Surgical management of osteoarthritis: options and outcomes

Abstract

Purpose: To review the options and outcomes of surgical management of osteoarthritis of the knee and hip. Methods: Review of pertinent peer reviewed literature. Results: Arthroscopic lavage and debridement are no more efficacious than sham surgery or physical therapy in the management of osteoarthritis of the knee. The efficacy of arthroscopic partial meniscectomy in the management of meniscal tear in the setting of knee ostearthritis is uncertain and requires further study. There has been little rigorous comparison of osteotomy or unicompartmental knee arthroplasty with nonoperative treatments for knee OA. Total joint arthroplasty is an effective and cost effective intervention for advanced knee or hip osteoarthritis. The utilization of total knee arthroplasty has expanded considerably into younger and older populations, particularly patients <65 years old. The outcomes of TKA in this population requires careful study. New surgical approaches, devices and biomaterials are introduced routinely in an effort to improve outcomes of total joint arthplasty. These innovations must be scrutinized carefully before widespread adoption in order to ensure that they improve upon the excellent short and long term outcomes achieved with existing technology. Conclusions: While continued research is needed urgently to optimze use of these costly interventions, a growing body of evidence permits judicious use of surgical interventions for osteoarthritis of the hip and knee.