Basics of Surgery for Arthritis.
Last updated Thursday, December 30, 2004
Types of surgeryJoint structure Understanding what surgery can do for you will be easier if you have a good idea of the structure of joints.
A joint
is a place in the body where two bones come together. Ligaments are
fibrous cords that attach bones to bones. Tendons are like ligaments
except they connect muscles to bones. A bursa is a fluid-filled sac
that acts as a cushion between muscles and bone or tendons.
The tissue lining the joints is called the synovium. In conditions
like rheumatoid arthritis, the synovium becomes inflamed. This
inflammation releases chemicals that, over months or years, will
thicken the synovium and damage the cartilage and bone of the affected
joints. Inflammation of the synovium causes pain and swelling.
The ends of the bones are covered with cartilage. In osteoarthritis,
the cartilage becomes cracked and pitted and no longer allows smooth
movement of the joint. When cartilage wears away in a weight-bearing
joint such as the hip or knee, it can produce severe pain, deformity,
and loss of mobility. Synovectomy? Synovectomy is the removal of diseased synovium. This reduces the pain and swelling of rheumatoid arthritis
and prevents or slows down the destruction of joints. However, the
synovium often grows back several years after surgery and the problem
can happen again.Osteotomy Osteotomy is the correction of bone deformity by cutting and
repositioning the bone, then resetting it in a better position.
Osteotomy of the tibia (shinbone) is occasionally performed to correct
curvature and weight-bearing position of the lower leg in people with osteoarthritis of the knee.Resection Resection is the removal of part or all of a bone. This is often done
when diseased joints in the foot make walking very painful and
difficult. Resection is also done to remove painful bunions. Resection
on parts of the wrist, thumb, or elbow can help improve function and
relieve pain.Arthrodesis Arthrodesis, or bone fusion, is done to relieve pain, usually in the
ankles, wrists, fingers, and thumbs. The two bones forming a joint are
joined together so that the resulting fused joint loses flexibility.
However, a fused joint can bear weight better, is more stable, and is
no longer painful.Arthroplasty Arthroplasty is the rebuilding of joints. This can be done by
resurfacing or relining the ends of bones where cartilage has worn away
and bone has been destroyed. Arthroplasty also refers to total joint
replacement, where all or part of an arthritic joint is removed and
replaced with metal, ceramic, and plastic parts.
Total joint replacement has been widely used for many years, and the
results are usually excellent, especially in hips and knees. Other
joints, such as the shoulders, elbows, ankles, and knuckles, may also
be replaced. With new materials, improved surgical methods, and a
better understanding of replacement joint function, this procedure has
enabled many people who were severely disabled to become more active
again. Arthroscopy Arthroscopy is a process that allows a doctor to see directly into
the joint through an instrument called an arthroscope. This is a very
thin tube with a light at the end. The arthroscope is connected to
closed-circuit television. Arthroscopic surgery can be used to find out
what kind of arthritis exists and how much damage is present. Also, the
surgeon can perform many other procedures such as biopsy, cutting away
a loose piece of tissue that is causing pain, repairing a torn
cartilage, or smoothing a joint where the surface has become rough.
Extensive surgery, such as synovectomy or reconstruction of ligaments,
is also performed through an arthroscope.
The advantage of arthroscopic surgery is that it does not require as
much anesthesia or as much cutting as a standard operation. A person
can recover from it much more quickly and start walking sooner. The
procedure is most often done on the knee or shoulder, but is being used
more often on other joints such as the elbow, wrist, and ankle.
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