Arthritis Pain – Do I Need Surgery? Part 4

In the previous blogs I discussed conservative, or non-operative, treatment for arthritis.  Most Americans will have arthritis in at least one joint in their lifetime.  Fortunately, the non-operative treatments will be sufficient to control the symptoms of arthritis.  For those who have failed conservative treatment and have been cleared for surgery, many surgical options are available.  Joint replacements are available for most joints in the body.

Not surprisingly, when I discuss joint replacements with patients, they often think everything about the joint is replaced.  If we look at a joint in a more detailed level, we see that this concept is not true.  A joint is comprised of multiple different anatomic structures.  Cartilage covered bones are held together with muscles, ligaments, and capsules.  Take the knee for example.  We have three bones: the femur, tibia, and patella.  The tibia and femur are connected directly by 4 ligaments: the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament.  These are static stabilizers of the knee.  More dynamic stabilizers holding the joint together are the muscles and tendons of the quadriceps, the hamstrings, and the gastrocnemius.  These muscles can even strengthen and work to compensate for tears of ligaments.  This is especially true of anterior cruciate ligament tears and hamstring strengthening.  Finally, thick fibrous tissue called a capsule surrounds the joint.  This tissue layer holds the lubricating joint fluid.

When we replace a joint, we basically replace the cartilage surface of the bone with metal and/or plastic.  In general, we try to preserve the surrounding muscles, tendons, and capsule during surgery.  Inevitably, some of these structures are violated in order to get to the bone.  We repair those structures when we can and sacrifice them when necessary.  So when you have a total joint replacement, you are essentially having a joint resurfacing procedure.

Written by  Dr. Brimacombe, MD 

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