The Role of Surgery in the Treatment of Arthritis
Role of surgery in arthritis:
Prevention: create normal joint surface
- after trauma
- for certain developmental joint abnormalities
Modulation: slow down the progression
Restoration:
- biological
- prosthetic replacement
Pain relief only:
Surgery for pain relief only
Excise painful joint
- Usually poor control of joint motion (flail)
Eliminate pain through elimination of motion
- Fusion surgery
- Commonly used in smaller joints
- Now rarely used in large joints
- Main option in spine, ankle, foot, wrist, hand
End-stage Osteo-Arthritis ankle, pre-op
End-stage O.A. ankle, 1 year post ankle fusion
Prosthetic Replacment Surgery
- Eliminate arthritic pain by providing smooth gliding joint surface.
- Optimize range of motion and functional capacity
Prosthetic replacement surgery
Current trends:
- implants more 'bone-and-joint' friendly
- better bearing surfaces
- less-invasive surgery
- 'recover faster and better'
Shoulder replacement
Ball and 'shallow socket' joint
- 'Socket' replacement controversial
- 'Ball' replacement well established
- Traditional stemmed design
- More recent: bone-preserving design
Shoulder replacement, Rheumatoid Arthritis Before Surgery
Shoulder Replacement, Rheumatoid Arthritis
rotator cuff deficient, stem
Shoulder Replacement Rheumatoid Arthritis
rotator cuff deficient, Copeland
Shoulder Replacement Osteo-Arthritis
rotator cuff intact, Copeland
Hip replacement
Ball and 'deep socket'
Both are replaced
- Traditional stemmed design
- More recent bone-preserving design
Stemmed hip replacement
Well-proven technology
Recent improvements:
- better bearings
- less-invasive surgery
Hip replacement -bearing surfaces
Hip replacement: implants
Hip replacement: bone preserving
For the 'young and vigorous'
Resurfacing of femoral head
Metal-on-metal bearing
Allows higher activity level
Requires full traditional exposure
Unknown: possibility of toxicity of metal in long run
Osteo-arthritis left hip, 52 y old woman
Osteo-arthritis left hip Birmingham hip
Osteo-arthrosis left hip Birmingham hip
Hip replacement: bone preserving
Why?
Will last longer
More options for revision after failure
But: upfront costs are higher-->
difficulty with funding
Hip replacement: bone preserving
Cobalt Chrome Alloys
Hip replacement
So:
1/ older and more sedentary-->
refine standard hip replacement
2/ younger and more vigorous-->
refine standard hip replacement
OR
consider metal-on-metal resurfacing
Knee replacement
Total knee replacement:
- well established
- big operation
Newer trend:
- if possible, consider less invasive partial knee replacement
Knee replacement: implants
Knee replacement: total
If entire knee 'worn out'-->
Total knee replacement is by far the best solution
Knee replacement: partial
If only part of the knee 'worn out'-->
Partial knee replacement.
Less invasive
Faster and better recovery
'Don't burn bridges'
Knee replacement: partial
vs.
Knee replacement: partial
Step 1: Must demonstrate intact opposite compartment
Step 2: Must demonstrate ACL integrity for mobile bearing knee
Knee replacement: partial, Standing
Knee replacement: partial, Stress views
Knee replacement: partial
Knee replacement: partial
Knee replacement: partial
Knee replacement: partial
Conclusion
- Surgery will remain an important tool to deal with end-stage, disabling
arthritis
- Improvements in materials, design and surgical technique continue to be refined
- Biological solutions for end-stage arthritis are NOT imminent
- The main issue today is ACCESS.
Thank You !!!
