Surgical Benefits for Specific Joints

Hip: The greatest success with joint surgery for arthritis thus far has been through replacement of hip joints. According to the US Arthritis Foundation, more than 75,000 such replacements are performed each year. The success rate for osteoarthritis is 95 percent and is almost as high for rheumatoid arthritis.

Two types of techniques are used. One is total hip replacement, and the other is resurfacing. In deciding which procedure is most appropriate and will be most successful for the individual patient, the surgeon will consider the age of the patient and the condition of the bones. Until the past few years, bone cement used in total hip replacement had poor holding power and that operation was reserved for older people. Now, with improvements in the cement used, expectations are that the cement will hold for about 25 years, and hip replacement operations are now being done for younger people.

The other technique, resurfacing, involves cleaning away the top of the thigh bone (femur) and capping it with a metal covering. The socket of the hip is also cleaned and lined with a plastic material. Although this procedure has the same pain- relieving and motion-restoring potential as total replacement, it is not known whether this procedure will last as long as total joint replacement. However, should it be required, a total replacement can be done later on.

Ankle and Foot: Surgical procedures are performed in many joints in the foot to correct defects caused by arthritis. Arthrodesis, or fusion of the bone of the foot or ankle, is a commonly performed operation. Replacement of the ankle also is done under some circumstances. When the metatarsal arch is painful and prevents walking, resection of the heads of the metatarsals may be considered. With resection toe deformities can be corrected for some individuals.

Hand and Wrist: Several types of surgical procedures are done on the hands and wrists to restore function after they have been damaged by arthritis. One type of surgery is aimed at the improvement of a condition called dorsal tenosynovitis, which affects the lining of the long tendons on the back of the hand. Sometimes the affected tendon tears apart and requires repair. If this occurs, surgical repair of these ruptured tendons gives good results for the majority of patients and recovery is fairly the rapid. Synovectomy done for both the fingers and the wrists in early stages of deformity has not been successful. The dexterity of the fingers and hand is sometimes improved by operations done to tighten or loosen the pull of the tendons.

Another technique used to relieve the crippling effects of arthritis in the fingers involves silicone rubber implants in the finger joints. This is appropriate in some cases and requires careful analysis by the surgeon before a decision regarding the surgery is made.

Several techniques are also available for the wrist. Arthrodesis can relieve pain and provide more stability for the hand, but some limited motion will result. The range of motion may be improved with resection of the end of one of the bones in the wrist. Another possibility, in some cases, is total joint replacement.

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Surgical Benefits for Specific Joints