Why do people with osteoarthritis have joint surgery?
Surgery for osteoarthritis is only recommended when other non-surgical treatments haven’t been effective. The goal of surgery in OA is to replace the damaged joint surfaces with artificial coatings through a procedure called total joint arthroplasty (TJA). This is a well-established surgical option for advanced osteoarthritis, especially in the hip and knee. TJA is often successful, providing significant pain relief, restoring function, and improving the overall quality of life for people with advanced OA.
When should I talk to my doctor about joint surgery?
If you have any of the following signs you should talk to your doctor about the possibility of surgery. •
- You have pain that stops you going to sleep at night.
- Your pain does not improve with rest, medicines, exercise or other treatments.
- Your affected joint makes it difficult for you to look after yourself (such as showering, getting dressed, preparing meals, getting out of a chair) and you require help from others for everyday tasks.
- Your condition makes it difficult for you to work or look after people who require your care.
- Your pain is keeping you from doing things you enjoy, such as exercising or doing hobbies.
Do I need surgery for my osteoarthritis?
If you and your doctor think you may require surgery, your doctor will refer you to an orthopaedic surgeon. The surgeon will assess you and recommend whether or not you will benefit from surgery. In some cases surgery may not be recommended. If surgery is recommended it is still your decision whether to have it, you may seek a second opinion regarding the surgery. Before you decide, make sure you understand:
- the possible benefits
- the specific risks with this type of surgery
- whether there are any other options
- what will happen if you don’t have this surgery
- the likely cost
Remember not having surgery is always one of your options. Your doctor or surgeon should be happy to arrange a second opinion if you want one.
What are the common types of surgery for osteoarthritis?
Arthrodesis: Sometimes referred to as joint fusion, this surgery involves fusing (joining) the two bones forming the joint together. If the fused joint cannot be moved and this may reduce pain. This type of surgery is most commonly done on ankles, wrists, fingers or thumbs. It is usually done as a last resort.
Arthroscopy: is often called ‘key hole’ surgery. A thin instrument (arthroscope) is put into your joint through a small cut in the skin. The arthroscope is a telescope and allows the surgeon to see directly into your joint. It can be connected to a camera to allow for better viewing of your joint and recording of pictures. The cause of the symptoms can be seen and sometimes be treated (for example, remove or repair torn cartilage). This type of surgery is usually done on knees and shoulders. This type of surgery is discouraged for osteoarthritis and degenerate meniscal tear1,2.
Osteotomy: involves cutting and repositioning a bone. This can help put the joint into better alignment and reduce pressure on the affected side of the joint. This type of surgery is usually done on knees and occasionally hips
Resection: is the removal of part or all of a bone or an entire joint. This is often done for damaged joints in the foot and big toe.
Synovectomy: is an operation to remove the lining of the joints, the synovium. This may be effective for osteoarthritis, to reduce pain, swelling and joint damage. However the synovium may regrow several years later and the symptoms can return.
Total Joint Arthroplasty: is also called total joint replacement. This involves the removal of damaged surfaces of the joint. These surfaces are then replaced with metal, ceramic or plastic parts. The entire joint can be replaced (total arthroplasty) or just one part of the joint (hemiarthroplasty). Joint replacements can be done on knees, hips, shoulders, elbows, fingers, ankles, toes and even the spine.
What are the risks of surgery for osteoarthritis?
All surgery has risks. There are general risks with having any type of operation, as well as specific risks related to the type of surgery. Make sure you understand the possible risks, their likelihood and their consequences before you decide to have surgery3. You should discuss this carefully with your surgeon.
Getting ready for surgery
Here are some tips to help you prepare for surgery:
- Plan for recovery and returning home. During your recovery, which may take days, weeks or even months, you may need help with daily tasks such as cooking and showering. Make sure you have family and/or friends available to help you during this time. If you do not have help available, talk to your doctor about local support services or staying at a rehabilitation centre after surgery.
- Some people recovering from hip surgery have found recliner lift chairs to be a helpful aid when getting up from sitting and to assist with staying active in the early stage of recovery from total hip arthroplasty.
- You may be required to attend an assessment at the hospital before your surgery. This is a good chance for you to ask questions about your surgery and recovery. Also, you may be able to talk to a physiotherapist or occupational therapist about any equipment you may need, such as crutches and handrails in the shower.
- Lose weight if you are overweight.
- Stop smoking
- Start an exercise program. People with greater fitness and muscle strength usually recover more quickly from surgery. If you have severe pain, you may find water exercise more comfortable. See a physiotherapist for hydrotherapy, or contact your local Arthritis Office for details of warm water exercise classes.
- You will probably need to follow a physiotherapy or exercise program after surgery. Be ready for several weeks or even months of exercise. Remember, the amount of effort you put into your program can make a big difference in how well you recover.
Your healthcare team can give you more advice and information about whether any of these or other treatments might be useful for you. If looking for more information to assist with making a decision as to whether to have surgery or not a decision support tool may help3.
Other resources
State/Territory Arthritis Offices
Your local Arthritis Office can provide further information to assist you and will have a range of education and support activities. Click here to find your local office.
Websites & resources
Osteoarthritis of the knee decision support tool available at: safetyandquality.gov.au
The American Academy of Orthopaedic Surgeons has a wide range of information sheets about joint surgery available at: www.aaos.org
The Australian Physiotherapy Association can help you ‘find a physio’ specialising in hydrotherapy (aquatic physiotherapy) at www.physiotherapy.asn.au
References
The below references have been used to develop this fact sheet with the most up-to-date evidence available.
- Position Statement From the Australian Knee Society on Arthroscopic Surgery of the Knee, Including Reference to the Presence of Osteoarthritis or Degenerative Joint Disease: Updated October 2016. Orthop J Sports Med. 2017;5(9):2325967117728677.
- Gibbs AJ, Gray B, Wallis JA, et al. Recommendations for the management of hip and knee osteoarthritis: A systematic review of clinical practice guidelines. Osteoarthritis and cartilage. 2023;31(10):1280-1292.
- Australian Commission on Safety and Quality in Health Care. Evidence Sources: Osteoarthritis of the Knee Clinical Care Standard. In:2017.
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