Arthroscopy to Treat Arthritis

Degenerative joint disease (DJD), commonly known as “arthritis” has been the subject of this column on more than one occasion. Its repeated inclusion is justified for several reasons. It affects millions of people worldwide. It is one of the most common reasons for patients to visit an orthopaedic surgeon. And, probably most importantly, the therapeutic options for managing DJD (osteoarthritis) are advancing at an astounding pace.

DJD is a condition that affects one or more joints and results from a mechanical cause rather than immune or infectious cause. It can occur in virtually any joint but is common in the joints of the lower extremity that bear the majority of weight. Degenerative joint disease affects many adults at a variety of ages but is more common after middle age. Several factors may predispose one to developing DJD including genetics, occupation and previous injury.

Although DJD is a chronic condition, acute injuries may superimpose themselves on the long-term problem. For example, people with DJD of the knee may also have a torn meniscus cartilage. The latter condition is very correctable with a minor procedure. Recent advances in understanding, research and technology are allowing orthopaedic surgeons many more options in the treatment of arthritis than ever before.

Synthetic joint fluid injections, the subject of a previous column, are a highly effective treatment in some people. These injections are minimally invasive, relatively inexpensive and may provide moderate and long-term relief of symptoms.

Advances are also being made in the area of pharmaceutical. New anti-inflammatory medicines are available that decrease the pain and inflammation associated with arthritis without the gastrointestinal side effects that can be associated with their predecessors. These medicines are known as COX-2 inhibitors (for example, Celebrex). If you’ve been unable to take arthritis medicine previously due to the GI side effects, ask an orthopaedist if Celebrex is right for you.

From a surgical standpoint, orthopaedic surgeons have adapted the minimally invasive arthroscopic (scope) techniques to treat mild to moderate DJD. It has long been known that arthroscopy is an invaluable tool in the surgical treatment of sports injuries. Anyone who has had a torn cartilage, ACL reconstruction, or kneecap surgery in recent years is likely to be familiar with the knee scope. More recently however, it has been proven that the knee scope is a very effective treatment for DJD. Using the fiber optic camera, the surgeon can trim away the frayed cartilage, smooth the join surfaces using a shaver or laser, and correct many overlying acute and chronic problems such as a torn cartilage that are common in patients with DJD. Also, the saline that is introduced into the joint during the surgery serves as a lavage or washout which washes away many of the inflammatory molecules that are responsible for pain, stiffness, and soreness. It should be noted that arthroscopy is not a cure for arthritis. Rather, it is yet one more way that orthopaedic surgeons can manage and slow the progression of the disease. Although, the procedure is largely palliative, many patients have significantly reduced symptoms for 1-4 years following surgery.

The gold standard for the treatment of advanced DJD is still knee replacement. The vast majority of patients who undergo knee replacement surgery have little or no pain and much less stiffness and soreness after recovering form surgery. Advances in understanding the mechanics of the knee and hip have led to safer, more effective and longer lasting prosthetic joints. Today, artificial knee joints more closely approximate the mechanics of the normal knee than ever before. Also, the surgery has been streamlined so that the new knee can be implanted with minimal time under anesthesia.

The average patient who receives a new knee joint in 1999 can expect for the joint to last in excess of 20 years with normal usage. It is not necessary for most people to live with the pain and stiffness of arthritis until they need a knee replacement. Talk with an orthopaedist to see if one of the new treatments would work for you.

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