If OA becomes impossible to live with, surgery may be the answer. There are many types of surgical procedures, from arthroscopy to total knee replacement. However, there are limits to what surgery can achieve. Strenuous exercise such as downhill skiing after total knee replacement may not be possible. Pain relief and greater freedom of motion are likely outcomes. A strict treatment and rehabilitation program after surgery is in large part dependent upon active participation by the patient. Now let’s look at the various surgical options available today.

Arthroscopic surgery

– For repair of damaged cartilage

– For removal of loose bits of cartilage and bone

– To drain infected or excess synovial fluid

– May be performed in the office or in the hospital, depending upon nature of the surgery.

The arthroscope is inserted through a very small incision, which leaves little scarring. Arthroscopic surgery can, in many cases, be done in the office.

Osteotomy

May be an option when OA involves a single, weight bearing compartment of the knee joint. – To correct deformities by selective trimming away of bone. – Improves joint alignment – Generally preferred for young and active patients.

Osteotomy literally means “bone cutting”. Even slight bone deformities can put pressure and strain on joints, and contribute to OA. The deformity is corrected by removing or adding triangular wedges of bone. Osteotomy can be useful in preventing the deterioration of joints with OA due to a preexisting deformity such as bowleggedness. Osteotomy is generally preferred for young, active patients.

Arthrodesis (Fusion)

Reserved for patients who cannot undergo total knee replacement. – Relieves pain – Leg is left permanently rigid – Interferes with walking, sitting, driving, and other movement

The word arthrodesis means ‘fusion of a joint’. When this surgery is performed on the knee, the thigh and shin bones are fused to become one bone. Pain is relieved, but the leg is left permanently rigid, which interferes with walking, sitting, driving, or moving in a narrow space. For these reasons, arthrodesis is used only when certain infections or ligaments loss make it unsafe to implant a prosthesis.