Arthritis Pain – Do I Need Surgery? Part 3

This is part 3 of my discourse on arthritis.  The first two blogs discussed various non-operative treatments for arthritis including weight loss, therapy, exercises, medication, bracing, etc.  For many people, these non-operative treatments will not adequately control their symptoms forever.  They will become limited by their pain and/or stiffness.  They will not be able to adequately perform desired activities like walking, running, exercising, going to the store, etc.  In the upper extremities, people may have trouble moving their arms, gripping, lifting, getting dressed, cleaning themselves, opening jars, etc.  A fair number of people will be burdened with pain at rest or at night in their arthritic joints.

For those people who have failed non-operative treatment, surgery then becomes a consideration.  Patients who are interested in surgical intervention should see their orthopaedic surgeon to discuss their options.  One thing to keep in mind is that while most surgical patients will experience a significant improvement in their function and quality of life, arthritis is not a life-threatening condition.  Nobody ever needs to have surgery.  This is important because your doctors may determine you are not a good surgical candidate.  Orthopedic surgeons will often work with a patient’s primary care physician, cardiologist, nephrologist, etc to determine if their patient is “medically cleared” for surgery.  Since there are no guarantees in medicine, the phrase “medically cleared” is perhaps better thought of as risk stratification.  A recent heart attack is classic reason why somebody may not be a good surgical candidate.  Other medical conditions put patients at increased surgical risk including uncontrolled diabetes, uncontrolled hypertension, morbid obesity, carotid artery or peripheral artery stenosis, kidney or liver failure, chronic viral infections, and heart or lung disease, to name some common medical conditions. Often times, medical risks can be optimized or improved around time of a surgery.  Even quitting smoking around a surgery may decrease wound healing complications.

Written by Sean Brimacombe, MD

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