Surgery for Osteoarthritis Joint Pain

If you get little or no joint pain relief from osteoarthritis medications, it may be time to consider joint surgery.

Talk it over with your doctor. Ask what the risks and benefits are and if there is something else you should try first.

If your doctor thinks you may need surgery, ask for a referral to an orthopedic surgeon to talk about what type of surgery you may need.

Arthroscopy

What happens: The surgeon will make a small cut near the damaged joint and use a tiny light and video camera, called an arthroscope, to see inside. The surgeon can see the camera’s view on a monitor and treat the areas that need to be fixed.

For instance, the doctor can take out damaged cartilage and free-floating pieces of bone and other tissue in the knee, which can wear down the joint.

Benefits:

  • It’s quick, sometimes taking as little as an hour.
  • Most people don’t need to stay in a hospital overnight.
  • There's less tissue damage and blood loss.
  • There will be less pain after surgery.
  • Complications are less likely.

Risks: As with any surgery, there is a risk of infection and complications from anesthesia, which can include mental confusion, lung infection, and heart problems. Risks of arthroscopic joint surgery include:

  • Bleeding inside the joint, or a blood clot
  • Nerve damage
  • Damage to cartilage, muscles, ligaments, or tendons
  • Infection

Recovery: You will probably get medicine to ease your pain and reduce inflammation. For a few days after surgery, you may have to wrap your joint and ice it, rest it, and elevate it to help reduce pain and swelling. You may need crutches, a sling, or splints. Your surgeon may suggest physical therapy.

After arthroscopy, most people go back to their normal routine within days. It may take a few weeks before the joint recovers fully.

Total Joint Replacement (Arthroplasty)

What happens: Your surgeon will remove all or part of a damaged joint and replace it with a new one.

Knees and hips are the most commonly replaced joints. Doctors can also replace shoulders, elbows, fingers, ankles, and other joints, but the results are not as reliable.

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Benefits: Improvements include:

  • Relief of joint pain when other options haven't worked
  • Better, easier joint movement
  • Realignment of deformed joints, improving how they work and look.

New joints typically last between 10 and 15 years. When they wear out, you can get the joint replaced.

Risks: The risks depend on your medical history, including any bone problems, and your tendency to form blood clots.

Recovery: While you're still in the hospital, expect to begin walking with crutches or a walker. You will take medicine for pain. You may start physical therapy the day after surgery. Gentle exercises will help strengthen the muscles around the new joint and improve your ability to move it.

Osteotomy

What happens: During this operation, which is done most often on the knee, your surgeon will make cuts to the bones near your joint. The goal is to shift weight to the parts of your knee that are stronger, sections with less damage from osteoarthritis. Your surgeon may take out a wedge of your shinbone, too.

Osteotomy can be an alternative to joint replacement, especially if you have much more damage to the knee joint on one side or problems with bone alignment in your hip. Osteotomy may also be an option for people who are too young for joint replacement.

After the surgery, you'll spend at least two hours in the recovery room. Most people who have osteotomy spend two to four days recovering in the hospital.

Benefits: Besides helping to correct the knee deformity, osteotomy may help:

  • Relieve joint pain and symptoms
  • Slow down osteoarthritis by taking some stress off the knee
  • Delay the need for joint replacement in younger, active people with osteoarthritis pain

Risks:

  • A failure of the bones to heal or failure to heal properly
  • Blood clotting
  • Bleeding in the joint
  • Inflammation of joint tissues, nerve damage, or infection

Recovery: The knee will be bandaged and iced after an osteotomy. It's common to have night sweats or a fever of up to 101F. You'll receive pain medicine either by mouth or by IV.

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You may have a lot of pain at first. You'll take pain medicine, either as pills or by IV. At home, take your pain medication as directed.

After surgery, it’s important to keep the muscles active, so your doctor will give you instructions on how you can move. As soon as possible, even while you are still in bed recovering, you should begin to bend your knee and then extend your leg to keep it from stiffening.

