Surgical management of an arthritic joint

Question 1

When should surgery be considered in an arthritic joint?

Answer 1

Only when conservative options have been exhausted

Question 2

What is the main indication for surgery?

Answer 2

Pain (treat the patient, not the X-ray)

Question 3

What is open debridement useful for?

Answer 3

Removal of an impinging osteophyte- may “buy time” for younger patients

Question 4

When is cartilage regeneration used?

Answer 4

Small discrete lesions in knee and ankle- not widespread OA

Question 5

What are the three possible techniques for cartilage regeneration?

Answer 5

Microfracture- make small holes in bone to stimulate chondrocytes.
Mosaicplasty- harvesting and transplant of osteochondral “plugs” from less weight-bearing areas.
Autologous chrondoplast implantation

Question 6

Which joints is excision arthroplasty sometimes used for?

Answer 6

1st CMC joint in hand; 1st MTPJ; end stage rheumatoid foot and end stage hip infection or THR failure

Question 7

What is arthrodesis and what is it the gold standard treatment for?

Answer 7

Surgical fusion of joint in a functional position

Gold standard for: PIP and DIP joints, 1st MTP, end stage ankle and wrist

Question 8

What are the drawbacks of arthrodesis?

Answer 8

Impaired range of movement; may lead to arthritis change in surrounding joints due to extra load bearing

Question 9

What is osteotomy?

Answer 9

Surgical re-alignment of bone

Question 10

Where in the body is osteotomy often used?

Answer 10

Knee (70% success rate)

Hallux valgus

Question 11

What are the potential late complications of joint replacement arthroplasty?

Answer 11

Infection; loosening; fracture; component breakage; eventual failure with decreased favourable outcomes when surgery is re-done