Patients who have severe joint damage that is painful and interferes with daily activities may be candidates for surgery. The goal of surgery is to repair the damage, reduce pain, and restore function. Joint surgery should not be performed for cosmetic purposes alone.

Depending on the joint involved and the soft-tissue impact, there are several orthopedic surgery options to repair joint damage, including total joint replacement, arthrodesis (fusion), synovectomy, arthroscopy, osteotomy, and resection.

Joint Replacement

Total joint replacement surgery is commonly performed on the hips (THR) and knees (TKR). Other joints, including the shoulders, elbows, ankles, and knuckles may also be replaced. With a total joint replacement (also referred to as arthroplasty), the damaged joint is removed and replaced with a prosthesis made of metal, ceramic, or plastic. Some prostheses are cemented and others are uncemented. The uncemented type of prosthesis is designed to allow bone to grow into the porous coating on the prosthesis and stabilize the joint.

Over the years, there have been advancements in the field of reconstructive joint surgery. Advancements, such as minimally invasive surgery, have made joint replacement recovery easier for patients. The minimally invasive procedure requires less dissection and smaller incisions for patients who qualify for the procedure. Another significant advancement has been the development of the unicondylar knee replacement or partial knee replacement. The knee joint is comprised of the medial, lateral, and kneecap compartment. When only the medial or lateral component is severely affected by arthritis, there are distinct advantages to the unicondylar knee replacement over a total knee replacement. Because the surgeon is dealing with only one component, there is less bone loss. If the need for revision arises, the procedure is easier for the surgeon to perform and recovery is shorter for the patient.

Joint replacements can last decades in some patients. At some point, the prosthesis can wear out and revision surgery is required for that joint. Loosening is a common problem with hip replacements. Some designs that have a plastic liner in the acetabular component shed microscopic fragments due to the friction caused by walking and everyday use of the joint. The fragments can cause an inflammatory process and the end result is a loose hip replacement. Loose hip prostheses are very painful and range of motion can be severely impacted.

A revision is a repeat total joint replacement, but first the old prosthesis has to come out. The revision is considered more difficult than a virgin (first-time) hip replacement, and takes longer. If you need a revision, it is very important to have a surgeon who is experienced with revision joint surgery.

Gender-specific knee replacements have been another interesting development in joint surgery. More than 400,000 knee replacements are performed in the United States every year. Two-thirds of the knee replacement patients are women. Though traditional knee replacement prostheses come in various sizes, a new prosthesis developed by Zimmer is gender-specific, designed just for women. The reason for the gender-specific knee is that women's knees are shaped differently than men's knees. The expectation is that the gender-specific knee will perform better — time will tell.

Hip Resurfacing

As an alternative to total joint replacement, another procedure known as resurfacing may be an option for some patients. The Birmingham Hip Resurfacing System is the only FDA-approved hip resurfacing system available in the United States. The system was first introduced in the United Kingdom in 1997 and has been used in other countries.

The Birmingham hip is a two component, metal-on-metal prosthesis. A metal cup fits into the acetabulum after it's resurfaced, and another metal cup fits over the femoral ball after it's resurfaced. The benefit of the Birmingham hip, which has been implanted in more than 60,000 patients, is that it conserves more bone than a traditional hip replacement, and it preserves future surgical options, especially for younger patients who may face more revisions.

Arthrodesis

Arthrodesis is the technical name for joint fusion. Arthrodesis is performed for one purpose — to relieve pain. The procedure can be performed on ankles, wrists, fingers, and thumbs. With arthrodesis, the two bones that form a joint are joined or fused together. Mobility and flexibility is lost following a fusion, but the joint is more stable and stronger and pain relief can be as much as 100 percent. After the procedure, if performed on your ankle, you will likely be non-weight-bearing for several weeks or months until x-rays reveal the bones are fusing. Other joints that are being fused (such as wrist, fingers, thumbs) may be splinted or casted to keep a patient from moving or using the joint until it shows x-ray evidence of fusion.

Arthroscopy

Arthroscopy is both a diagnostic procedure and a surgical procedure. An arthroscope (thin tube with a light at the end) is inserted directly into a joint through a small incision. The arthroscope is hooked up to a closed-circuit television and the surgeon can view the joint damage and decide what repairs can be performed arthroscopically to relieve pain. Arthroscopic surgery is most commonly performed on knees and shoulders.

Synovectomy, Osteotomy, and Resection

Synovectomy can be performed by surgically opening the knee or as an arthroscopic procedure. During a synovectomy, the synovium or lining of the joints is removed. A synovectomy can reduce joint pain and swelling associated with rheumatoid arthritis and is thought to slow joint destruction. It's not a one-time fix, however; the synovium often grows back.

An osteotomy involves the cutting and repositioning of bone. The procedure is primarily used for patients with mild osteoarthritis who have misalignment of a joint. Osteotomy is used to shorten, lengthen, or correct misalignment of bone.

A surgical resection involves removing part or all of a bone. Most commonly, resection is performed on the feet (metatarsal resection, bunion removal) because pain is so severe it interferes with walking. The recovery period can take time, but the goal is to regain a certain level of comfort.