Essential facts

Introduction

Surgery for arthritis is generally considered when medical management fails to control troublesome symptoms. The most common indication for surgery is to relieve pain. However, there may be other indications, including progressive deformity and disability resulting from the acquired stiffness that is a feature of most progressive arthritic conditions. More detailed information on these surgical procedures may be found within the chapters dealing with regional joint pathology.

Arthroscopy

Arthroscopy is examination of a joint with a rigid endoscope. It was first used in the knee joint, but is now used for most major joints including the wrist, elbow, shoulder, hip, knee and ankle (Fig. 8.1). Arthroscopy was formerly commonly used for diagnostic purposes, but the use of computed tomography (CT) and magnetic resonance imaging (MRI) has largely supplanted this. In most situations, arthroscopy is now used for operative treatment of joint disorders (Box 8.1). Although it can be used in many joints, the majority of arthroscopies in clinical practice are performed on the knee or shoulder joint.

FIGURE 8.1 Photograph showing knee arthroscopy

The scope of surgical procedures that can be carried out using arthroscopic surgery has greatly increased in the past two decades.

Repair or excision of intra-articular soft-tissue structures

Many joints have intra-articular structures that can be injured during normal or sporting activity. These structures include the meniscus of the knee, the glenoid labrum in the shoulder and the acetabular labrum in the hip joint. When these structures tear they can produce mechanical symptoms. Surgical excision or repair of the damaged structure by arthroscopy has largely supplanted open surgery to deal with these problems.

Joint stabilization

Recurrent joint instability usually requires open surgery to correct the problem. However, anterior shoulder instability is now amenable to arthroscopic stabilization, and success rates approach those that can be achieved by open surgery. Similarly, patellar instability in selected cases can be treated by arthroscopic lateral release, which avoids more major open surgery.

Loose bodies

Loose bodies may form in joints due to a variety of conditions, most commonly trauma, osteochondritis dissecans and synovial osteochondromatosis. Retrieval or replacement and fixation can be carried out arthroscopically.