1. Arthroscopy
Arthroscopy is the use of a lens on the end of a long, narrow tube to view the joint. The lens is attached to a camera headpiece, which then transmits the video to a television monitor. Using specialized narrow instruments, procedures can be performed through small skin incisions. Arthroscopy performed for advanced arthritis will most likely have a minimal or temporary effect, because it doesn't change the fact that there is bone-on-bone grinding causing pain. On the other hand, arthroscopy done for mechanical symptoms, such as meniscus tears or cartilage flaps, can help with early arthritis. Knee arthroscopies are the most common orthopedic procedure done in the United States, with upwards of 800,000 performed per year.
2. Realignment Osteotomy
Osteotomy is the cutting of a bone to realign it. It usually involves placing implants (plates, screws or pins) to keep the bone in its new position until it heals. The goal of this surgery is to redistribute the forces across a joint. It works by offloading the diseased portion and putting more of the forces onto an portion of the joint that is better equipped to handle the load. Osteotomies can be performed around the knee, ankle and foot, and more rarely, around the hip and pelvis. For instance, with arthritis predominantly in the medial compartment of the knee, a tibial (shin bone) osteotomy can make you more "knock-kneed" to place more of the contact pressures on the lateral compartment.
3. Cartilage Transplantation
In a few cases, cartilage can be stimulated to regrow or can even be transplanted. These types of surgeries are mostly limited to focal defects of cartilage and are covered in the sports medicine section. With advanced arthritis, most of these surgeries are not appropriate. Think of the articular cartilage as a road. When there are small potholes but the rest of the road is smooth, then we can just fill the potholes. However, if the whole road is worn away, it's time to repave the whole road (joint replacement).
4. Arthroplasty
Arthroplasty is joint replacement. This involves removing the ends of the diseased bone and replacing them with a combination of metal, plastic or other newer materials, such as ceramics. Hip and knee arthroplasties are the most common replacement procedures. In 2005, over 500,000 knee replacements and over 200,000 hip replacements were done in the United States. Shoulder, elbow, spinal disc and ankle replacements are also performed, but are less common.
5. Arthrodesis
Arthrodesis is joint fusion. With the advent of joint replacements, arthrodeses are becoming less common. In joints where there are not as good options for arthroplasties, fusions are still an effective way of treating arthritis. f bone-on-bone grinding causes pain and swelling, then putting the two bones together to eliminate the joint effectively stops the grinding and pain. The trade-off is stiffness. However, in most cases, a stiff but painless joint is better than a painful, moveable joint. Fusions of the hand and fingers, as well as foot and ankle fusions are still being done relatively commonly. Hip and knee arthrodeses are becoming much less common.
