Fundamentals of osteoarthritis: Surgical therapy in osteoarthritis

To deliver an updated, evidence-based overview of the different surgical therapies for osteoarthritis (OA).

This narrative review reports on principles of surgical therapies for severe, end stage OA and of options addressing pre-osteoarthritic deformities, aiming to possibly delay OA development. It focuses primarily on joint arthroplasty and other surgical approaches for the knee, hip and other major joints affected by OA.

Surgical therapy in end-stage OA aims to reduce pain and restore joint function, allowing patients to regain their regular activities. Usually, this involves total joint arthroplasty (TJA), by far the most common surgical procedure addressing severe hip and knee OA, with a high evidence supported by randomized controlled trials and registry data. Evidence for osteotomies around the knee to delay TJA is fair. High-quality evidence supporting other surgical therapies addressing pre-osteoarthritic deformities to possibly delay OA progression and for other joints affected by OA is weaker compared to TJA.

Surgical therapy is an important part of the continuum of care when conservative methods fail to provide adequate pain relief, classically indicated in cases of end-stage OA in older patients. Total knee and hip arthroplasty are the gold standard procedures, providing significant pain relief and improved function. Future studies need to confirm the long-term potential of other surgical therapies addressing pre-osteoarthritic deformities to possibly delay OA progression.