Surgery and Arthritis
Whether you're having total joint replacement or just a minor repair of damaged cartilage, you should learn as much as possible about the procedure before you enter the operating room. Try to find a surgeon who has extensive experience with the operation you'll be having, and be sure to ask plenty of questions. One in particular should be at the top of your list: What will this surgery actually accomplish?
Asking this question is especially crucial if your doctor recommends arthroscopic debridement surgery to remove bits of loose cartilage from an arthritic knee. This operation is performed roughly 650,000 times each year, but its value has come under fire.
In a study published in the New England Journal of Medicine, researchers with the department of Veterans Affairs and Baylor College of Medicine compared the operation with a phony procedure in which patients received small incisions on their knee, but didn't have actual surgery. Both procedures seemed to improve pain and stiffness, but the real surgery wasn't any more effective than the fake surgery.
While the value of arthroscopic knee surgery for arthritis is doubtful, many other procedures have helped a large number of patients overcome their arthritis and resume most of their normal activities. Here's an introduction to some common arthritis surgeries.
Total joint replacement (arthroplasty)
If you have severe arthritis, you probably feel like doing anything to ease your pain, stiffness and decreasing mobility. And that may include having surgery.
When a joint becomes severely damaged by arthritis, so that it's difficult to participate in daily activities without severe pain, joint replacement may be the best option for relief. Today's artificial joints move just like real joints, but they're much less vulnerable to stiffness and pain. Doctors have long been replacing hips and knees with metal or plastic joints and getting excellent results. Patients today can also get brand-new elbow, shoulder, or knuckle joints. Most new joints last for a decade or more, but if you're relatively young, you may need to have the joint replaced more than once.
According to the American Academy of Orthopaedic Surgeons, more than 90 percent of total joint replacements are successful. Ten percent fail for various reasons, including infections, loosening of the joint, or, rarely, breakdown of the joint. Remember that joint replacement is a major surgery, so it's a good idea to be absolutely sure that this is the best option before proceeding.
A successful operation takes a team effort. For your part, do any doctor-recommended exercises both before and after the operation. If you're overweight, shedding some pounds before the operation will help tremendously. Your doctor will carefully monitor your health before the joint replacement. If you have heart disease, lung disease, or an active infection, the operation may need to be postponed until your health improves. Your doctor may ask you to bank your own blood before the surgery in case you need a transfusion during the procedure.
Afterward, you may have to take blood-thinning medication for a few weeks to lower the risk of a blood clot, or take a short course of antibiotics to prevent an infection. You will also have to take some extra precautions after surgery to ensure you don't damage your new knee or hip.
At first you may need to use a crutch, cane or walker. The new joint will not make you feel "just like new." The pain should be gone and you should have better mobility, but the replacement joint will feel different than your original joint, and it will take some time to get used to it. You should find out in advance what kind of activity will be safe with your new joint -- for example, patients with hip or knee replacements are usually advised not to do too much running or jumping.
Rebuilding joints (arthroplasty)
This refers to relining or resurfacing the ends of the bones where the cartilage has been worn away by arthritis and the bone destroyed.
"Arthroscopy" refers to any operation performed with an arthroscope, a very thin tube equipped with a light and a camera. An arthroscope enables a surgeon to operate through a tiny incision. Compared with traditional surgery, arthroscopy is usually less painful, rarely requires an overnight hospital stay, and also means a quicker recovery.
While the benefit of arthroscopic surgery to remove loose cartilage from the knee may be questionable, other arthroscopic procedures are undeniably helpful. For example, surgeons also use an arthroscope to examine a joint, repair torn cartilage or tendons, and remove inflamed tissue lining your joints.
Every joint is lined with a smooth layer of tissue called synovium. In patients with rheumatoid arthritis, the synovium can become inflamed, causing pain and swelling. In some cases, surgeons can dramatically reduce the symptoms by surgically removing the inflamed synovium. (The operation can often be performed with an arthroscope.) Unfortunately, relief may not be permanent. After several years, the synovium may grow back and symptoms may return.
Bones that are slightly deformed or out of place can aggravate arthritis. In such cases, surgeons can move bones to a better position and shift some of the stress. The edges are fastened together with staples, screws, or plates. This procedure is most often performed on weight-bearing joints like the knee or hip.
Recovering from this kind of surgery is like recovering from a broken bone. You'll have to wear a cast or brace while it heals, and use crutches or a cane to walk. After two or three months, you may work up to more weight-bearing activities, like walking.
When arthritis damages bones in the foot, walking can be very painful. Removal (or resection) of the damaged bone often brings great relief because it keeps bones from rubbing against each other and gives joints room to move.
Arthrodesis (bone fusion)
In some cases, the best way to treat a joint is to remove it altogether. Surgeons do this by connecting the two bones that meet at the joint -- ankles, wrists, and fingers can all be fused. The fused joint is obviously no longer flexible, but it won't be painful either. Fused bones are also usually stronger than arthritic joints and can bear more weight.
After any one of these surgeries, there's a good chance you'll be back on your feet in just a few weeks. But give yourself the extra time you need to recover. Watch for signs of infection, and seek immediate medical help if you have a temperature over 100 degrees Fahrenheit, pain that doesn't go away with medication, or if you notice swelling, tenderness, or numbness in your limbs.
Arthritis Foundation. Types of surgery.
University of Washington Department of Orthopaedics and Sports Medicine. Basics of surgery for arthritis.
American Academy of Orthopaedic Surgeons. Total Joint Replacement. http://orthoinfo.aaos.org/topic.cfm?topic=A00233
Moseley JB et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. New England Journal of Medicine, Vol. 347(2): 81-88.