Non-replacement options
Non-replacement procedures are operations that try to improve symptoms or joint mechanics without replacing the arthritic joint surface with an artificial joint.
What non-replacement surgery means
Historically, several procedures were tried before joint replacement was considered. These included joint "cleaning" or debridement, realignment procedures, excision of painful bone or soft tissue, and fusion of selected joints.
Today, these operations have a much narrower role. They may still be useful in carefully selected situations, but they are not a general solution for established osteoarthritis.
Arthroscopic debridement
Arthroscopic debridement, often called joint cleaning, uses small instruments inserted through tiny incisions to remove loose fragments, unstable tissue, or inflamed tissue from inside the joint.
For osteoarthritis alone, high-quality studies and modern guidelines show that arthroscopic debridement usually provides little or no durable benefit. It should not be viewed as a way to wash out arthritis, rebuild cartilage, or reverse the disease.
Arthroscopy may still be considered in selected cases when there is a specific mechanical problem, such as a loose body or a clearly unstable meniscal fragment causing true locking or catching. In that situation, the goal is to treat the mechanical problem, not to cure arthritis.
Realignment procedures
Realignment surgery, such as an osteotomy, changes the alignment of the limb to shift load away from a damaged part of the joint. It may occasionally be considered in younger or more active patients with localized arthritis and a correctable alignment problem.
Realignment surgery is usually not appropriate for diffuse, advanced arthritis involving most of the joint surface.
Excision and fusion
Excision procedures remove selected painful bone, bone spurs, or damaged tissue. Fusion permanently stiffens a joint to reduce pain. These options are rarely used for hip or knee osteoarthritis, but they may have a role in selected smaller joints or specific anatomical situations.
Practical conclusion
For most patients with advanced symptomatic osteoarthritis, non-replacement operations offer limited benefit. When non-surgical treatment is no longer enough, joint replacement surgery is usually the most predictable surgical option for severe arthritis of the hip or knee.