Surgical Options for Osteoarthritis

Surgical Indications - When the Knife Calls

• Failure of conservative management (>3-6 months):
  • Includes analgesics, NSAIDs, physiotherapy, lifestyle changes, joint injections.
• Patient Factors:
  • Appropriate age, activity level.
  • Manageable comorbidities.
  • Realistic expectations; motivated for rehabilitation.
• Osteoarthritis Severity:
  • Radiographic: Kellgren-Lawrence Grade III-IV.
  • Symptomatic: Severe pain (e.g., VAS >6/10), functional disability, poor QoL.
• 📌 PAIN Triggers Surgery:
  • Persistent pain
  • Activity-limiting
  • Intolerable / Incapacitating
  • Night pain

⭐ Key indication for surgery is pain and functional disability refractory to adequate conservative treatment.

Arthroscopy - Scope & Hope

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Osteotomy - Angle Adjusters

Surgical bone cut & realignment to shift load, unload damaged compartment, delay arthroplasty.

• Aim: Correct malalignment, relieve pain, improve function, preserve joint.
• Key Indications: Unicompartmental OA, active patients <60 yrs, good ROM, stable ligaments.

⭐ HTO is ideal for young (<60 yrs), active patients with isolated medial compartment knee OA & varus deformity, delaying TKR. surgical technique correcting varus knee deformity diagram)oka

Arthroplasty - New Joints Now!

• Replaces diseased joint with prosthesis; relieves pain, restores function. Lifespan: 15-20 years.

• Types:

  • TJA: Hip (THA), Knee (TKA), Shoulder (TSA).
  • UKA: Medial/lateral knee compartment.

• Components:

  • Metal (Co-Cr, Ti)
  • Polyethylene (UHMWPE)
  • Ceramics (Alumina, Zirconia)

• Fixation:

  Feature	Cemented (PMMA)	Uncemented (Press-fit)
  Mechanism	Grout, immediate stability	Bone ingrowth
  Ideal For	Older, poor bone	Younger, active, good bone
  Pros	Early WB, ↓ fracture risk	Longer fixation potential
  Cons	Cement debris, heat necrosis	Micromotion, thigh pain

• Complications: 📌 "In D-LoW P-ain":

  • Infection (early/delayed/late)
  • DVT/PE
  • Loosening (aseptic/septic)
  • Wear & Osteolysis
  • Periprosthetic Fracture
  • Dislocation (THA common)
  • Stiffness / Arthrofibrosis

⭐ Aseptic loosening, often due to polyethylene wear and subsequent osteolysis, is the most common reason for late failure of total joint arthroplasty.

Arthrodesis - Motion No More

• Surgical joint fusion: sacrifices motion for stability & pain relief.
• Indications:
  • End-stage OA (ankle, wrist, spine, small hand/foot joints).
  • Failed TJA, severe instability, infection.
• Trade-off: Pain relief for permanent loss of motion.

⭐ Arthrodesis is a salvage procedure providing pain relief and stability, particularly effective for end-stage ankle or wrist arthritis, but results in complete loss of joint motion.

High‑Yield Points - ⚡ Biggest Takeaways

• Arthrodesis: Pain relief & stability for young patients, monoarticular OA (e.g., ankle); sacrifices motion.
• High Tibial Osteotomy (HTO): For medial knee OA in young, active patients with varus; delays TKR.
• Total Joint Replacement (TJR): Gold standard for end-stage OA (hip, knee); best pain relief & function.
• Unicompartmental Knee Arthroplasty (UKA): For isolated compartment knee OA; faster recovery than TKR.
• Arthroscopic debridement: Temporary relief in mild OA; no disease modification.
• Cartilage repair procedures (e.g., ACI, OATS): For focal chondral defects, not generalized OA_._