Osteoarthritis Surgery

What Is Osteoarthritis Surgery?

Osteoarthritis surgery is a surgical procedure performed by a physician to treat joints affected by osteoarthritis and provide patients with relief from, or complete recovery from, their symptoms. If patients suffer from osteoarthritis, it is a degenerative (slowly progressing) chronic joint wear. Especially the joint cartilage decreases, up to the complete loss, and the joint capsule, which produces synovial fluid, can become painfully inflamed.

A surgical procedure is used depending on the cause of osteoarthritis. The surgical treatment of slowly acquired osteoarthritis in old age differs significantly from that of a younger patient developed by trauma.

When Is Osteoarthritis Surgery Advisable?

If the standard conservative, non-surgical treatment methods have not led to a satisfactory improvement in the patient's symptoms, surgery is the next option. The resulting deterioration in the quality of life is a decisive factor.

Depending on the severity of the osteoarthritis, various methods are available. According to imaging diagnostics, the seriousness of arthrosis is classified into stages I-IV (X-ray, CT, MRI).

In general, it can be said that in stages I-II, the aim is to preserve the natural joint tissue as long as possible. Minimally invasive, joint-preserving procedures are used to delay a progressing degenerative process for as long as possible. On the other hand, for patients with progressive osteoarthritis stages III-IV, a joint prosthesis is often the last choice.

Which Osteoarthritis Surgeries Are Available?

Surgery for Knee Osteoarthritis

Patients with cartilage damage in the knee joint are on the verge of developing gonarthrosis (stage I-II). In this case, specialists try to keep the joint functional for as long as possible using minimally invasive, arthroscopic surgical procedures.

A variety of methods are available, particularly for the knee joint, due to the joint's complexity. For example, if there is still cartilage, it can be smoothed or transplanted. Removal of troublesome intra-articular free bodies and rinsing the joint can also provide relief. Microfracture surgery can also stimulate developing cartilage replacement to keep the joint function for a long time.

If the cause is an axial misalignment of the leg, resulting in unilateral wear of the articular cartilage, this can also be corrected with an osteotomy (bone realignment). The subsequent correct weight-bearing on the articular cartilage does not eliminate arthrosis, but it slows down its progression.

Implanting an artificial knee joint is used for patients aged about 60 years who suffer from osteoarthritis stage III-IV, depending on the severity.

Ankle Joint Osteoarthritis Surgery

Common surgeries for osteoarthritis of the upper ankle joint are joint-preserving arthroscopies in the early stages. The joint is stabilized (ligament stabilizations), or the joint surfaces are treated with cartilage transplantation or cartilage smoothing. Since the ankle joints have to bear most of the body's weight, foot malpositions lead to a strong incorrect weight-bearing of the joint cartilage, which can be reduced with realignment surgery (osteotomy) and the joint surfaces wear more evenly.

If joint-preserving surgery is no longer possible, an artificial ankle joint can be implanted. If this is not possible or does not alleviate the patient's symptoms, the standard surgery is a stiffening of the ankle joint.

Shoulder Osteoarthritis Surgery

Suppose osteoarthritis in the shoulder joint is not yet very advanced and preferably limited to one joint partner (glenoid or head). In that case, a partial joint replacement can contribute to improved function and pain relief. Likewise, bone-saving surgery is performed in this way, in the case of replacement of prosthetic material.

In the case of a shoulder TEP (total joint replacement), the entire joint is replaced. Depending on the bony and muscle-tendon defects, the surgeon decides whether an anatomical or inverse (joint head and socket interchanged) prosthesis will be used.

Hip Osteoarthritis Surgery

The hip joint, like the knee and ankle joints, must bear a large part of the body's weight. Due to axial misalignments, this results in considerably uneven cartilage loads and wear throughout a lifetime. The loads can be better distributed over the cartilage surfaces at an early stage with an osteotomy.

If joint-preserving surgeries can achieve no satisfactory long-term improvement of the symptoms, a hip prosthesis is also successfully recommended. As an alternative to total joint replacement, there is also hip resurfacing, according to McMinn, which is carried out in rather younger patients with adequate bone tissue. If hip osteoarthritis is more advanced in older patients, total hip replacement (TEP) is the gold standard.

Hand Osteoarthritis Surgery

Osteoarthritis of the wrist is much less common than in the joints of the lower extremity. Nevertheless, pain can severely block the hand's movement and limit the joint's range of motion. Mostly everyday activities, such as eating and personal hygiene, become painful. Surgically, the surgeon partially stiffens the part of the carpal bones that are affected by osteoarthritis, which results in less mobility, but solves the pain situation.

Implanting wrist prosthesis, as in the case of the knee and hip joints is very rarely performed.

Finger Osteoarthritis Surgery

Rhizarthrosis (thumb saddle joint) and finger joint arthrosis can be well alleviated surgically by special procedures. Affected patients can be enabled to lead a pain-free everyday life.

Alternatives to Osteoarthritis Surgery

Patients are recommended to exhaust all current, conservative therapy methods before undergoing a joint surgical intervention.

Scientifically based alternatives are:

• Physical therapy with strength training, mobilization, and posture training.
• Reduction of body weight
• Pain medication
• Learning joint-sparing behavior
• Sports that are easy on the joints, such as swimming and cycling
• Doctors also have the option of injections into the knee. In addition to hyaluronic acid, cortisone is also used as an anti-inflammatory medication.

Which Doctors and Clinics are Specialists in Osteoarthritis Surgery?

Experienced orthopedists are the right people to contact for osteoarthritis surgery. We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in osteoarthritis surgery and are awaiting your inquiry or request for treatment.

Sources:

• Deutsche Gesellschaft für Unfallchirurgie
• Klassifikation von Knorpelschaden und Arthrose, G. Spahn, Dt. Ärzteverlag
• AWMF Leitlinie Gonarthrose
• Duale Reihe Orthopädie/Unfallchirurgie, Thieme