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Arthritis Surgery

Posted Jan 04 2010 6:00am

If you suffer from severe osteoarthritis, surgery may be in store for you.

Arthritis literally means joint inflammation. Most of the cases of arthritis involve the body joints but joints are not the only body parts to be affected by arthritis. In its various forms arthritis can also affect other parts of the body. It is one of the most commonly occurring diseases affecting people of all ages. However most of the victims are able to go about their business as usual.

At a body joint, ends of two bones come together. The ends of the bones are covered with cartilage which makes the surfaces of bone ends smooth for sliding against each other. The smoothness of surfaces makes it possible to carry out the joint movement easily and painlessly with minimum friction thousands of times in a day. The two bones of a joint are held together firmly in place by ligaments which also form a capsule around the joint. The surface of ligaments is lined with synovial membrane which secretes synovial fluid for lubricating the joint.

Osteoarthritis, one of the more common types, results when cartilage wears out. When this happens the ends of the bones in contact with each other lose their protective cover as well as the smooth gliding surface. The bone ends then directly rub against each other. The joint becomes stiff and starts paining. This osteoarthritis involves joints which are exposed to frequent wear and tear such as fingers, big toes, knees, hips, lower spine.

Surgery is no small choice, and doctors and the surgeons they work with are naturally reluctant to operate unless you meet criteria that they consider important.

Hand Arthritis Surgery

Hand Arthritis Surgery

Two of the key factors that all surgeons probably consider are the life-expectancies of the artificial joint and of you. Historically artificial joints last about 15 to 20 years. New technologies may extend this, but there’s really no one offering a guarantee that this will be so. For the new technologies, the long-term data just isn’t there yet. (That’s why it’s called “new.”)

Doctors call the replacement of an artificial joint gone bad a “revision.” And revisions are sometimes more difficult than the original operation. This also forms one more cause for reluctance in treating younger patients.

There seem to be two models that doctors and the surgeons they work with go by.

Model #1: Age and pain intensity.

In this model, the age is a critically important factor. If you’re expected to live, on average, to age 75 or 80, and the joint is only going to last 15 years, surgeons using this model will be reluctant to operate until you’re 65 years old.

The other parameter is pain intensity. No matter how old you are, if you need the replacement because the pain is just unbearable, many (most?) physicians will agree to operate.

Model #2: Add “life style”

In this model, the factors of the first model are still considered, but to them is added the question of whether you’re sacrificing your life right now in order to have some kind of “ideal state” when you’re 65.

This is clearly a subjective area for both the patient and the doctor, but in many cases, the evidence is so overwhelmingly clear that the call for a replacement of the joint is considered very reasonable.

And there are clear advantages to getting the artificial joint while you are younger.

  • Generally, you’re better able to withstand surgery when you’re younger than when you’re in your latter years.
  • Assuming the operation and recovery go well, you’ll have years of a better life that you can look back on when you’re older – even if at that time you get sidelined because a revision isn’t possible.
  • Technology is improving all the time. By the time you need a revision (assuming that the newer materials do wear out in 15 to 20 years), the procedures may be in place to make revisions much easier to successfully perform.

Concluding Remarks

This article is a clarion call for osteoarthritis patients to be advocates on their own behalf and to have a discussion of the effects that your osteoarthritis is having on your life. If you are severely restricted in what you can do, if your family is suffering so as to compensate for your pain, and if you can imagine what it would be like for you to see your loved ones in pain and know that this is what they feel about you right now, then it may be past due for you to have this conversation.

And if your physician and surgeon will not take lifestyle as an important factor, seek out a second, third and fourth doctor who will.

This is NOT a call for unnecessary or ill-advised surgery. It is a call for a very important discussion that you should have with your doctor.

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