The Surgical Treatment of Osteoarthritis

Abstract

Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

Keywords: CAOS; ankle and foot; computer-assisted orthopaedic surgery; elbow; hip; knee; osteoarthritis; shoulder; spine; wrist and hand.

Figure 1

Interspinous spacer. Postoperative X-ray after interspinous spacer implantation (L4–L5 segment).

Figure 2

Interposition (anconeus) arthroplasty. (a,b) preoperative X-rays; (c,d) postoperative X-rays after interposition anconeus arthroplasty.

Figure 3

Interposition (anconeus) arthroplasty, intraoperative images. (a) radial head resection; (b) anconeus muscle preparation; (c) the final position of the interposed anconeus muscle.

Figure 4

Varus femoral osteotomy. (a) preoperative X-ray; (b) postoperative X-ray.

Figure 5

Periacetabular osteotomy (PAO). (a) preoperative X-ray and patient-specific 3D preoperative planning; (b) preoperative 3D CT, planned position of the 3D reoriented acetabular fragment and postoperative X-ray after PAO according to the preoperative patient-specific 3D plan.

Figure 6

Bilateral distal femoral osteotomy (DFO). (a) preoperative X-ray of bilateral limb torsional deformity; (b) postoperative X-ray after bilateral DFO.

Figure 7

Dome-shaped supra-malleolar osteotomy. (a) preoperative X-ray; (b) intraoperative X-ray; (c) postoperative X-ray.

Figure 8

Anterior cervical discectomy and fusion (ACDF). (a) preoperative X-ray; (b) postoperative X-ray of the ACDF (C5–C6 segment).

Figure 9

Shoulder arthrodesis. (a) preoperative X-ray after failed shoulder arthroplasty; (b) postoperative X-ray after shoulder arthrodesis.

Figure 10

Elbow arthrodesis. (a) preoperative X-ray; (b) postoperative X-ray after elbow arthrodesis; (c) intraoperative image.

Figure 11

Secondary conversion of a hip arthrodesis to a total hip arthroplasty. (a) preoperative X-ray after left hip arthrodesis; (b) postoperative X-ray after secondary conversion to a total hip arthroplasty.

Figure 12

Knee arthrodesis. (a) preoperative X-ray in a splint; (b) postoperative X-ray after limb salvage knee arthrodesis with a nail.

Figure 13

Knee arthrodesis. (a) preoperative X-ray of residual knee deformity after severe trauma; (b) postoperative X-ray after limb salvage knee arthrodesis with Ilizarov technique.

Figure 14

Ankle arthrodesis. (a) preoperative X-ray; (b) postoperative X-ray after ankle arthrodesis.

Figure 15

Reverse total shoulder arthroplasty (rTSA). (a) preoperative X-ray; (b) postoperative X-ray after reverse total shoulder arthroplasty.

Figure 16

Total elbow arthroplasty. (a) preoperative X-ray; (b) postoperative X-ray after total elbow arthroplasty.

Figure 17

Bilateral total hip arthroplasty (THA). (a) preoperative X-ray; (b) immediate postoperative X-ray after one-stage bilateral total hip arthroplasty.

Figure 18

Unicompartmental (partial) knee arthroplasty (UKA). (a) preoperative X-ray; (b) postoperative X-ray after unicompartmental knee arthroplasty for isolated knee osteoarthritis of the lateral compartment.

Figure 19

Patellofemoral arthroplasty. (a) preoperative X-ray of isolated patellofemoral osteoarthritis caused by torsional limb deformity; (b) postoperative X-ray after patellofemoral arthroplasty with concomitant distal femoral osteotomy (DFO) for limb deformity correction.

Figure 20

Total ankle arthroplasty (TAA). (a) preoperative X-ray; (b) postoperative X-ray after total ankle arthroplasty.