Arthroplasty & Arthroscopy: What’s the difference?
As we age, joints tend to wear down or even wear out. Two options your doctor might suggest are arthroscopy or arthroplasty. They sound very similar. What is the difference? In this podcast, Dr. William Cook, chief of orthopaedic surgery at UM Upper Chesapeake Health, addresses that very question as well as considerations each patient should address with their doctor.
Featured Speaker:
He is chief of orthopaedic surgery at University of Maryland Upper Chesapeake Health. Dr. Cook is a member of the University of Maryland Joint Network, a group of surgeons known for their advanced expertise and positive outcomes in total hip and knee replacement. He sees patients in Bel Air and Aberdeen and is affiliated with University of Maryland Community Medical Group and UM Upper Chesapeake Health.
Learn more about Dr. Cook
Learn more about the Upper Chesapeake Orthopaedic Specialty Group
William Cook, MD
William Pierson Cook, IV, MD, is an orthopedic surgeon who specializes in total joint replacement, including total knee replacement, minimally invasive anterior total hip replacement, traditional shoulder replacement, reverse shoulder replacement, and disorders of the rotator cuff. He has more than 30 years of experience. He treats patients of all ages and develops lasting relationships with them and their families.He is chief of orthopaedic surgery at University of Maryland Upper Chesapeake Health. Dr. Cook is a member of the University of Maryland Joint Network, a group of surgeons known for their advanced expertise and positive outcomes in total hip and knee replacement. He sees patients in Bel Air and Aberdeen and is affiliated with University of Maryland Community Medical Group and UM Upper Chesapeake Health.
Learn more about Dr. Cook
Learn more about the Upper Chesapeake Orthopaedic Specialty Group
Transcription:
Arthroplasty & Arthroscopy: What’s the difference?
Joey Wahler: As we age, our joints tend to wear down or wear out. Arthoscopy and arthroplasty can help. So what's the difference between those two? Welcome to the Live Greater Podcast Series information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Our guest, Dr. William P. Cook, chief of orthopedic surgery at University of Maryland Upper Chesapeake Health. Dr. Cook. Thanks for joining.
Dr. William Cook: You're very welcome. How are you?
Joey Wahler: Good. Great to have you with us doc. So first, what are some examples of conditions or injuries that would entail getting an arthoscopy or arthroplasty procedure in the first place?
Dr. William Cook: Well, the difference between the two is that one is a minimally invasive procedure. Whereas the other requires opening the joint. Arthro means joint and arthroscopy means scope of the joint. Whereas arthroplasty means opening the joint and replacing the surface of the joint where the cartilage is worn out. So for instance, with arthroscopy, more minor procedures could be done with a minimally invasive approach as an outpatient. Procedures, such as repairing damaged cartilage or, removing a torn meniscus, which is a cartilage cushion in the knee.
Also ligaments can be repaired such as a Cruciate ligament after a sports injury. Sometimes we also use arthroscopy for removing inflamed tissue. If it overgrows and becomes painful or causes bleeding. It can also be used for malalignment problems with the kneecap to balance the ligaments in the knee. And also certain fractures of cartilage or bone can be treated with arthroscopy, such as a, cartilage fracture that maybe come detached or, fractures that can be visualized more easily with the scope for fixation.
Such as a avulsion fracture of the tibial plateau. In contrast, arthroplasty usually is for the replacement of damaged or worn out cartilage on the surface of the joint. So for instance, if someone has bad arthritis, we would open the joint. Place a metal or plastic surface to take the place of the cartilage that's worn out. This might be applicable in conditions such as degenerative joint disease or rheumatoid arthritis or arthritis that's the result of previous injury. We call post traumatic arthritis.
There are other conditions as well, less known, but often, needing of replacement, such as a condition called avascular necrosis, where the blood supply to the surface of the bone and cartilage is lost and it causes deterioration. Those are the major differences.
Joey Wahler: Gotcha. Now with arthroscopy, those of us that follow sports know that often will hear that an athlete was subject to one so that doctors could quote unquote, take a look to see what's doing, what's meant by that actually?
Dr. William Cook: Well, we can get, a good, first estimate of what's going on with physical. And with imaging studies, but sometimes we just have to look in the joint and assess different structures to see if something's torn or out of place. Or if there was something that wasn't recognized on an imaging study, such as an x-ray or an MRI.
Joey Wahler: So what about in a situation where it might be unclear at first, or it might be kind of a toss up, so to speak as to whether the one procedure is needed, as opposed to the other, what are some of the determining factors? How do you make that diagnosis?
Dr. William Cook: Generally for more minor. Issues, arthroscopy is the preferred treatment and that's because the incisions are smaller. It's an outpatient procedure. And often the recovery is much quicker. So if we were to see an x-ray that didn't show much cartilage loss, arthroscopy would still be an appropriate procedure. However, if on the x-ray or an MRI or a CT scan imaging study, we saw that there was no cartilage left in the joint, and we saw what was called bone on bone. Then it would be more appropriate to consider opening the joint and replacing the surface of the joint with arthroplasty.
Joey Wahler: Is there ever a situation where neither of these procedures is what the doctor ordered, so to speak?
Dr. William Cook: Yes, in injuries such as sprains or minor tears. Very often we don't need to operate at all and physical therapy and some time off from the Sports, or, rigorous activities that caused the problem would be appropriate. Arthroscopy or arthroplasty would be used to correct a situation that's not going to heal otherwise without intervention.
Joey Wahler: Understood. So now let me turn that last question upside down. Does a patient ever need both of these procedures and what might that scenario be?
Dr. William Cook: In a lifetime of a joint, it may require both procedures, but almost always the arthroscopy precedes the arthro plasty. And that would be for a joint that still has some usable cartilage left and some life left in the knee. Now there are some indications for arthroscopy after arthroplasty, and that would be if someone had, overgrown too much scar tissue after undergoing a knee replacement or other joint procedure. And very often arthroscopy is a useful tool for removing loose bodies or removing scar tissue that may be interfering with joint motion or be causing bleeding or causing pain.
Joey Wahler: Now you mentioned earlier, there's a difference in the recovery timetable between these two. So typically what is it for each?
Dr. William Cook: With modern day arthroscopic procedures, anywhere from three to six weeks, most people are doing quite well. If there's a component of arthritis or there's tissue that needs longer to heal. Sometimes therapy can last up to three months, but more typical, be three to six weeks for arthro plasty. The, usual healing time is between two and three months.
Joey Wahler: How about in the time you've been at this yourself doctor, how much easier, how much more advanced have these procedures become?
Dr. William Cook: Well, when I first went into practice, I was at a training program known for its advancement and anterior cruciate, ligament reconstruction. They were starting to use arthroscopy for that, but still patients would stay a couple of nights in the hospital. Now with complete arthroscopic reconstruction of cruciate, ligament, tears. We have patients going home within an hour or two of their surgery, so that the procedures have changed dramatically based on our instrumentation, our anesthesia, methods, and our accelerated therapy protocols.
In a similar fashion, arthro plasty has changed dramatically. We now have, patients that are routinely going home within hours of a joint reconstruction. And when I first went into training, it was not unusual for three to five day hospital stay. And then it transitioned to a transitional care unit rehab program for another couple of weeks. So both have dramatically changed over my 30 year career.
Joey Wahler: Great to hear and I'm sure those in our audience, considering this, either procedure that is, are relieved to hear that. But as you well know, more than anyone, anytime someone hears the word surgery, albeit minor, it can be a little disconcerting. So in summary here, what would you say to those listening that have been thinking about this that have been told they might need it or do need it? What would you say to put them more at ease?
Dr. William Cook: Both these procedures are wonderful for decreasing pain and improving function for more minor procedures, arthroscopy. Done through two small incisions just below the kneecap require a single stitch and an ACE wrap and you're walking on it, often the same day. The risks are very minor. Complications are very uncommo. For arthro plasty, if you're hobbled by arthritis, I can tell you that my most common comment is I wish I hadn't waited so long doc. The risks are about 1% for, infection or blood clot or stiffness.
And that's often in patients who have other health problems that put them at higher risk. Our implants are lasting greater than 20 years now. In fact, the 20 year survival is better than 90% and they continue to improve. So both are very beneficial procedures with low complication rates, which help to improve function and decrease pain.
Joey Wahler: One last thing real quick, because you mentioned it right there, doc, you alluded to the good old ACE bandage. This is the second interview recently in which the ACE bandage has come up in conversation. It's still a valuable tool after all these years. Isn't it?
