Surgery

Osteoarthritis

Osteoarthritis (OA), also known as degenerative arthritis, is a slowly progressive joint disease causing destruction of joint cartilage and adjacent bone. Osteoarthritis has become the most common disease in the western world with the probability of 11% over age 65 and over 80% over age 80 of the total population. The probability of osteoarthritis in women is twice that of men.

Causes

General: aging, obesity and heredity.

Local:

  • Degenerative changes (Degenerative Osteoarthritis)
  • Inflammatory changes (Rheumatoid Arthritis)
  • Trauma to the joint and articular cartilage injury
  • Lack of blood supply to the bone (Avascular Necrosis) by trauma, steroid use, and alcohol use
  • Tumors and metabolic diseases

Most joint pain is caused by degenerative changes in the joint or inflammatory processes. Knees and hips are the most common major joints in the body that are affected by these changes.

Pathophysiology

The disease is characterized by loss of cartilage in the joint layer. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged leading to restricted movement and pain.

Symptoms

Symptoms usually manifest as gradual intermittent pain, especially during activity, and further develop to pain during rest and sleep. In addition, there is joint stiffness and functional limitation leading to decline in quality of life and increasing the risk of other related diseases.

Treatment

Treatments of OA intended to control pain and improve daily functioning by:

  • Non-pharmacological treatment: exercise, change of habits and weight loss.
  • Medication: Anti-inflammatory drugs (NSAIDs), steroid and hyaluronic acid injections.
  • Non-surgical treatment: designed to lower the load of the joint by splints / support (especially the knee), orthotics and physical therapy.
  • Surgical treatment: osteotomy with axis realignment of the limb (in young patients), arthroscopy and joint replacement.

Joint Replacement Surgery

The goals are pain control and improved functioning. Patients with significant pain in hip and knee joints, which affects the ability to perform everyday activities, and after failure of non-surgical treatment, are suitable for joint replacement.

Joint replacement surgery involves replacing the joint surfaces with artificial metal and plastic components. These have been shown to have a high survival rate in many studies, ranging between 93% – 97% to 15-20 years.

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