Because motion in the joint is causing the pain, the goal of a fusion surgery is to stop the motion and thereby stop the pain. However, spine fusion surgery is generally not recommended for osteoarthritis of the spine since the arthritic condition tends to affect multiple vertebral levels in the spine initially or over time and multi-level fusions are generally not advisable. The spine is designed to move, and if motion is stopped along multiple adjacent levels of the spine, the significantly limited motion in the spine can in and of itself stress the spine and potentially cause pain.
In cases where osteoarthritis of the facet joint leads to spinal instability degenerative spondylolisthesis , fusion surgery can be considered to stop the instability for that particular joint. This generally occurs at the L4-L5 segment , and sometimes at L3-L4, levels of the lower back. If the arthritis is affecting the nerves in the spine, then surgical decompression of the nerve roots may be an option. As mentioned earlier, spinal arthritis may lead to the formation of bone spurs osteophytes , which are boney growths in the spine that form in response to the friction in the arthritic joint.
A bone spur may then intrude into the neuroforamen, which is the space where spinal nerves branch off from the spine and exit the spinal canal. The general diagnosis for this problem is called spinal stenosis. See What Is Spinal Stenosis? The type of surgery to remove bone spurs is usually a laminectomy.
The goal of a laminectomy is to relieve the pain and neurological symptoms by removing the bones spurs and any thick ligaments that are causing symptomatic nerve compression. You may need days or weeks of rest.
In addition, you may need to use splints, a cane, a walker, a wheelchair, or crutches before you are able to perform your usual tasks. Talk with your doctor about any short-term limitations and what you can expect during the recovery period. You may also be referred to an occupational therapist for advice on how to do your daily activities in ways that are safe for your joints. If your surgery involved your hand s or arm s , you will most likely be able to get up the first day after the operation.
If it involved one or both legs, how soon you are allowed out of bed will depend on the surgery. Often, you will be able to get up the first day after surgery, but it may be longer. Once your doctor has given permission for you to get up, you will begin to feel better the more you move around.
As soon as you're able and depending on the type of surgery you've had, you will begin physical therapy consisting of various exercises.
You must dedicate yourself to this program and be prepared to work hard. If you don't, your repaired joint may be less useful than it could be. Some pain is common during the early stages of physical therapy. This pain usually comes from the muscles, not the joint. Some of your muscles have not been used much or may have been working in abnormal ways to protect a sore joint.
Some muscles may have been cut and stitched during surgery. It is important to realize that muscles strengthen in response to exercise. An exercise that hurts today may hurt a little less tomorrow. You will see improvements in range of motion, along with decreased pain, as time goes on. You will have to work hard for the first few weeks after surgery to achieve range of motion, and a little less so for several months after that to regain strength.
As time goes on, keeping up with your physical therapy requires dedication. You may find that you're bored with the exercises, and you may be tempted to slack off. Remember that it takes time, but the rewards can be great. You should start to see some encouraging results, such as the ability to perform a task that was too painful to do before surgery. The combined efforts of your doctors, nurses, therapists--and most important--yourself are essential to success.
Costs will vary depending on the surgeon, anesthesiologist, admitting physician, hospital, type of surgery performed, medication, physical therapy requirements, types of implants used, and any other special tests or treatments.
Check with your doctor, insurance company, and if you qualify, Medicaid or Medicare to find out what your coverage includes. Do this before the surgery so you won't have any unpleasant surprises. A hospital stay is expensive. If you've already spent time in the hospital during the year, you should check your insurance policy for benefits coverage during the remainder of the year. You will probably want to check on the managed care requirements of your policy, which may include second surgical opinions and assigned length-of-stay designations.
Joint surgery is not for everybody. Even if your doctor and surgeon determine your condition would be improved by surgery, the decision to have the operation is up to you. You need to weigh your options and understand what the surgery will involve--before, during, and after surgery, and over the months of physical therapy.
It will require patience and the willingness to follow through with physical therapy. Your commitment is the key ingredient in the success of joint surgery. If you're not sure about having surgery, ask for a second opinion from another doctor. Ask your doctor to suggest a surgeon with arthritis experience. Sign a release form and ask that your medical records and X-rays be sen to the consulting physician.
Consider the advice of all your doctors carefully. Doctors, nurses, physical and occupational therapists, and social workers are part of the team that will work to make the surgery a success. Your family and friends are also members of the team. Look to them for emotional support and for assistance during your recovery.
But the most important team member is you. Understanding what surgery can do for you will be easier if you have a good idea of the structure of joints. A joint is a place in the body where two bones come together.
Ligaments are fibrous cords that attach bones to bones. Tendons are like ligaments except they connect muscles to bones. A bursa is a fluid-filled sac that acts as a cushion between muscles and bone or tendons. The tissue lining the joints is called the synovium.
In conditions like rheumatoid arthritis, the synovium becomes inflamed. This inflammation releases chemicals that, over months or years, will thicken the synovium and damage the cartilage and bone of the affected joints. Inflammation of the synovium causes pain and swelling. The ends of the bones are covered with cartilage. In osteoarthritis, the cartilage becomes cracked and pitted and no longer allows smooth movement of the joint.
When cartilage wears away in a weight-bearing joint such as the hip or knee, it can produce severe pain, deformity, and loss of mobility. Synovectomy is the removal of diseased synovium. This reduces the pain and swelling of rheumatoid arthritis and prevents or slows down the destruction of joints.