Dr. William Cook: It certainly is. It helps to prevent swelling and put some compression on the surgical side, which helps relieve pain as well.
Joey Wahler: Great to know that if you have one of those laying around, don't throw it out, right. You never know.
Dr. William Cook: That's correct.
Joey Wahler: All right. Well, folks, we trust you are now more familiar with arthroscopy and arthro plasty as well. The differences. And so Dr. William P. Cook. Thanks so much again.
Dr. William Cook: My pleasure, call anytime.
Joey Wahler: Sure. And you can find more shows just like this one at umms.org/podcast. Again, that's umms.org/podcast. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater. A health and wellness podcast brought to you by the university of Maryland Medical System. We look forward to you joining us again, hoping your health is good health. I am Joey Wahler,
Arthroplasty & Arthroscopy: What’s the difference?
Joey Wahler: As we age, our joints tend to wear down or wear out. Arthoscopy and arthroplasty can help. So what's the difference between those two? Welcome to the Live Greater Podcast Series information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Our guest, Dr. William P. Cook, chief of orthopedic surgery at University of Maryland Upper Chesapeake Health. Dr. Cook. Thanks for joining.
Dr. William Cook: You're very welcome. How are you?
Joey Wahler: Good. Great to have you with us doc. So first, what are some examples of conditions or injuries that would entail getting an arthoscopy or arthroplasty procedure in the first place?
Dr. William Cook: Well, the difference between the two is that one is a minimally invasive procedure. Whereas the other requires opening the joint. Arthro means joint and arthroscopy means scope of the joint. Whereas arthroplasty means opening the joint and replacing the surface of the joint where the cartilage is worn out. So for instance, with arthroscopy, more minor procedures could be done with a minimally invasive approach as an outpatient. Procedures, such as repairing damaged cartilage or, removing a torn meniscus, which is a cartilage cushion in the knee.
Also ligaments can be repaired such as a Cruciate ligament after a sports injury. Sometimes we also use arthroscopy for removing inflamed tissue. If it overgrows and becomes painful or causes bleeding. It can also be used for malalignment problems with the kneecap to balance the ligaments in the knee. And also certain fractures of cartilage or bone can be treated with arthroscopy, such as a, cartilage fracture that maybe come detached or, fractures that can be visualized more easily with the scope for fixation.
Such as a avulsion fracture of the tibial plateau. In contrast, arthroplasty usually is for the replacement of damaged or worn out cartilage on the surface of the joint. So for instance, if someone has bad arthritis, we would open the joint. Place a metal or plastic surface to take the place of the cartilage that's worn out. This might be applicable in conditions such as degenerative joint disease or rheumatoid arthritis or arthritis that's the result of previous injury. We call post traumatic arthritis.
There are other conditions as well, less known, but often, needing of replacement, such as a condition called avascular necrosis, where the blood supply to the surface of the bone and cartilage is lost and it causes deterioration. Those are the major differences.
Joey Wahler: Gotcha. Now with arthroscopy, those of us that follow sports know that often will hear that an athlete was subject to one so that doctors could quote unquote, take a look to see what's doing, what's meant by that actually?
Dr. William Cook: Well, we can get, a good, first estimate of what's going on with physical. And with imaging studies, but sometimes we just have to look in the joint and assess different structures to see if something's torn or out of place. Or if there was something that wasn't recognized on an imaging study, such as an x-ray or an MRI.
Joey Wahler: So what about in a situation where it might be unclear at first, or it might be kind of a toss up, so to speak as to whether the one procedure is needed, as opposed to the other, what are some of the determining factors? How do you make that diagnosis?
Dr. William Cook: Generally for more minor. Issues, arthroscopy is the preferred treatment and that's because the incisions are smaller. It's an outpatient procedure. And often the recovery is much quicker. So if we were to see an x-ray that didn't show much cartilage loss, arthroscopy would still be an appropriate procedure. However, if on the x-ray or an MRI or a CT scan imaging study, we saw that there was no cartilage left in the joint, and we saw what was called bone on bone. Then it would be more appropriate to consider opening the joint and replacing the surface of the joint with arthroplasty.
