Osteoarthritis (OA) is degenerative joint disease. The ends of bones are covered with cartilage which forms the normal smooth gliding surface responsible for painfree movement. In OA there is a failure of the normal repair mechanisms and cartilage is lost. As a result the gliding surface is no longer smooth and this can lead to pain. At the extreme cartilage is lost completely (bone on bone).
Most commonly there is no identifiable cause for OA but gender, occupation and genetics play a role. While the risk of OA increases with age, and the majority of people over 60 have OA to some degree, it is not the same as the normal ageing process. In some cases there is an identifiable cause such as trauma, deformity or inflammatory joint diseases (eg rheumatoid arthritis, gout).
Although cartilage is not seen with normal x-rays OA can usually be diagnosed as the ‘joint space’ (between the bones) becomes narrowed because of the loss of cartilage. You can also see other changes in the bones near the joints.
Many treatment options exist for arthritis and surgery is only undertaken if other options have failed.
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Operative treatment (surgery)
Many different types of operations have been utilised. The most common techniques are:
Debridement (smoothing of rough edges and prominent bone) also called cheilectomy
This can be done through open or keyhole surgery. This technique is often beneficial in the short term but it does not correct the underlying problem and symptoms usually recur to some degree after a while.
Arthroplasty (joint replacement)
Either one surface (hemiarthroplasty) or both surfaces (total joint replacement) can be replaced. This is one of the most successful procedures in orthopaedic surgery. However we aim to avoid this in young active patients as inevitably over time the joint surfaces wear out and need to be replaced. This is a more complex surgery with a higher rate of complications. As a result other types of surgery are often tried first in young patients.
In this type of procedure the bone on one side of a joint is shortened so it no longer rubs on the other side so relieving pain. This is only performed on certain sites such as the ACJ and in the small bones of the hand or in certain situations such as rheumatoid arthritis.
Arthrodesis – fusion
In some joints where movement is not required for day to day activity the joint can be surgically stiffened. This is good for pain relief but obviously sacrifices range of motion.
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