Know Your Bones

How can Arthroscopic Surgery relieve arthritis pain-Part 2?

Continuing our discussion of arthroscopy...

When is it used? Knees are the joints 'scoped most often, but shoulders, ankles, elbows and other joints also do well after a "clean out." 

If your pain is coming from swelling and irritation within a joint (and not from the surrounding ligaments and muscles), then arthroscopy might be right for you.

How do you know exactly where your pain is coming from? A cortisone shot is an excellent test.  If the shot relieved most of your pain, even if only for an hour or so, you've confirmed that the inside of the joint was the source.

If the cartilage in your joint has completely worn away, and your pain comes from the grinding of bone-on-bone, arthroscopic surgery probably won't help you.  Instead, it's time to replace or remove the joint.  Stay tuned later posts about arthrodesis or arthroplasty. 

How can Arthroscopic Surgery relieve arthritis pain-Part 1?

In this 4-week series, I'll cover the basics on four surgical techniques that are used to treat arthritic joints.  Week 1:  Arthroscopy (ar-THROSS-ko-pee).

"Arthro-" = joint, "-scopy" = camera

What is it?  This procedure is often called a "scope."  A pencil-thin camera and tools are inserted in the joint through 1/2 inch incisions.  The camera is connected to a television, and is used to explore all surfaces within the joint.  The tools are tiny shavers, scissors and graspers.  A constant flow of sterile water distends the joint, so the picture on TV looks like an undersea adventure!

Arthroscopy relieves pain in your arthritic joint in several ways: by trimming away the inflamed lining that's getting pinched between the moving bones; by removing loose fragments of cartilage or bone that are floating around; trimming flaps of torn cartilage that irritate the joint.

Because arthroscopy is minimally invasive, your recovery is fairly quick.  "Minimally Invasive" means that the surgeon doesn't have to cut through a lot of soft tissue to get into the joint.  The scars are small, and muscles and ligaments aren't disrupted in order to view the inside of the joint with the camera.  Because less is disturbed, less has to heal.

Don't confuse "minimally invasive" with "microsurgery" or "laser" surgery.  Microsurgery is done under a microscope, like reattaching the nerves and blood vessels of a severed finger.  Lasers aren't used in arthroscopic surgery on arthritic joints (yet!)

Coming 2/27:  When is arthroscopy used? Then 3/1:  How long does arthroscopy last?  Later in March, we'll continue with osteotomy, arthrodesis and arthroplasty.  We'll wrap up with my suggestions about "what's right for me?"  (FYI:  You'll find the whole series conveniently bound in Appendix B of Know Your Bones--order your copy today!)

What about surgery for Arthritis?

Are you thinking what I’m thinking?  How can an orthopedic surgeon like me write a book about arthritis treatments without mentioning surgery? 

Surgery is a great solution to arthritis pain. There are many surgical procedures that can “fix” arthritic joints; the right technique depends on your specific problem and situation.  On the other hand, surgery is a big step, doesn’t “cure” arthritis, and isn’t right for everyone.  Hmm… many options, should be specific to your symptoms, potential for complications, not a cure, not right for everyone… Sounds like everything we discovered about OA medications throughout the book!

Think of medicine as a “chemical” means to relieve pain, and surgery as the “mechanical” method.  That is, surgery improves the structure of painful joint.  If you clean out, straighten out, resurface or eliminate the joint, the pain goes away. 

What kind of surgical techniques are used for arthritic joints?  When are they used? How long does do they “last”?  Over the next four weeks I'll cover the principles of arthroscopy, osteotomy, arthrodesis and arthroplasty.

Please write in with comments on your experience, expectations and concerns about joint surgery.  I'm interested in my patients' perspective.  (FYI--you'll find the series conveniently bound in Appendix B of Know Your Bones--get your copy today!)