Tx and Followup:
Surgical treatment is indicated in severely affected joints that are unresponsive to conservative treatment, leading to pain at rest that interferes with sleep, inability to bear weight without severe pain, unacceptable interference with daily activity, and a requirement for narcotics to control pain. Osteotomy to correct the mechanical defects in OA of the knee and early OA of the hip does seem to provide some short-term benefit. However, no good studies have been done comparing such surgical therapy with medical management, and results of long-term follow-up are often disappointing. Such surgeries are usually used as a temporizing measures to delay total joint replacement. Arthroscopic surgery, to smooth joint surfaces and wash out of debris, appears to benefit the patients who undergo the procedure. Total joint replacement is the procedure most commonly indicated when the joint has lost its articular cartilage surfaces, or when other procedures have failed or are unfeasable. Such surgeries are, luckily, often very successful but require a demanding period of rehabilitation afterwards.