Surgical Options to treat OA

Radiofrequency denervation

Radiofrequency denervation is also known as radiofrequency neurotomy and radiofrequency rhizotomy. Radiofrequency energy is inserted through a probe of a needle to burn the nerve. This disrupts nerve function in an attempt to force the nerve drop the signals processing ability. Nerves can grow back and repair themselves and this is not a permanent solution for pain relief.

This treatment is often applied to areas of the spine. Limited scientific evidence suggests this can provide short-term relief of chronic neck and back pain but there are serious complications with the treatment [1].

When applied to other joints such as knees, systematic reviews of 13 publications identify a high success rate of treating chronic pain, lasting between 1 to 12 months post treatment. The reviews have also confirmed serious adverse events are unlikely if the therapy is applied away from the spine [29], [30].

Joint Arthroscopy

Arthroscopy involves opening up a joint via keyhole surgery and cleaning out any debris that may be present. During this procedure, it is often used to shave areas of cartilage to “buy more space”, trim loose sections and potentially repair torn areas of the cartilage.

Meta-analysis reviews of 13 randomised trials as well as 12 general observational studies present a high certainty that pain reduction is very minor post arthroscopy and lasts up to 3 months [38]. Joint function is similar, very minor short term improvements and 2 years post treatment, there is no difference at all. Overall, individuals who undergo joint arthroscopy do not have good benefits in pain relief or function in comparison to more conservative arthritis management strategies [38].

One of the reviews looked at supplementation, hyaluronic acid injections and PRP injections in comparison to joint arthroscopies. The outcome indicated PRP injections were the most effective of all the options listed above. There were no advantages in having joint arthroscopy even when examining those patients with combined cartilage tears and osteoarthritis [37].

On a final note, studies have also considered the cost factors associated with arthroscopies. The observations reveal arthroscopic surgeries are not an economically viable option [36]. There are many other treatments available with a greater cost to benefit ratio.

Joint fusion

To fuse a joint, means the joint is locked into one position. This is only applicable to extremities of the body, such as ankles, wrists, fingers and in some cases the discs of your spine. Larger more mobile joints such as knees, hips, shoulders will not be suitable.

It is commonly known, joint fusion is the very last approach aside from joint replacement. Typically patients will have tried all options and failed all medical treatments. Secondary to failed previous surgeries or bone infection, this is often the only way to achieve a stable and painless joint [34].

Studies have demonstrated pain relief for patients, contrary to pain relief joint function has almost ceased for patients post joint fusion [35].

Osteotomy

Osteotomy is a surgical procedure where the bone is cut and then re-aligned, lengthened or shortened depending on the specific requirement of the patient. This procedure is only required if there are structural imbalances with alignment or height in patients joints. This can lead to premature wear and tear of the joint and debilitating pain.

The best way to address this imbalance is by an osteotomy procedure or joint replacement. With regard to patient age and level of activity, osteotomy may be a good option. Studies reviewing osteotomy procedures indicate good outcomes in relation to decreasing the rate of cartilage wear and tear as well as patient outcomes associated with pain and function.

Osteotomy studies have shown that patient outcomes can be greater with the combination of alternative therapies [32]. One study evaluated 5-year outcomes after lower limb realignment (osteotomy), the results indicated change in load distribution during walking. This has resulted in long-term improvements in relation to wear, tear as well as symptoms associated with misalignment [33].

Joint replacement

Joint replacement is the bottom line of osteoarthritis, this is a process whereby the patient’s original joint is cut out and removed completely, then replaced with a ball and socket type metal fabricated structure. This structure is physically held inside the bone with glue and it is sutured into the tendons.

Replacements are not suitable for all patients and all joints, however once performed they can be very effective in relieving pain and improving joint function [2].

Despite large improvements in pain and function of joints post replacement, individuals do not increase their level of activity, in many cases they tend to decrease. It is suspected this is due to a preventative thought processes [39]. Statistic reveal, approximately 15% of cases of joint replacements, this surgery have not met the patients’ expectations [40].

HIP REPLACEMENT revisions are on the rise from 2.0% to 12.6% over the long term 10 year interval.

oa table

The risk of the first joint replacement failing is greatest between 7 to 10 years post-surgery [41]. The table below indicates joint replacement revision risk as the years increase.

Table courtesy: National Joint Replacement Registry of Australia 2015

KNEE REPLACEMENTS revision rates appear to be similar to the hip joints, they have raised by 2.6% to 11.2% over the past 10 years [41]. The table below indicates joint replacement revision risk as the years increase.

table knee oa

Table courtesy: National Joint Replacement Registry of Australia 2015

The most common reasons for patients to undergo second joint replacements are listed below [41];

  • Loosening/lysis (28.7%)
  • Infection (22.4%)
  • Pain (20.9%)
  • Instability (6.3%)

Younger patients under the age of 70 have a higher rate of second replacement compared to older patients [41].

Individuals should think carefully prior to proceeding with a joint replacement procedure. This procedure is certainly able to alleviate pain and increase function of the joint at a cost of completely removing the individual’s original joint. Just like any other surgical procedure, replacements can fail. They are likely to last 10 – 15 years [41]. Joint replacements can often only be revised 2 times. If the joint replacement fails for the 3rd time, patients may face serious consequences. Joint replacements are suitable best for patients who are at an age where they are not very active but also suitable for the surgical aspect of the procedure.

It is highly recommended, patients seek multiple opinions from health practitioners and they have tried all other methods of treating/managing arthritis prior to accepting a joint replacement.

Read about more treatment options for osteoarthritis on this page.

All references can be found in our list of references page here.