• Patients with severe symptomatic osteoarthritis who have no improvement with medical therapy and with progressive limitation in daily activities should be referred to an Orthopedic surgeon for evaluation and management

Arthroscopic Debridement

• Some studies have shown short-term symptom relief, but has no effect on function and stiffness
• May be useful in patients with history of mechanical locking or giving way that may be due to meniscal tear or intra-articular loose body in radiographic exams

Joint Replacement Surgery

• Recommended for patients with severe pain and reduced function who failed to respond with conservative and pharmacological management
  • May be suggested at the 1st sign of functional limitation and presence of severe pain
• Effective in relieving pain, correcting deformity, and improving quality of life
• Should be based on the severity of pain and disability, age, and comorbidities

Unicondylar/Unicompartmental Knee Replacement

• Used when only 1 of the 2 major joint compartments of the knee is severely involved
• Advantages over total knee replacement:
  • Less bone loss at surgery
  • Easier revision when and if it becomes necessary
  • Usually have shorter operating time and recovery period

Osteotomy

• High tibial osteotomy is an alternative in a young patient with severe medial compartment osteoarthritis with minimal involvement of the lateral joint compartment resulting in varus deformity
  • Delays the need of joint replacement for 10 years and has only 25% overall failure rate after 10 years

Trapiziectomy

• Procedure of choice for 1st CMC osteoarthritis

Finger Arthrodesis or Arthroplasty

• May be considered in patients with interphalangeal osteoarthritis
• Arthroplasty is the recommended procedure for PIP joints except PIP-2
• Arthrodesis is the recommended procedure for DIP joints and for PIP-2