Joint Surgery – what you need to know

Joint surgery is a big decision and it’s important that you are well informed about your options. There are many different types of surgery for various joints that may be beneficial to you.

For hips and knees, it’s important to be aware that the 2018 ‘Royal Australian College of General Practitioners Guidelines for the management of knee and hip osteoarthritis’ puts strong focus on self-management and non-surgical treatments, rather than surgery.

Learn more below about joint surgery – the why, when, types, current recommendations – the questions to ask your doctor and planning for surgery.

Why do people with arthritis have joint surgery?

Most types of surgery for arthritis are performed to:

relieve severe pain that has not responded to other less invasive treatments
improve movement and use of a joint, for example improve flexibility of your hip to allow you to walk and sit more comfortably
improve alignment (position) of joints, for example straighten finger joints to allow you to grip and hold objects.

This can help make daily activities easier and improve your quality of life.

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. However, be aware that the surgeon may stall you from getting the surgery if it’s not medicinally recommended.

What are the common types of surgery for arthritis?

Arthrodesis: involves fusing (joining) the two bones forming the joint together. As the fused joint cannot be moved it is no longer painful. This type of surgery is most commonly done on ankles, wrists, fingers or thumbs.
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). For people with osteoarthritis of the knee, arthroscopy is not an effective treatment for pain and is not recommended unless your knee locks.
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 is effective for rheumatoid arthritis, to reduce pain, swelling and joint damage. However the synovium may regrow several years later and the symptoms can return.
Joint replacement: is also called arthroplasty. 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. In Sources & Further Reading below, see item 3. Joint Replacement Booklet for more information.

Royal Australian College of General Practitioners (RACGP): Guidelines for the management of knee and hip osteoarthritis

The 2018 RACGP Guidelines for the management of knee and hip osteoarthritis puts strong emphasis on self-management and non-surgical treatments to improve the health of people with knee and/or hip OA.

In fact the guidelines state that: ‘There is a strong recommendation against surgery such as arthroscopic lavage and debridement, meniscectomy and cartilage repair for people with knee OA, unless the person also has signs and symptoms of a ‘locked knee’. This is important to keep in mind when discussing surgery with your GP and/or specialist.

Self-Management outlined in the Guidelines includes “exercise, weight management, cognitive behavioural therapy, hot & cold therapy, assistive devices, manual therapy, TENS and certain medications. “

To read further detail, refer to Sources & Further Reading below, item no 2. RACGP Guideline for the management of knee and hip osteoarthritis, pages 1-3 include a summary and page 59 outlines their recommendations on surgical intervention.

Questions to ask your Doctor

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.

All surgery has risks and varying outcomes. 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 surgery. You should discuss this carefully with your surgeon.

In some cases surgery may not be recommended.

If surgery is recommended it is still your decision whether to have it. Before you decide, make sure you ask the following:

What are the possible benefits?
What are the specific risks with this type of surgery?
Are there are any other non-surgical options?
What will happen if I don’t have this surgery?
What is the likely cost for both the surgery and post-surgery therapy?
What are my options in the private vs public system and what are the waiting lists like?

Remember not having surgery is always one of your options, particularly given the RACGP Guidelines above for hip and knee OA. Your doctor or surgeon should be happy to arrange a second opinion if you want one.

Private Health Insurance Coverage

If you are going through the private health system, you need to be aware of the new tiered system which came into effect on 1 April 2019. The tiers include the following coverage for joint surgery. Contact your health insurance provider to check on your level of cover and what you can expect to get back.

Joint re-constructions –Bronze, Silver and Gold Tiers
Such as knee or shoulder re-constructions including torn tendons, rotator cuff tears, damaged ligaments
Bone, Joint & Muscle – Bronze, Silver and Gold Tiers
Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system including carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis, bone cancer
Back, Neck & Spine – Silver and Gold category
Hospital treatment for the investigation and treatment of the back, neck and spinal column, including spinal fusion and sciatica, prolapsed or herniated disc, spine curvature disorders such as scoliosis, kyphosis and lordosis
Joint Replacements – only covered in Gold Tier
Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses. Such as replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint and spinal disc replacement

Planning for Surgery

Here are some tips and recommendations 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.
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 information about our ANSW exercise programs here.
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.

If you are considering surgery, remember it’s important to be well informed and discuss any concerns you may have with your GP, rheumatologist or surgeon. Surgery isn’t a cure, you will still need to manage your weight, stay strong and flexible through exercise and take prescribed medications to maintain your overall health.

Refer to the links below for further information.

Sources & Further Reading

Please note that every person and surgery is unique, this article is not a substitute for expert medical advice.

For more useful information about managing your condition, please refer to our other BLOG articles here https://www.arthritisnsw.org.au/news/news-articles/