For the vast majority of people who suffer with arthritis, surgery is seldom necessary. But when all else fails, orthopedic surgery can reduce pain and increase mobility significantly. For some, surgery can spell the difference between living a life that is severely restricted and being able to continue with a full, independent, active life.
There are a number of operations offered for arthritic conditions. The most commonly used procedures are osteotomy, synovectomy, tendon reconstruction and joint replacement. The surgeon may use an arthroscope (a thin tube, with a light and magnifying lens on the end that is inserted into the joint) or an open procedure, in which the surgeon makes an incision allowing him or her to see the joint directly. In general, arthroscopy is considered a minor procedure, whereas an open operation is considered major surgery with a longer recovery period.
An orthopedic surgeon can realign the joint in a procedure called an osteotomy, in which a section of bone is removed, allowing the joint surface or the joint angle to change. For example, a less damaged portion of the joint may be realigned so that weight is placed on it rather than on a more damaged portion.
When the lining of the joint (synovium) is damaged or chronically inflamed, a surgeon may remove the tissue in an operation called a synovectomy. However, because it is difficult to remove all of the tissue, synovectomy is seldom performed by itself. Rather, this procedure is more often done as part of reconstructive surgery, especially tendon reconstruction. Synovectomy may be performed through an arthroscope or during a more extensive surgery, in which the joint is opened. Often the procedure is performed to prevent tendon rupture or to reduce pain when other treatments have failed.
When a tendon (the tissues that attach muscle to bone) is damaged or ruptured, a procedure called tendon reconstruction rebuilds the tissue by attaching an intact tendon to it. This procedure is most successful in restoring function to a hand or ankle, for example, if it is done before the tendon is completely ruptured.
Joint replacement is the most commonly performed surgery for arthritis. In this type of operation, a seriously damaged joint — most often, a hip or knee — is replaced with an artificial joint. This type of surgery can dramatically reduce pain and improve function. Although, in many cases, the results can be dramatic, surgery is not for everyone. The decision should be made only after considering the person's overall health, function, quality of life, and the condition of the affected joint or supporting structures. If it appears that this major surgery will improve function and quality of life at an acceptable risk, joint replacement surgery should be seriously considered. Rehabilitation after surgery lasts months and is carefully planned before the operation.