Surgical Options for Arthritis Patients
Arthroscopy is a minimally invasive procedure that uses tiny instruments to remove or repair damaged tissue in the joint. This provides relief from pain and swelling while possibly preventing further damage to the joint. Almost all joints are amenable to arthroscopy. Fusion is a procedure that makes the joint stiff. It is most commonly used in the ankles, hands, wrists and spine to provide pain relief for arthritis in those joints. Cartilage transplantation is another procedure in which cartilage cells are harvested from your joint during an arthroscopic procedure. Cells may be directly transplanted or grown in a lab for later transplantation. It is indicated in younger patients who have not yet developed severe arthritis. Most cases of these are done in the knee. Dr. Paul King, orthopedic surgeon said cartilage transplantation has been successful in Europe for the last nine years and was approved in the U.S. just a few years ago. “This surgery has the potential to halt or slow the progression of osteoarthritis in the long-term,” he said. Joint replacement surgery is one of the most successful procedures in orthopedics says Dr. Marshall K. Steele Director of the Joint Replacement Center. “In this surgery damaged cartilage is replaced to restore the cushion and mobility to the joint. Rapid recovery techniques used by surgeons and staff allow patients to be mobile in one day and return home in three days,” he said. Options for Specific Joints
Neurosurgeon Clifford Solomon, M.D. said neurosurgeons and orthopedic spine surgeons are using several minimally invasive techniques at AAMC that draw patients from up and down the East Coast. “We can do a minimally invasive laminotomy, creating a window in the lamina that can provide tremendous relief to some patients who have nerve damage as the result of arthritis in the spine. This technique works well because it maintains some support and structural integrity for the arthritic portion of the spine.” “The bottom line,” said Dr. Solomon, “is that the surgeons at AAMC are using a variety of new technologies to provide patients with minimally invasive ways to decrease the debilitating effects of arthritis.” Knees: Several procedures are helpful for knee arthritis. In younger patients with deformities an Osteotomy corrects the alignment of the leg. This involves cutting the tibia (shinbone) and correcting the deformity. Knee replacements have been an extremely successful. In patients with arthritis limited to only one area of the joint Unicondylar surgery may be indicated. This is a less invasive way to resurface the cartilage from one of the three compartments of the knee. There is a higher failure rate when compared to total knee replacements the first 10 years In total knee replacement, the knee itself is not replaced but all three compartments of the knee are resurfaced. They usually last 10-20 years dependant on the patient. Because no surgery lasts forever Dr. Marc Brassard, an orthopedic surgeon says non operative treatment should be continued as long as possible. However, he said it is possible to have a second replacement, if the first one wears out or fails. Hips: While arthroscopy and partial replacements aren’t good options for arthritic hips, total hip replacements are extremely successful, says Dr. King. Replacing the ball and socket of the hip generally has a quick recovery of about three days in the hospital and 8 to 10 weeks of physical therapy. “Patients walk the day after surgery and within a few days are usually off any pain medication. And the good news is that we’re moving towards more minimally invasive surgeries that speeds recovery even more,” said Dr. King. Ankles: Arthroscopy may benefit many ankle arthritis patients through removal of bone spurs and arthritic debris. Fusion, unlike knee, hip or shoulder fusion, is a satisfactory option for many patients since the remaining joints of the foot allow adequate motion for normal comfortable walking. Total ankle replacement is now an alternative with success rates comparable to those for total hip or total knee replacement. “With our newest technology in ankle replacement, we can expect excellent results that last 10 to 15 years or more before needing to have it redone,” says Dr. Edward Holt, a specialist in ankle surgery. Shoulders: In shoulder replacement surgery, the ball end of the shoulder is replaced with a metal ball. The socket may be resurfaced with plastic. Arthroscopy can helpful in less severe cases. Elbows: The total elbow replacement is not often indicated, but can produce outstanding results in the appropriate patient. Hand and Wrist: The joints of the hand and wrist can be treated arthroscopically for some types of arthritis and total replacement surgery can be useful in the joints of the hand and occasionally in the wrist as well. 
Hip Replacement 
On September 21, 2001, Matt Jones fell 30 feet from an extension ladder under an eave of a house he was repairing. The 28-year-old construction worker from Odenton landed on a brick retaining wall. He smashed his hip in 16 places in addition to other injuries. Two months after he was released from the hospital, he began the slow recovery from a wheel chair to crutches. Nerve damage to the shoulder made using crutches very painful, but as he got strength back working with a physical therapist, he was able to wean himself from crutches and return to work. By the middle of the summer, though, the pain in his hip was unbearable. One leg was 1 1/2 inches shorter than the other, which exacerbated an already compromised spine. “I walked with a pretty serious gait, and sometimes my back would just pop out and I’d be on the ground in terrible pain, then laid up for days,” he recalls. Hip fusion was discussed, but Matt didn’t want to spend the rest of his life with a decided limp so he began researching other options. Hip replacement is usually reserved for much older patients and the doctors he spoke with told him to put it off as long as possible. “I was taking glucosamine and pain killers. But I really didn’t like the pain killers. I knew they weren’t good for me. And my back was hurting bad.” Dr. Marc Brassard replaced his hip in AAMC’s Joint Replacement Center. “The day after surgery, I stood up. I almost cried I was so happy. When one foot touched the floor so did the other! There was some pain from the incision, but that was all I felt. One day I was a mess, the next I was fine. I walked a mile that day around the joint center. Three days later I was home.” Now he and his 15-year-old arthritic dog both take glucosamine, a natural substance that helps most all arthritis patients… human and canine. “We stretch and walk together almost every day. And I have no real problems now, except I can tell when the weather is changing… It’s like bells ringing inside me. I can tell you 20 minutes before it starts drizzling.” |
 
|
Arthritis Surgery
When conservative treatments for arthritis fail, surgery is often helpful. There are a variety of surgical procedures that can reduce pain and restore your quality of life. Each joint is different.
Spine: “The spine is ingenious,” says Brian Kahan, D.O. “Muscles attach to the spine to form triangles. This A-frame
structure supports the spinal column from head to toe to take the stress off the spine. The pyramids in Egypt are based on the same theory. By exercising your muscles, you help support your spine and decrease the stress.” But when arthritis causes pain that can’t be relieved, Roy Bands, M.D., an orthopedic surgeon who specializes in spine surgery, says that surgery can provide relief. “We can decompress the spine, which really means we’re ‘unpinching’ nerves that have been pinned by degenerating cartilage. We can also fuse joints that are causing pain.” This may result in some loss of
mobility, said Dr. Bands, depending on which joints are fused.
Dr. Alessandro Speciale, orthopedic surgeon and spine specialist, agrees that fusion is a good surgical option for treating neurologic pain resulting from arthritis. “With fusion, you don’t lose much functional mobility.” On the horizon, he said, is total disc
replacement, the advantage being the preservation of motion.
2001 Medical Parkway, Annapolis Maryland 21401
(443) 481-1000 | TDD: 443-481-1235
www.askAAMC.org