What Is Resection Arthroplasty?

Joint pain isn’t quite as certain as death and taxes, but it’s a fact of life for many people. Your joints get a lot of wear and tear, so a past injury or a condition like osteoarthritis can catch up with you as you age. Whether your problem’s in your shoulders, toes, or any joint in between, you have a lot of treatment options. One of them is a surgery called resection arthroplasty, also known as excision arthroplasty.

Arthroplasty is surgery to rebuild your joint. There are many kinds, including having a joint replaced. Resection means to take something out. Resection arthroplasty is surgery where your doctor removes part of your joint to relieve your symptoms. The space that’s left fills in with scar tissue over time.

For some joint problems, it’s a common surgery. For others, it’s used only as a last resort.

When Would I Need It?

Surgery isn’t usually the first treatment for joint pain. Often, you start with options like splints, drugs, or physical therapy. But they may not help. Your pain can get worse, and you may find that you have less motion in your joint than you used to. That’s when you might think about surgery.

You can get resection arthroplasty on your:

  • Toes, to treat arthritis, bunions, and problems like hammertoe and mallet toe
  • Thumb, to relieve osteoarthritis pain in the carpometacarpal (CMC) joint, where your thumb attaches to your hand
  • Shoulder, to treat arthritis in your acromioclavicular (AC) joint (That’s where your collarbone, also called the clavicle, meets the front tip of your shoulder blade.)

You might also get this surgery after a hip, knee, or shoulder replacement that failed or keeps getting infected. It’s not commonly done, but it’s sometimes a better option for older adults when repeated surgeries would only cause more problems.

How Do I Know If It’s Right for Me?

Every surgery has its pros and cons. With some joint problems, resection arthroplasty helps with pain, but it can limit how your joint works. For example, after toe surgery, you may have less power in your big toe. With your thumb, you may have less pinch strength. And with your hip, you may need support walking after having this surgery. Talk to your doctor to make sure resection arthroplasty is right for you.

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How Do I Get Ready for It?

First, your doctor will make sure you’re healthy enough for surgery. You’ll likely start with a physical exam and some basic tests. For example, you might get blood tests, a chest X-ray, and a test for your heart called a cardiogram. You may also get X-rays or other imaging on your joint to help guide the surgery.

Make sure to talk to your doctor about any medicines, herbs, or supplements you take. You may need to stop taking some of them before surgery. You’ll also need to tell him if you have any allergies.

Your doctor will tell you what you can eat and drink before the surgery. Be sure to follow these directions closely.

What’s Involved With the Surgery?

It depends on where and why you’re having it. You’ll be awake for some types of resection arthroplasty, but not for others. Some are done arthroscopically: Your doctor makes a few small openings around the joint and does the surgery with small tools guided by a camera. Others are standard, open surgeries, where your doctor creates a single, larger opening in your skin.

Still, the basic idea is the same: Your doctor removes part of the joint -- some bone and cartilage -- and in time scar tissue fills up the space that’s left behind.

Here are a few common types of resection arthroplasty:

  • Toe: Typically, you get drugs to numb the area around your toe, but you’ll be awake for the surgery. Your doctor will make one opening in your skin to remove part of your toe joint. You’ll likely go home the same day.
  • Thumb: For the CMC joint, you get open surgery, just like with your toe. You may be asleep for the surgery, or your doctor might just numb the area around your thumb. Your doctor removes a small bone called the trapezium and may put a tendon in its place.
  • Shoulder: AC joint surgery may be done arthroscopically or with open surgery. Typically, you’ll be asleep for this one, as your doctor removes a small part of the end of your collarbone.

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What’s Recovery Like?

Again, it depends on the surgery. It’ll take some time to heal, and in most cases, you’ll need physical therapy.

With toe surgery, you can typically get back to normal walking within a few weeks.

After thumb surgery, you usually wear a brace for about 6 weeks. It may take up to 6 months to fully recover.

After AC joint surgery, you might wear a sling for up to 4 weeks. It typically takes 2 to 3 months to get back to your normal activities.

WebMD Medical Reference Reviewed by David Zelman, MD on April 05, 2017

Sources

SOURCES:

Arthritis Foundation: “What Is Osteoarthritis?”

National Health Service (U.K.), The Dudley Group: “Thumb Basal Arthritis.”

American Academy of Orthopaedic Surgeons: “Glossary,” “Arthritis of the Shoulder,” “Bunion Surgery.”

Journal of Bone and Joint Surgery: “Hip Resection Arthroplasty.”

American Orthopaedic Foot and Ankle Society: “First MTP Joint Resection Arthroplasty (Keller Procedure).”

National Health Service (U.K.): “Bunion - Treatment Options.”

Mayo Clinic: “Hammertoe and Mallet Toe.”

National Health Service (U.K.), Royal Berkshire: “Digital Excision Arthroplasty (Hammer Toe Repair).”

The University of Minnesota: “The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections.”

Medscape: “Management of Prosthetic Joint Infections.”

National Institutes of Health, National Library of Medicine: “CMC Arthroplasty of the Thumb: A Review,” “Wide-awake trapeziectomy: video detailing local anesthetic injection and surgery,” “Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome.”

National Health Service (U.K.), Barts Trust: “Excision of the acromioclavicular joint.”

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