Overview of surgical therapy of knee and hip osteoarthritis
- Lisa A Mandl, MD, MPH
Lisa A Mandl, MD, MPH
- Assistant Professor of Medicine
- Weill Cornell Medical College
- Gregory M Martin, MD
Gregory M Martin, MD
- Medical Director, Orthopedic Institute at JFK Medical Center
- Preferred Orthopedics of the Palm Beaches
The goals of management of patients with osteoarthritis (OA) are to control pain and swelling, minimize disability, and improve the quality of life. Treatments should be individualized to the patient’s functional status, disease severity, occupational and vocational needs, and the nature of any coexisting medical problems. The patient’s expectations should be discussed to ensure they are realistic.
Surgical interventions for patients with OA are generally reserved for those who have failed less invasive modes of therapy. This topic will review the effectiveness of surgical approaches used to treat OA. Pharmacologic and nonpharmacologic approaches to the treatment of OA other than surgery are presented separately. (See "Initial pharmacologic therapy of osteoarthritis" and "Nonpharmacologic therapy of osteoarthritis".)
Total joint arthroplasty (replacement) is the definitive treatment for osteoarthritis (OA) in patients who have failed nonoperative interventions. The indications for pursuing a total knee or hip arthroplasty are discussed in detail separately (see "Total knee arthroplasty", section on 'Indications' and "Total hip arthroplasty", section on 'Indications'). In addition, a variety of other surgical procedures may be considered in selected patients with OA. In younger patients with less severe and/or more localized areas of OA, alternative procedures may include joint resurfacing, autologous chondrocyte transplantation, and unicompartmental arthroplasty. Some patients with OA secondary to varus or valgus knee deformities or congenital hip dysplasia may benefit from an osteotomy.
Surgical procedures that have been used to treat OA which are generally not recommended include joint irrigation, arthroscopic debridement, arthroscopic abrasion arthroplasty, and arthroscopic synovectomy. There may be a role for arthroscopic debridement in younger patients with a labral tear or femoroacetabular impingement (FAI) of the hip without advanced OA, but additional studies are needed to establish the efficacy of this procedure for these indications.
Knee — We do not recommend the use of joint irrigation (or lavage) in the treatment of knee ostearthritis (OA). Joint irrigation consists of rinsing out the knee with fluid, and can be done arthroscopically or non-arthroscopically. It is thought that joint irrigation relieves knee pain secondary to OA by removing cartilaginous debris and inflammatory cytokines, which may contribute to synovitis and pain [1-3].
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- GENERAL PRINCIPLES
- JOINT IRRIGATION
- ARTHROSCOPIC DEBRIDEMENT
- - Isolated osteoarthritis
- - Osteoarthritis plus a meniscal tear
- ARTHROSCOPIC ABRASION ARTHROPLASTY
- ARTHROSCOPIC SYNOVECTOMY
- AUTOLOGOUS CHONDROCYTE IMPLANTATION
- JOINT RESURFACING
- UNICOMPARTMENTAL ARTHROPLASTY
- TOTAL JOINT ARTHROPLASTY (REPLACEMENT)
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS