Surgical interventions in Severe Osteoarthritis: Pros and Cons

Author(s): Andre Aabedi, Marcel P Fraix, Devendra K. Agrawal

Severe osteoarthritis (OA) is a debilitating condition that often necessitates surgical intervention when conservative treatments fail. We carefully reviewed the literature on the pros and cons of surgical options for severe OA, focusing on total joint arthroplasty (TJA) and other surgical techniques. Total joint arthroplasty, including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is the most established surgical option for severe OA, providing significant pain relief, functional restoration, and improved quality of life. The American College of Rheumatology and the American Association of Hip and Knee Surgeons recommend proceeding to TJA without delay in patients with symptomatic moderateto- severe OA unresponsive to nonoperative therapy. Osteotomies and cartilage repair procedures are less commonly performed and have limited evidence supporting their long-term efficacy in reducing OA progression. Arthroscopic interventions, such as lavage and debridement, do not alter disease progression and are not recommended for routine treatment of OA. While TJA is highly effective, it is associated with risks such as postoperative complications, revisions, and reoperations. The costeffectiveness of TJA is well-documented, making it a favorable option for managing end stage OA. However, patient selection is crucial, and factors such as age, comorbidities, and obesity must be considered to optimize outcomes. Total joint arthroplasty remains the gold standard for surgical management of severe OA, offering substantial benefits in pain relief and functional improvement. Other surgical options, such as osteotomies and arthroscopy, have limited roles and should be considered based on individual patient factors and disease severity. Evidence-based guidelines support the timely use of TJA to enhance patient outcomes and quality of life.