SURGERY: UNDERSTANDING YOUR OPTIONS

If your arthritis becomes severe, you may start to wonder if you need surgery. How do you decide what’s best when nonsurgical treatments are not working?

Surgery may be indicated when your joint(s) appears to be completely worn out. X-rays will confirm this when the joint appears to be “bone-on-bone” because of complete loss of cartilage. Also, with certain types of arthritis an x-ray may show erosions or destruction at the surfaces of the bone. Clinically, your joints may lose the ability to move normally, or deformities may develop that change the alignment in ways that cause a loss of function. Along with pain, people may lose grip strength, develop instability, become unsteady on their feet, or lose the ability to move, depending which joints are affected.

Surgery has 2 main roles: decrease pain and improve function. However, results will vary depending on several factors.

Each joint has different surgical options. Many joints, such as the knee, hip, and shoulder, can be replaced with an artificial prosthesis. The diseased joint is cleared and the prosthesis is inserted into the joint space. Some joints can be fused together, which permanently limits motion but tends to resolve pain. Joint fusion may improve function because of the pain relief, but this will be far from perfect. In milder cases, bones can be reshaped and joints can be “cleaned out”, but the results may not be long lasting.

If you can work around your joint pain, stiffness, and swelling, even when severe, then you really do not need to consider surgery. However, if you cannot bear your pain and activity limitations, then surgery is an option worth discussing with your surgeon. Surgery can be helpful, but has risks that range from mild to life-threatening. Even successful joint surgeries may need revision if parts wear down, or if infections develop, or if the surgery comes undone over the years.