Joey Wahler: Is there ever a situation where neither of these procedures is what the doctor ordered, so to speak?
Dr. William Cook: Yes, in injuries such as sprains or minor tears. Very often we don't need to operate at all and physical therapy and some time off from the Sports, or, rigorous activities that caused the problem would be appropriate. Arthroscopy or arthroplasty would be used to correct a situation that's not going to heal otherwise without intervention.
Joey Wahler: Understood. So now let me turn that last question upside down. Does a patient ever need both of these procedures and what might that scenario be?
Dr. William Cook: In a lifetime of a joint, it may require both procedures, but almost always the arthroscopy precedes the arthro plasty. And that would be for a joint that still has some usable cartilage left and some life left in the knee. Now there are some indications for arthroscopy after arthroplasty, and that would be if someone had, overgrown too much scar tissue after undergoing a knee replacement or other joint procedure. And very often arthroscopy is a useful tool for removing loose bodies or removing scar tissue that may be interfering with joint motion or be causing bleeding or causing pain.
Joey Wahler: Now you mentioned earlier, there's a difference in the recovery timetable between these two. So typically what is it for each?
Dr. William Cook: With modern day arthroscopic procedures, anywhere from three to six weeks, most people are doing quite well. If there's a component of arthritis or there's tissue that needs longer to heal. Sometimes therapy can last up to three months, but more typical, be three to six weeks for arthro plasty. The, usual healing time is between two and three months.
Joey Wahler: How about in the time you've been at this yourself doctor, how much easier, how much more advanced have these procedures become?
Dr. William Cook: Well, when I first went into practice, I was at a training program known for its advancement and anterior cruciate, ligament reconstruction. They were starting to use arthroscopy for that, but still patients would stay a couple of nights in the hospital. Now with complete arthroscopic reconstruction of cruciate, ligament, tears. We have patients going home within an hour or two of their surgery, so that the procedures have changed dramatically based on our instrumentation, our anesthesia, methods, and our accelerated therapy protocols.
In a similar fashion, arthro plasty has changed dramatically. We now have, patients that are routinely going home within hours of a joint reconstruction. And when I first went into training, it was not unusual for three to five day hospital stay. And then it transitioned to a transitional care unit rehab program for another couple of weeks. So both have dramatically changed over my 30 year career.
Joey Wahler: Great to hear and I'm sure those in our audience, considering this, either procedure that is, are relieved to hear that. But as you well know, more than anyone, anytime someone hears the word surgery, albeit minor, it can be a little disconcerting. So in summary here, what would you say to those listening that have been thinking about this that have been told they might need it or do need it? What would you say to put them more at ease?
Dr. William Cook: Both these procedures are wonderful for decreasing pain and improving function for more minor procedures, arthroscopy. Done through two small incisions just below the kneecap require a single stitch and an ACE wrap and you're walking on it, often the same day. The risks are very minor. Complications are very uncommo. For arthro plasty, if you're hobbled by arthritis, I can tell you that my most common comment is I wish I hadn't waited so long doc. The risks are about 1% for, infection or blood clot or stiffness.
And that's often in patients who have other health problems that put them at higher risk. Our implants are lasting greater than 20 years now. In fact, the 20 year survival is better than 90% and they continue to improve. So both are very beneficial procedures with low complication rates, which help to improve function and decrease pain.
Joey Wahler: One last thing real quick, because you mentioned it right there, doc, you alluded to the good old ACE bandage. This is the second interview recently in which the ACE bandage has come up in conversation. It's still a valuable tool after all these years. Isn't it?
Dr. William Cook: It certainly is. It helps to prevent swelling and put some compression on the surgical side, which helps relieve pain as well.
Joey Wahler: Great to know that if you have one of those laying around, don't throw it out, right. You never know.
Dr. William Cook: That's correct.
Joey Wahler: All right. Well, folks, we trust you are now more familiar with arthroscopy and arthro plasty as well. The differences. And so Dr. William P. Cook. Thanks so much again.
Dr. William Cook: My pleasure, call anytime.
Joey Wahler: Sure. And you can find more shows just like this one at umms.org/podcast. Again, that's umms.org/podcast. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Live Greater. A health and wellness podcast brought to you by the university of Maryland Medical System. We look forward to you joining us again, hoping your health is good health. I am Joey Wahler,