Arthritis - When Surgery Is Necessary

You exercise conscientiously and wisely; you choose your foods carefully and you've lost your excess weight. You have faithfully limited activity that would make your arthritis worse, and you and your doctor have explored many types of medication. But you're still in such pain that your lifestyle has dramatically changed.

Forty years ago, if you had severe osteoarthritis of the knee or hip, for example, you might easily have wound up bed bound. Today, there's a far brighter future, thanks to remarkable surgical procedures that can leave you feeling like a new person. In most cases, people with arthritis for whom surgery is appropriate will find themselves dramatically improved.

So if your doctor says, "We'll need to consider surgery" the truth is those may be the most encouraging words you've heard yet.

Of course, it's natural to feel cautious about surgical procedures. Just as you shouldn't rule out surgery without considering it, neither do you want to leap into the operating room without considering the pros and cons. No two people are identical: A type of operation that works wonderfully for one may not be suitable for another. There are many possibilities, ranging from various types of joint replacements to a minor procedure that you can watch on a television screen while it's underway.

In most cases, surgery doesn't need to take place right away, so you'll have some time to consider your options, prepare for the operation, and plan for your recovery period afterward.

Here are the types of surgery available.

What Is Arthroscopy?

Arthroscopy may become your best friend. For some problems, this relatively quick and simple procedure can have you walking out of the hospital just a few hours after you limped in on crutches. Named after the clever instrument, arthroscopy is done using an arthroscope, a bundle of very thin, light-transmitting glass fibers inside a tube about the thickness of a pencil. It is attached to a small camera, which lets the surgeon see right inside your joint.

How is it done? This fascinating procedure can often be performed while you are awake, with just the area to be operated on numbed. In these cases, you can watch on a television monitor. If the procedure is to be done on your knee, you will likely receive an epidural anesthetic, a shot near your spine that anesthetizes you from the waist down. You'll have an intravenous line, and your heart rate and blood pressure will be monitored. An orthopedic surgeon will make a tiny cut, then insert the arthroscope into your joint. The surgeon can then use the tube to look around and see what the problem is or insert small surgical instruments through it to repair cartilage and remove loose pieces of bone, all the while watching the inside of your joint on the monitor.

Who gets it? Damage to cartilage or to bone (such as loose bone fragments) in a specific, localized area of a joint may qualify you for arthroscopy. The vast majority of these procedures are done for knees (around 85 percent), around 10 percent for shoulders, and around 5 percent for other joints. Arthroscopy is virtually never used for the hips.

What are the pros and cons? You don't have to stay in the hospital overnight, and you have only tiny incisions. Generally, the only possible complications are infections and some residual pain or stiffness. While this procedure can remove or smooth out damaged cartilage and remove bone bits, it cannot replace or actually repair your existing cartilage.

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