Treatment of Osteoarhtirits-Surgery

Several surgical options:

•Total Hip replacement or arthroplasty
•Arthroscopic levage or debridement
Using a small camera (arthroscope)Lavage-using saline to flush out blood, fluid or loose debris inside your joint- or Debridement-which removes loose fragments of bone or cartilage inside your joint- are performed. These procedures may provide short-term pain relief and improved joint function for some people, not really for severe osteoarthritis
•Repositioning bones or osteotomy
Surgeons can also reposition your bones to help correct deformities
•Fusing bones or arthrodesis
Surgeons also can permanently fuse bones in a joint to increase stability and reduce pain. The fused joint, can then bear weight without pain, but has no flexibility.

Total Hip Replacement At A Glance
• The prosthesis for a total hip replacement can be inserted into the femur bone with or without cement.
• Chronic pain and impairment of daily function of patients with severe hip arthritis are reasons for considering treatment with total hip replacement. Age important (usually for 60+ yo patients).
• Complication and risks of total hip replacement surgery have been identified.
• Preoperative banking of the blood of patients planning total hip replacement is considered when possible.
• Physical therapy is an essential part of rehabilitation after a total hip replacement.
• Patients with artificial joints are recommended to take antibiotics before, during, and after any elective invasive procedures (including dental work).


What is a total hip replacement?
• the diseased cartilage and bone i.e. the diseased acetabulum and femur, are replaced with a metal ball and stem (“prosthesis”) inserted into the femur bone, and an artificial plastic cup socket.
• prosthesis inserted into the central core of the femur, then fixed with a bony cement called methylmethacrylate. Alternatively, a "cementless" prosthesis is used which has microscopic pores that allow bony in growth from the normal femur into the prosthesis stem. "cementless" hip is felt to have a longer duration esp. good for younger patients

Who is a candidate for total hip replacement?
• performed most commonly b/c of progressively severe arthritis( esp. O/A) in the hip joint
• Other conditions leading to total hip replacement include bony fractures, rheumatoid arthritis, aseptic necrosis-caused by fracture, drugs-alcohol, prednisone, prednisolone, diseases-systemic lupus erythematosus
• The progressively intense chronic pain together with impairment of daily function like walking, climbing stairs and rising from a sitting position, eventually become reasons to consider a total hip replacement.
• Because replaced hip joints can fail with time, whether and when to perform total hip replacement are not easy decisions, especially in younger patients. Replacement is generally considered after pain becomes so severe that it impedes normal function despite use of antiinflammatory and/or pain medications
• 60s are good age. Surgeons unlikely to undertake operation earlier (i.e at 55 yo) b/c of 20% chance that prosthesis will fail within 10-12yrs
• A total hip joint replacement is an elective procedure, a decision made with an understanding of the potential risks and benefits.

What are the risks of total hip replacement?
• The risks of total hip replacement include blood clots in the lower extremities (pulmonary embolism), difficulty with urination, local skin or joint infection, fracture of the bone during and after surgery, scarring and limitation of motion of the hip, and loosening of the prosthesis which eventually leads to prosthesis failure.
• Because total hip joint replacement requires anesthesia, the usual risks of anesthesia apply and include heart arrhythmias, liver toxicity, and pneumonia.
What does the preoperative evaluation entail?
• Total hip joint replacement can involve blood loss, so patients planning to undergo Rx often will donate their own (autologous) blood to be banked for transfusion during the surgery.
• The preoperative evaluation: a review of all medications being taken by the patient, complete blood counts, electrolytes (potassium, sodium, chloride, bicarbonate), blood tests for kidney and liver functions, urinalysis, chest x-ray, EKG, and a physical examination.
• Any indications of infection, severe heart or lung disease, or active metabolic disturbances such as uncontrolled diabetes, may postpone or defer total hip joint surgery.

What will it be like for the patient after surgery?
• A total hip joint replacement takes two to four hours of surgical time
• After surgery, taken to a recovery room for immediate observation-one to four hours. The lower extremities closely observed for both sensation and circulation.
• Upon stabilization, the patient is transferred to a hospital room.
• During the immediate recovery period, patients are given intravenous fluids, to maintain a patient's electrolytes as well as for administering antibiotics.
• Pain control medications are commonly given through a patient-controlled analgesia (PCA) pump whereby patients can actually administer their own dose of medications on demand. Pain medications occasionally can cause nausea and vomiting. Anti-nausea medications may then be given.
• Immediately after surgery, patients are encouraged to frequently perform deep breathing and coughing in order to avoid lung congestion and the collapse of tiny airways in the lungs.

What is involved in the rehabilitation process after total hip joint replacement?
• After total hip joint replacement surgery, patients often start physical therapy immediately! Eventually, rehabilitation incorporates stepping, walking, and climbing. Initially, supportive devices such as walker or crutches are used.
• Physical therapy is extremely important in the overall outcome of any joint replacement surgery. The goals of physical therapy are:
o to prevent contractures-resulting from scarring of tissues around joint, loss ROM
o improve patient education
o strengthen muscles around the hip joint through controlled exercises.
o given home exercise programs to strengthen muscles around the buttock and thigh.
• Most patients attend outpatient physical therapy for a period of time while incorporating home exercises regularly into their daily living.