Total joint arthroplasty for persons with osteoarthritis

Osteoarthritis is a process largely associated with aging, and Americans today are living longer than ever before, with the most recent data from the Centers for Disease Control and Prevention showing an average life expectancy of 78.2 years. With an increasingly older society, there will be an increased need for medical and surgical treatment of osteoarthritis. At the same time, a decline in the number of surgeons performing total joint arthroplasty is anticipated, by as much as 30% in some studies. Due to this anticipated shortage, nonoperative physicians will play a more prominent role in patient care and should become better educated in maximizing nonoperative care, recognizing appropriate surgical indications, and educating their patients on surgical outcomes. Total joint arthroplasty offers pain relief and potential functional improvement. Unfortunately, the outcomes for joint replacement differ significantly by the joint being replaced. The best examples of positive outcome for both pain relief and functional improvement are total hip arthroplasty and total knee arthroplasty. Shoulder arthroplasty has demonstrated encouraging outcomes but the outcome data is not yet as robust as the data for hip and knee arthroplasty. Elbow arthroplasty provides good pain relief but functional outcomes are not nearly as good, and significant potential complications exist. Lastly, ankle arthroplasty has not demonstrated outcomes that are as positive as the other major joints, and the criterion standard treatment continues to be ankle fusion. In this article, surgical options for arthroplasty will be reviewed for each of the major joints, including the joint-specific indications and outcomes for each procedure.