When conservative measures have failed to provide any relief, or the disease progresses beyond control, surgical options may be considered. Consultation with an orthopedic surgeon is then indicated. Orthopedic surgeons are specialists at treating bone and joint conditions. All graduate from medical school and complete a five to six year residency. During their residency, they are trained in the surgical management of arthritis. Some orthopedic surgeons subspecialize in arthritis surgery and may have had additional training in this area through a fellowship with another subspecialist.
Dr. Fisher will be interested in learning about the history of your problem, as well as your medical history in general. An examination of your joints will be performed. If not already available, X-rays will be needed to evaluate your painful joint and assess the degree of cartilage damage. Dr. Fisher will look for evidence of cartilage loss, bone spurs, bone cysts or other evidence of arthritis.
Surgical options may include an arthroscopy, osteotomy, partial or total joint replacement. An arthroscopy is an outpatient procedure in which Dr. Fisher inserts a fiberoptic scope into the joint to visualize the inside. An assessment of the damage can be made and in many cases, the joint can be cleaned up to relieve pain or catching that the patient may feel. It can be very effective for catching or locking symptoms. Unfortunately, arthroscopy is not as effective for arthritis as it is for younger patients who injure their joints. Therefore, arthroscopy is generally not recommended when advanced changes are seen on X-rays.
Some patients will have worn out only a part of their joint cartilage while the rest remains, relatively healthy. In these cases, the joint can be surgically altered to take the stress off of the bad cartilage and place it on the healthy part. This procedure is called an osteotomy and involves surgically cutting the bone above or below the joint and changing the mechanics of the joint. Once healed, this can give good pain relief for many years. Over 85 percent of the patients can expect satisfactory results over the first two years with a gradual deterioration over time. This is a good procedure for young patients with certain types of arthritis.