Arthroscopy vs. Arthroplasty for Knees & Hips: Pros & Cons

Understanding the differences between the various procedures recommended to treat your joint pain and arthritis is very important. However, like most things in healthcare, the osteoarthritis world is confusing. In this article, we will breakdown the 3 main procedures your care team will likely recommend to treat your hip or knee.

Read on as we breakdown the key differences between an arthroscopy and arthroplasty, and explain what exactly arthrocentesis is.

Check out this article for a complete list of definitions, abbreviations and differences in joint replacement types.

But First...What is Arthrocentesis?

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Arthrocentesis is the least invasive of the three named procedures to treat joint pain and arthritis. If you think about your evolving hip and knee arthritis or pain, you likely started treating your discomfort with icing, anti-inflammatory medications or physical therapy. Once these “entry-level” treatments no longer cut it, your physician may recommend injections or arthrocentesis. Alternatively, some people jump straight into injection therapy and arthrocentesis.

Basically, arthrocentesis is a step before any of the 4 types of therapeutic injections for joint pain and arthritis (Cortisone, Viscosupplementation, PRP and Stem Cell). Arthrocentesis can be a standalone procedure, or paired with injection therapy. In the procedure, local anesthetic (regional) is applied to “freeze” the joint area. Then one (sometimes two) small needles are to remove excess fluid from the joint. This helps relieve pressure in the joint and will offset pain.

Some experts argue that during injection therapy (like “gel” or “rooster comb” injections) it’s the arthrocentesis process (where fluid is removed from the joint) that creates the relief. In other words, it’s not the hyaluronic acid that’s added to “lubricate” the joint that offers pain relief--it’s the fluid removal. A doctor may perform arthrocentesis before giving any type of therapeutic injection to help remove fluid that is may cause inflammation. During arthrocentesis, the offending tissue that is making the fluid is not removed. As such, it is a temporary treatment that provides short-term relief.

When your care provider will perform arthrocentesis:
  • Before a therapeutic injection (part of injection therapy)
  • If excess fluid is causing pressure and pain in the joint
  • If your care team is determining a diagnosis or the recommended treatment for your joint pain, inflammation etc.
  • If you have a joint injection
  • A traumatic injury has caused bleeding into the joint space
  • To treat a joint disorder such as rheumatoid arthritis
  • If you have bursitis (especially common for those with hip arthritis or chronic pain)

A good way to think about arthrocentesis, arthroscopy, and then arthroplasty, is that they gradually progress in terms of patient commitment, invasiveness, cost, the level of PreHab and ReHab recommended, and so forth.

What is Arthroscopy?

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Your surgeon may recommend a hip or knee arthroscopy as an end-all treatment for your joint issues. However, commonly an arthroscopy is performed by an orthopedic surgeon to buy you some extra time before a full-on arthroplasty (also known as a joint replacement). An arthroscopy is also a surgery but should be thought of as a step after injections, but a step before a total or partial knee replacement or hip replacement.

During an arthroscopy, you will be placed under local or general anesthetic. Once asleep, a small incision will be made that allows for the arthroscope (a tube with a miniature camera) to be inserted into your joint. The arthroscope with the fixed camera, projects the image of your joint onto a screen. Seeing the inside of your joint lets your care team assess the arthritic damage, properly diagnose your issue, and fix some of the problems.

During the operation your joint can be irrigated (like in arthrocentesis), scarring and damaged tissue can be removed, ligaments can be stretched, and medication can be injected. This can offer real treatment and relief for cartilage and meniscus damage that is creating painful symptoms. If you just have arthritis and osteoarthritis, an arthroscopy is unlikely to help.

What is Arthroplasty (Joint Replacement Surgery)?

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In a hip or knee replacement, regardless of approach or type, an incision is made after the anesthesia has been administered. During the procedure your bone and cartilage are resurfaced (damage is removed), and the artificial prosthetic hip or knee joint pieces are fixed into place. Your surgeon will test the fit, bend, and straightening once everything is in place to ensure it’s a “go”. The whole operation lasts about 1-2 hours (knee replacement surgery tends to be quicker while hips take longer).

Read a detailed post on just what exactly is involved in knee replacement surgery. Get walked through the first 24 hours of your hip replacement.

During arthroplasty the aim is that each patient walks on the same day as surgery. Once discharged from the hospital after hip and knee replacement surgery, weeks of physical therapy, rehabilitation and recovery will follow. Pain relief and regained mobility will not happen overnight. However, a joint replacement is a successful, long-term fix. Here’s what to expect after hip or knee replacement surgery.

The rate of patient satisfaction rate for joint replacement surgery is the highest of any orthopaedic procedure. 80-90+% of patients are satisfied with the procedure!

Pros and Cons: Arthroscopy vs. Arthroplasty

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Pros for Arthroscopy

  • Offers your surgeon a better view to properly diagnosis your hip or knee issue (better than an X Ray).
  • Viable treatment option for cartilage or meniscus damage.
  • Can buy extra time before the more invasive arthroplasty.
  • Smaller incision than arthroplasty.
  • Faster healing and shorter recovery than arthroplasty.
  • Less scarring for incision site.
  • A less expensive procedure.
  • A same-day surgery.

Cons for Arthroscopy

  • A surgery with a recovery period.
  • Not used for arthritis. It won’t help pain associated with osteoarthritis.
  • Rehab may be required with a physical therapist to regain full movement.
  • If joint pain and arthritis is severe, it may not be as effective as arthroplasty.
  • A follow-up arthroplasty may still be required.
  • Risk of infection.

Pros for Arthroplasty

  • A permanent solution to joint pain and osteoarthritis.
  • High success rate for eliminating joint pain. Surgical techniques and the prosthetic implants are better than ever.
  • Can be performed same-day or with a short 1-2 day hospital stay (shorter than ever).

Cons for Arthroplasty

  • A lengthy recovery (6+ weeks without driving or being able to return to “normal life”
  • A tougher rehabilitation (must earn back knee and hip range of motion)
  • More costly (although likely covered by insurance)

Having joint replacement surgery, Join PeerWell. We will match you with a surgeon that offers PeerWell's complete PreHab program for free! PreHab gets you totally ready for your joint replacement surgery.

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Hi, I'm Grace. I write all things surgery for the PeerWell blog. You may remember me from such titles as: "Diabetes & Joint Replacement 101" & "Sex After a Joint Replacement".

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