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The Benefits of Arthroscopic Surgery Versus Total Joint Replacement for End Stage Osteoarthritis
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Posted on: 03/17/2016
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Osteoarthritis effects millions of Americans and treatment of the end stage joint degeneration often cumulates in surgery. Arthroscopic debridement is a minimally invasive technique in which surgeons make small incisions in the skin and use robotic probes to go into a joint space and clean up extra bony deposits that can be causing joint pain. This technique is often offered to patients after conservative methods for pain relief, such as physical therapy or medication, have been exhausted, but prior to offering a total joint replacement. There is controversy over whether or not arthroscopic debridement is actually beneficial or if it is just staving off the eminent total joint replacement, the gold standard treatment for end stage osteoarthritis. A recent review of the literature suggests that for the right patient, arthroscopic debridement is in fact beneficial.
The knee is the joint with the greatest amount of research and debate regarding the benefits of arthroscopic management. In general, the literature supports the non-routine use of arthroscopic surgery for patients with mild to moderate osteoarthritis with less than five degrees of malalignment at the knee (bowed legged or knock-kneed), with mechanical symptoms.
Total joint replacement for the shoulder is indicated if a patient is over 50 years old and has significant joint degeneration. Arthroscopic surgery of the shoulder joint is more beneficial for the shoulder joint than for the knee. Factors indicating appropriateness of arthroscopic surgery with a good outcome are younger patients with mild joint wear that is worn in a circular pattern with cartilage tears less than two centimeters and have at least two centimeters of joint space.
While elbow joint arthritis is less common, total joint replacement is beneficial for the older population. For a more active, younger population, varying forms of arthroscopic surgery prove very successful. Generally, arthroscopic surgery is good at treating pain in this population, but an open surgery to clean up debridement typically buys more motion.
The hip joint also responds well to arthroscopic debridement in the mild to moderate stages of joint degeneration. Evidence is lacking, however, regarding its place in the more degenerated hip joint. What studies do exist indicate that arthroscopic debridement is often quickly followed by a total hip joint replacement.
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References:
Pitta, M. M.D., et al. Arthroscopic Management of Osteoarthritis. Journal of the American Academy of Orthopedic Surgeons. February, 2016. Vol. 24, No. 2. Pp. 74-82.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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