However, the synovium often grows back several years after surgery and the problem can happen again. Osteotomy Osteotomy is the correction of bone deformity by cutting and repositioning the bone, then resetting it in a better position. Osteotomy of the tibia shinbone is occasionally performed to correct curvature and weight-bearing position of the lower leg in people with osteoarthritis of the knee.
Resection Resection is the removal of part or all of a bone. This is often done when diseased joints in the foot make walking very painful and difficult. Resection is also done to remove painful bunions. Resection on parts of the wrist, thumb, or elbow can help improve function and relieve pain. Arthrodesis Arthrodesis, or bone fusion, is done to relieve pain, usually in the ankles, wrists, fingers, and thumbs.
The two bones forming a joint are joined together so that the resulting fused joint loses flexibility. However, a fused joint can bear weight better, is more stable, and is no longer painful. Arthroplasty Arthroplasty is the rebuilding of joints. This can be done by resurfacing or relining the ends of bones where cartilage has worn away and bone has been destroyed. Arthroplasty also refers to total joint replacement, where all or part of an arthritic joint is removed and replaced with metal, ceramic, and plastic parts.
Total joint replacement has been widely used for many years, and the results are usually excellent, especially in hips and knees. Other joints, such as the shoulders, elbows, ankles, and knuckles, may also be replaced.
With new materials, improved surgical methods, and a better understanding of replacement joint function, this procedure has enabled many people who were severely disabled to become more active again. Arthroscopy is a process that allows a doctor to see directly into the joint through an instrument called an arthroscope. This is a very thin tube with a light at the end. The arthroscope is connected to closed-circuit television. Arthroscopic surgery can be used to find out what kind of arthritis exists and how much damage is present.
Also, the surgeon can perform many other procedures such as biopsy, cutting away a loose piece of tissue that is causing pain, repairing a torn cartilage, or smoothing a joint where the surface has become rough.
Extensive surgery, such as synovectomy or reconstruction of ligaments, is also performed through an arthroscope. The advantage of arthroscopic surgery is that it does not require as much anesthesia or as much cutting as a standard operation.
A person can recover from it much more quickly and start walking sooner. The procedure is most often done on the knee or shoulder, but is being used more often on other joints such as the elbow, wrist, and ankle.
The loss of hand function is a serious matter, especially when the hands are also painful. Post op X-ray of patient who has undergone arthroplasty of both knees. Most patients need to continue taking medication to protect their other joints.
In some cases, however, if the most problematic joint is treated successfully, the dose of medication taken may be reduced. Figgie says. Steroids can cause bone and muscle atrophy, and there's the ongoing problem of suppressing the immune system. In arthrodesis, the affected joint is fused, eliminating both motion and discomfort. This surgery is considered a "last resort" treatment since the associated lack of mobility can hinder the patient's functional ability.
In certain joints, however, where range of motion is less important as in the heel or in the big toe, this surgery can provide a satisfactory and lasting resolution of symptoms.
As with arthroplasty and synovectomy, the patient continues to take medication to protect their other joints, although the dosage may be reduced. However, in some situations, an arthrodesis is the best option," says Dr. Post op X-ray of patient who has undergone arthrodesis of both wrists. Patients with inflammatory arthritis are at greater risk for complications associated with surgery than individuals without the disease. In addition to lowered immunity due to drug therapy, the quality of their bones, and deformities of the joint may contribute to poor outcome.
Some problems are diagnosis-specific. Patients with lupus, for example, are particularly vulnerable to avascular necrosis AVN , a condition in which blood supply to the bone is cut off and the bone dies.
This may occur due to the high doses of steroids that are required to control their disease. Patients with Ankylosing Spondylitis have more difficulty regaining motion due to the stiffness of their tissues from the disease.
The orthopedists and rheumatologists who serve on the Surgical Arthritis Service at HSS have many years of experience in treating patients with inflammatory arthritis. Indeed, many patients have formed close relationships with this group of physicians and their colleagues who continue to treat each stage and development of the disease.
Conditions that fall into the category of inflammatory arthritis include: Rheumatoid arthritis Juvenile inflammatory arthritis Psoriatic arthritis Ankylosing Spondylitis Reactive arthritis Systemic Lupus Erythematosus Lupus Lyme disease In recent years, medical treatments for these conditions have expanded considerably. A Team Approach for the Surgical Patient To deal with the complexities of treating those patients with inflammatory arthritis who do require orthopedic surgery, at Hospital for Special Surgery HSS , a collaborative approach is used.
In addition to the systemic nature of the disease, and the effect of medications, this group must consider: the effect the disease can have on multiple joints physical limitations psychosocial challenges complex deformities poor bone quality higher complication rates This picture demonstrates severe and advanced RA in which significant joint damage has occurred.
Types of Surgery Surgical options for inflammatory arthritis include synovectomy , arthroplasty , and arthrodesis. Synovectomy In inflammatory arthritis, the synovium grows abnormally and produces an excessive amount of fluid that "eats away" at the cartilage, which results in pain and swelling. Arthroplasty When the cartilage in a joint is severely damaged, replacement with a prosthesis may be necessary. Post op X-ray of patient who has undergone arthroplasty of both hips Post op X-ray of patient who has undergone arthroplasty of both knees Most patients need to continue taking medication to protect their other joints.
Post op X-ray of patient who has undergone arthrodesis of both wrists Potential Complications Patients with inflammatory arthritis are at greater risk for complications associated with surgery than individuals without the disease. In-person and virtual physician appointments. Book online. Urgent Ortho Care. Same-day in-person or virtual appointments.
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