Surgery generally is reserved for patients who fail to respond to medical therapy and have progressive limitations in activities of daily living (ADL). In joint replacement surgery (arthroplasty), the damaged joint surfaces are replaced with metal or plastic prosthetic devices. Hip and knee joints are most commonly replaced, but arthroplasty may also be performed on shoulders, elbows, fingers, and ankles. Most pa tients achieve significant pain relief and functional restoration after arthroplasty, and

it is a reasonable option in carefully selected refractory patients.

Surgical debridement may be performed arthroscopically. With this procedure, a tiny video camera is inserted into the affected joint through a small incision, and the surgeon removes torn cartilage or other debris from the joint. The long-term benefits of arthroscopic surgery for OA are unclear, and it may be no better than optimized physical and medical therapy.48,49

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