Service de chirurgie orthopédique et oncologique, hôpital Cochin, AP-HP, 75014 Paris, France.
Service de chirurgie orthopédique et oncologique, hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris-Descartes, 75000 Paris, France; Inserm U1153, 75000 France.
Ann Phys Rehabil Med. 2016 Jun;59(3):227-233. doi: 10.1016/j.rehab.2016.04.003. Epub 2016 May 12.
There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures.
保守治疗，即保留受损的软骨；激进治疗，即用人工假体替代软骨；后者称为关节置换术。这些治疗方法仅提供给有症状的患者。对于骨关节炎患者，还可以选择关节融合术。这种手术会牺牲关节的关节功能，通常用于治疗小关节的骨关节炎，如手腕和脚踝等。骨关节炎的症状通常是关节所受负荷与支撑该负荷的表面之间失衡的结果。因此，保守治疗方法要么倾向于减轻关节所受的负荷，例如胫骨内翻截骨术，要么改善关节表面以支撑该负荷。有时，可以同时提供这两种方法；髋关节发育不良的髋臼周围截骨术就是一个例子。为了延缓甚至避免关节置换的需要，通常会为年轻患者提供保守治疗。这些治疗通常在骨关节炎出现之前或早期进行。关节置换术的功能效果非常好，目前的研究方向是提供快速恢复、非常长期的稳定性，并在极端条件下确保良好的功能。然而，关节置换术的并发症可能很严重，几乎没有合理的挽救措施。因此，这些手术仅提供给那些经过充分的药物治疗后仍未得到缓解的患者。
