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Surgical options for arthritis

Tuesday, May 29, 2007

In this article we will briefly discuss the various surgical options for arthritis. One of the most common questions I get regarding possible surgical treatment for arthritis is “Doc, can't you just scope the knee and clean it out?”

Arthroscopy is inserting a small fiberoptic camera into a joint, pumping fluid through the joint and then performing various procedures through other small portal site “poke holes.” It is very effective for trimming out torn pieces of meniscus cartilage, removing loose bodies such as loose pieces of cartilage or bone/bone spurs that have broken off.

It is also very useful for various ligament reconstructions and several other procedures.

Unfortunately, it is not very effective for the treatment of arthritis per se. Arthritis is when the articular cartilage on the end of the bone starts to wear down. We really don't have any good way at this stage to “re-tread the tire” especially over large diffuse areas of wear and tear. There are various surgical procedures, some of which can be done arthroscopically, others through an arthrotomy, which is a larger incision and opening into a joint that can replace, regenerate and/or regrow new cartilage, but it is really only for very small areas of articular cartilage wear or breakdown.

In most patients who have significant wear and tear/degeneration of their joints, arthroscopy really only benefits them if they have some type of mechanical symptoms that can be removed. The reason that arthroscopy is generally not very effective and has not been shown to affect the long-term outcome of arthritis is that once the arthroscopy is performed, the wear and tear is still there with the exception of perhaps cleaning out some loose particles. This is usually only effective for a very short period of time.

Within several weeks to months the arthritic symptoms usually come back. Sometimes the surgery can even make them worse or cause other problems or complications. The bottom line is, unfortunately, arthroscopy is really not an effective form of treatment for generalized arthritis.

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