Once your surgery wound closes (in about six days), you may be fitted with a knee brace, or the surgeon may put your knee in a cast for four to six weeks. Most people can start physical therapy six to eight weeks after the surgery.

Joint Fusion (Arthrodesis)

What happens: Like osteotomy, joint fusion surgery may be done when joint replacement isn't an option. The osteoarthritis-involved bones are fused so they grow together to form one bone. Although the fused joint is not flexible, it's very stable. Arthrodesis is done to relieve pain in the spine and smaller joints -- such as the ankles, wrists, fingers, and thumbs.

During joint fusion surgery, the surgeon makes a cut over the joint affected by osteoarthritis then exposes it by carefully moving aside muscles or ligaments. Next, she roughens the bones of the joint and lays pieces of donor bone or your own bone over the joint to start the fusion process.

Benefits:

  • Osteoarthritis pain relief
  • A straightened and stabilized joint

Risks:

  • There’s a chance of nerve or artery damage.
  • If the bones don’t fuse, you may need more surgery.

Recovery: During healing, the fused joint is kept in place with a cast, pins, screws, or plates. You may be hospitalized for one to four days and wear your joint support for a while after you go home.

It’s normal to have some pain, tenderness, and stiffness after surgery.

After joint fusion surgery, you'll need to adjust to moving and using the limb without bending it. This can make it harder to do some familiar things, like climbing stairs or getting into a small car. Some people walk differently after this surgery because of the differences that need to be adjusted to.

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Resection Arthroplasty

What happens: The surgeon removes all or part of a joint to eliminate damaged surfaces moving against each other. It's rarely done on a weight-bearing joint such as the knee or hip because you need the joint to walk. But it may be done on a "hanging joint" such as the shoulder.

If you get shoulder arthroplasty, your surgery could take place two possible ways. For open surgery, the surgeon typically makes a bone-cut through a 2-inch cut. If the surgeon used an arthroscope instead, the cut would be much smaller.

By removing the last half-inch of the collarbone (clavicle), the surgeon creates a space between it and the shoulder blade (scapula). Over time, scar tissue grows into this space and stops bones from being able to rub together, though the shoulder joint can still be moved.

Benefits:

  • Less shoulder pain and tenderness
  • Easier to move your shoulder

Risks:

  • Possible damage to nerves and blood vessels in the surgical area
  • Infection

Recovery: It's normal to have some pain, tenderness, and stiffness. You may need to wear a shoulder-support sling for a few days and ice the shoulder down. You'll probably need physical therapy -- first to control pain and swelling in the area and later to ensure that the joint moves smoothly.

As You Recover: General Tips for Any Arthritis Surgery

Once you’re home, continue to follow your doctor’s instructions about eating, medication, exercise, and physical therapy. Keep in mind that recovery from any surgery will take time.

Be sure to ask your doctors about problems or questions you have. It’s important to let them know, so they can help you recover ASAP and without complications.

WebMD Medical Reference Reviewed by David Zelman, MD on August 14, 2015

Sources

SOURCES: 

James J. Hamilton, MD, Rex L. Diveley Professor and Chair, department of orthopedic surgery, University of Missouri-Kansas City. 

Arthritis Foundation: "Types of Surgery," "How Do You Know It's Time for Surgery?" "Benefits and Risks of Joint Replacement Surgery." 

National Institute of Arthritis and Musculoskeletal and Skin Diseases: "Joint Replacement Surgery and You."  

The Knee Society: "Osteotomy." 

WebMD Medical Reference: "Hemicallotasis: A New Procedure for Arthritic Knees." 

American Academy of Orthopaedic Surgeons: "Rotating Platform/Mobile-bearing Knees," "Shoulder Surgery."

University of Michigan Health System: "Joint Fusion." 

Cleveland Clinic: "Arthritis of the Hand and Wrist." 

Lozada CJ (2013). Treatment of osteoarthritis. In GS Firestein et al., eds., Kelley's Textbook of Rheumatology 9th ed., vol. 2, pp. 1646-1659. Philadelphia: Saunders.

 

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