Osteoarthritis: Treatment Options and Minimally Invasive Surgery

Degenerative arthritis

Hello, Director Shi! My mother-in-law, who is over 70 years old, has been experiencing knee pain for the past few years and has been diagnosed with osteoarthritis.
She has been taking supplements, applying ointments, wearing knee braces, undergoing rehabilitation, and seeing a traditional Chinese medicine practitioner.
However, her pain has become unbearable recently.
I would like to ask:
(1) Is surgery absolutely necessary? A friend mentioned hyaluronic acid injections; how much do they cost and are they effective?
(2) I heard there is a type of "minimally invasive surgery" that allows for a quick recovery to normal activities post-surgery.
What are the advantages and disadvantages of this compared to traditional surgery? Is it suitable for everyone? Will the out-of-pocket costs be higher?
(3) Can minimally invasive surgery be performed at major hospitals? Could you recommend any hospitals or doctors? We live in New Taipei City.
Thank you for your time in answering these questions!

Ms. Wu, 40~49 year old female. Ask Date: 2010/02/02

Dr. Shi Guozheng reply Orthopedics

Whether surgery is necessary for degenerative arthritis depends on the severity of the patient's condition.
In addition to symptoms, an X-ray examination is required to assess if the joint surfaces have been worn down beyond recovery, and surgery is only considered if medication and rehabilitation treatments are ineffective.
Hyaluronic acid injections have specific indications and should be discussed with a physician before making a decision.
The effectiveness of these injections may be limited in cases of severe arthritis.
Many hospitals, including the one I am affiliated with, offer minimally invasive surgical options, and patients can refer to various hospital websites for more information.
Typically, minimally invasive surgeries allow for quicker recovery and smaller incisions; however, they may not be suitable for overweight individuals or those who have previously undergone surgery on the same joint.
The out-of-pocket costs are generally similar.

Reply Date: 2010/02/02

More Info

Osteoarthritis (OA) is a degenerative joint disease that commonly affects older adults, leading to pain, stiffness, and reduced mobility. In your case, your elderly mother has been diagnosed with OA and has been managing her symptoms through various conservative treatments, including supplements, topical medications, knee braces, physical therapy, and traditional Chinese medicine. However, as her pain has become unbearable, you are seeking further options.

1. Is Surgery Necessary?
Surgery is not always the first line of treatment for osteoarthritis. It is typically considered when conservative measures fail to provide relief. In cases where pain is severe and mobility is significantly impaired, surgical options may be warranted. One common procedure for advanced OA is knee arthroplasty (joint replacement). However, before considering surgery, it's essential to evaluate the effectiveness of non-surgical treatments. Hyaluronic acid injections, often referred to as "gel shots," can provide temporary relief by lubricating the joint, but their effectiveness varies among individuals. The cost of these injections can range from $500 to $1,500 per knee, depending on the provider and whether insurance covers it.

2. Minimally Invasive Surgery vs. Traditional Surgery:
Minimally invasive surgery (MIS) refers to techniques that use smaller incisions, resulting in less tissue damage, reduced pain, and quicker recovery times compared to traditional open surgery. For knee OA, procedures such as arthroscopy can be performed to clean out damaged tissue or remove loose bodies in the joint. The advantages of MIS include shorter hospital stays, less postoperative pain, and faster rehabilitation. However, not all patients are candidates for MIS, and the extent of joint damage may dictate the need for more extensive procedures like total knee replacement. Additionally, while MIS may have lower upfront costs, it can sometimes lead to higher overall expenses if additional treatments are needed later.

3. Availability of Minimally Invasive Surgery:
Minimally invasive procedures are widely available in many hospitals, especially those with orthopedic departments. In Taipei County, you can find reputable hospitals and orthopedic surgeons who specialize in these techniques. It is advisable to consult with an orthopedic specialist who can assess your mother's condition and recommend the most appropriate treatment plan. They can also provide information on the specific types of minimally invasive surgeries available and whether they are suitable for her case.

In conclusion, while surgery may be a viable option for your mother, it is essential to weigh the benefits and risks of both surgical and non-surgical treatments. Consulting with an orthopedic specialist will provide clarity on the best course of action tailored to her specific needs. Additionally, exploring the potential of hyaluronic acid injections may offer temporary relief while considering longer-term solutions. Ultimately, the goal is to improve her quality of life and restore her mobility as much as possible.

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