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Surgery and replacement
For advanced cases of OA, if conservative treatments cease to provide relief and good quality of life, joint surgery is the next option.
Arthroscopic surgery for OA--using very small incisions to insert a camera and then scrape and clean out the joint --used to be a common procedure. But now the surgery is not generally recommended for arthritis; a scientific study has shown that a patient group who received a sham surgery fared just as well.
In a select group of individuals with OA of the knee, the recommended treatment is osteotomy, in which a surgeon cuts away part of the bone to relieve pressure on damaged cartilage by repositioning the joint and redistributing weight properly. Recovery can take six to 12 months, and further surgery may be required if deterioration continues.
Joint replacement, or arthroplasty, is also a common surgical option for patients with very advanced OA, when the joint has deteriorated beyond repair. The entire joint--most often the hip or knee--is removed and replaced with a mechanical one. Patients who have not yet developed appreciable muscle weakness and who would medically withstand the stress of surgery are ideal candidates. The artificial joint is usually made of titanium or cobalt chrome and lined with a high-grade medical plastic to keep the joint moving smoothly. Implants may last as long as 30 years, although the average lifespan of an implant is about 15 years.
There are two types of replacements: cemented and uncemented. The cemented type is glued right to the bone. These are usually the better choice for older patients with weaker bones, because the cement holds the implant in place despite bone weakness; on the other hand, cement particles can break away and a further replacement (known as a revision), if one is needed, may be harder to perform. Uncemented implants, which rely on natural bone growth attaching to the prosthesis, are often used for younger patients. These implants are easier to replace than the cemented kind, but recovery takes longer because it depends on bone growth. Other risks of replacement surgery include infection and blood clots.
Surgeons have figured out how to insert implants using smaller incisions, reducing recovery time. But recovery is still a difficult process and should not be underestimated. Immediately after the surgery and for many days thereafter, patients may experience a lot of pain, caused mostly by muscles that were pushed and pulled during the operation. Patients are often given morphine for the pain while in the hospital.
Rehabilitation begins the day after surgery and continues either in the patient's home or at a rehabilitation facility, supervised by a physical therapist. Therapy focuses on rebuilding strength and regaining flexibility and range of motion in the joint. The success of the procedure depends, in large part, on the dedication of the patient to the rehabilitation process, which takes time, effort, and motivation. Recovery from a hip replacement procedure usually takes at least four weeks to regain most strength and motion, and about six months to completely regain it.
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