal cup, and the damaged hip ball is reshaped and capped with a metal, dome-shaped prosthesis.
Best candidates: For the knee, older, less active patients with arthritis in only one knee compartment. For hips, men younger than 60, especially athletes or those with physically demanding jobs.
Pros: In the knee, this procedure can relieve pain and improve function with daily activities. In the hip, it may increase the ability to participate in high-impact sports and activities that require flexibility, such as martial arts and yoga. Conserving the thighbone may make future hip surgery easier.
Cons: Higher complication rate than conventional implants, and the metal-on-metal hip system poses the same risks as other all-metal hip replacement systems. It’s not recommended for people with osteoporosis, kidney disease or diabetes.
What is it? The procedure involves cutting and removing bone or adding a wedge of bone near a damaged joint. In the knee, for example, an osteotomy shifts weight from an area damaged by arthritis to an undamaged area. In the hip it is often used to correct misalignment (hip dysplasia) that occurs early in life.
Best candidates: Patients in their 30s and younger or who are too young for total joint replacement.
Pros: Can halt damage and delay the need for a joint replacement.
Cons: Osteotomies are not simple, warns Robert L. Barrack, MD, chief of staff for orthopaedic surgery at Barnes-Jewish Hospital in St. Louis. “Because the surgery is so complex and highly specialized, only a small percentage of surgeons are best suited to perform it.”
What is it? In people with inflammatory arthritis, the lining of the joints – the synovium – can become inflamed or grow too much, damaging surrounding cartilage and joints.In this procedure surgeons remove most or all of the affected synovium, either in a traditional, open surgery or by using arthroscopy.
Best candidates: People with limited cartilage damage in the affected area who have tried anti-inflammatory medications, but who continue to have inflammation or overgrowth of the synovium around the knee, elbow, wrist, fingers or hips.
Pros: Relieves pain and improves function, and people who have had the procedure may be able to reduce their dosage of anti-inflammatory drugs.
Cons: The procedure may limit range of motion and provide only temporary relief of symptoms.
Arthrodesis, or Fusion
What is it? In this procedure surgeons use pins, plates, rods or other hardware to join two or more bones in the ankles, wrists, thumbs, fingers or spine, making one continuous joint. Over time the bones grow together and lock the joint in place.
Best candidates: People with severe joint damage from OA or inflammatory arthritis.
Pros: This procedure is very durable, and results should last a lifetime.People who have weight-bearing joints fused can often take part safely in high-impact physical activity.
Cons: Fusing joints eliminates their motion and reduces flexibility. It also changes the joint’s normal biomechanics, which can put stress on surrounding joints and lead to the development of arthritis in other areas.
Total Joint Replacement (TJR), or Total Joint Arthroplasty
What is it? The damaged joint is replaced with an implant that mimics the motion the natural joint and is made from combinations of metal, plastic and/or ceramic components.
Best candidates: People with severe joint pain who haven’t been helped by other treatments. Improvement in implant durability means that TJR is more common in younger people than in the past.
Pros: Strong, proven track record for safety and success; reduces pain and improves mobility, daily functioning and quality of life.
Cons: All artificial joints can wear out, which may require joint revision surgery. Implants made entirely of metal (called metal-on-metal) can release metal ions that may damage bone and cause other health problems. Ask before surgery about an implant’s track record. TJR is not usually recommended for people who have weak bones or who are obese.
Minimally Invasive TJR
What is it? This technique replaces a damaged joint, but uses shorter incisions than in a traditional TJR. Less muscle is cut and reattached.
Best candidates: Active normal-weight people younger than 50 years.
Pros: Less pain, less time in the hospital and quicker recovery than with conventional joint replacement.
Cons: These procedures are difficult and have higher complication rates than traditional TJR, according to Dr. Barrack. Look for an orthopaedic surgeon who does a high volume of these procedures.
What is it? Surgery to remove a failed, infected or worn-out implant and replace it with a new one.
Best candidates: People with a damaged artificial joint. Implants can last 20 years or longer, but those who get them as young adults may eventually need a revision.
Pros: Pain relief and improved mobility, strength and coordination.
Cons: Because of the alterations surgeons make to bones during an original joint replacement, revision procedures are more complex and less successful than initial replacement surgeries. Sometimes surgeons need to take a bone graft from another area to complete the operation. Possible complications include a higher fracture risk after surgery, and in the hip, twice the risk of dislocation and uneven leg lengths.
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