Continuing Medical Education: Understanding Osteoarthritis.

Edited By: Gregory C. Gardner, M.D.
Last updated Friday, January 07, 2005

Surgical therapy

Knee arthroscopy in osteoarthritis

Conditions that make arthroscopy useful

• Meniscal tear - Symptoms that suggest a meniscal tear include: recent onset of pain and swelling on top of previous OA symptoms, localized joint line tenderness, relatively normal X-rays for the amount of pain, locking, or joint giveway. The degenerative meniscus may be more likely to tear with less trauma. MRI can confirm the tear
• Loose body - Symptoms are usually knee locking and possibly giveway. If loose body is calcified, may be visible on X-rays

Conditions that make arthroscopy less useful

• Severe OA
• Varus or valgus deformity
• Chondrocalcinosis
• Previous meniscectomy

Total joint arthroplasty

Information to discuss with patient

• Cost of surgery is about $25,000 with expenses not completely covered by medicare and supplemental. Need to get cost estimate from surgeon's office
• Hospital 3-7 days without complications; protected ambulation and therapy for 6 weeks; return to full activities may take 6 months. There is a limitation to activity level as well.
• Complications include risks of anesthesia, DVT/PE, infection, and later loosening of the prosthesis.

Good candidates for TJA

• Uncontrolled pain - This is the main reason for considering TJA. If medical Rx in not satisfactory and the patient is willing to go through the risks and hassels of surgery, then >80% of patients will have good to excellent pain relief
• Immobility - Less important to pain in my mind but also a factor
• Age over 70 - Patients at this age are easier on prostheses and few require revision due to wear and tear
• Slender build - Easier on the prostheses
• Good health
• Sedentary lifestyle - Easier on prostheses and will find permitted activities acceptable

Surgery for arthritis at the University of Washington

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