1. Osteoarthritis (OA) is one of most common diseases
2. The cause of OA is not known but there are important contributing factors in development of OA
3. OA tends to affect weight bearing, hard working joints
4. With OA, articular cartilage breaks down and wears away
5. Common symptoms
7. Physical therapy and exercise
8. Weight control
9. Simple analgesics
10. Topical treatments
11. Hyaluronate preparations
12. Anti-inflammatory medications (NSAIDs)
13. Corticosteriod injections
14. Narcotic pain relievers
16. Arthroscopic surgery
18. Arthrodesis (Fusion)
19. A man-made prosthesis is used to replace the damaged joint when medical management is not effective.
20. There is no cure..... but you can live comfortably with Osteoarthritis
Osteoarthritis (OA) is one of most common diseases
Osteoarthritis, sometimes abbreviated to “OA”, is the most common form of arthritis, a very common disease. It is a chronic, slowly progressing disease that involves the breakdown of articular cartilage, the normally smooth, slippery covering that allows the bones of your joints to slide over each other. OA may involve many or only one or a few specific joints.... a hip, knee, finger, the lower back, About 17 million people in USA and many more in India have pain due to Osteoarthritis. The incidence of the disease increases with age, and women are affected twice as frequently as men.
The cause of OA is not known but there are important contributing factors in development of OA
Aging, Trauma, Obesity, Genetics.
Although we don't know the exact cause of OA, we have identified four important contributing factors. Age is one of these factors. The wear and tear on joints accumulated over the years is the only identifiable factor for many people.
Trauma (for injury) is another contributing factor. Overuse or occupational injuries, as well as sport injuries, are commonly associated with OA. Obesity plays a part, too, as extra weight puts added stress on weight bearing joints, like the hip and knee; but even light weight ballerinas are at greater risk of developing OA of the big toe and hip, due to great stresses put on these joints.
Genetic factors also play a role. A family history of OA can increase the risk of developing OA. People with poor joint alignment can develop OA as the joint cartilage wears unevenly.
OA tends to affect weight bearing, hard working joints
As you'd expect, the hardest working and weight-bearing joints are the ones usually affected by OA. These include the hips, knees, feet, spine, and hands. Except, as a result of injury or un-usual stress, ankles, wrists, and elbows are not common sites for OA, although other types of arthritis can affect these areas. People with OA in one joint often have OA in other joints. This so-called generalized arthritis is more common in women than in men and may be inherited.
With OA, articular cartilage breaks down and wears away
The rest of our discussion will focus on the knee joint, a common site of OA. The knee is a complex joint, composed of bone, cartilage, membranes, and joint fluid all working together for easy, comfortable motion. Normally, the articular cartilage covering the ends of each bone is smooth, and more slippery than ice. It allows the joint surfaces to glide easily and act as a shock absorber. The joint capsule is lined with the synovial membrane, which produces the synovial fluid that helps lubricate and cushion the joint. Muscles, ligaments, and tendons keep the joint aligned during joint movement.
In OA, the joint breaks down in stages, over a time; smooth cartilage becomes pitted and frayed. Damaged cartilage is less elastic, and more readily affected by overuse or injury. Synovial fluid may also lose its cushioning and lubricating properties. The ends of the bone can thicken and form spurs where the ligaments and synovial lining attach. Finally, bits of bone or cartilage (sometimes called 'joint mice') float in the joint space, causing further damage and pain.
Eventually, large areas of cartilage may wear away completely, so bones scrape over each other painfully. The joint may lose its proper alignment, and much of its function.
If you have OA of the knee, you're probably familiar with some of these symptoms. Pain, tenderness, and a grating or catching sensation in the knee are the common symptoms that cause most people to see a doctor.
If you're under 40, you may not associate these symptoms with OA. But don't discount the possibility, especially if you're very involved in activities that put a lot of stress on your knees, like football, skiing, and high-impact aerobics.
Diagnosis is based on a wide range of evidence.
There is no specific test for OA. Most people don't even know they have OA of the knee until pain, stiffness, or an injury lead them to see their doctor. A complete clinical assessment will include a discussion of any family history of OA, and a physical examination to identify misalignment, deformities, mechanical problems and which joints are affected.
OA is often visible on X-ray, and that can confirm that the pain and stiffness is indeed due to OA. X-ray can be useful in uncovering subtitle joint abnormalities and other joint and bone diseases, like osteoporosis. However, X-ray may not pick up early arthritic changes, even if there are symptoms.
Finally, lab tests may be ordered to check for certain metabolic or endocrine disorders (such as hypothyroidism or diabetes).
OA of the knee cannot be cured, but in most cases it can be effectively managed, resulting in less pain and stiffness, and better joint function. Physical therapy and exercise and, if appropriate, weight loss can be helpful in alleviating symptoms at any stage of OA. Assistance devices like canes, knee braces, and insoles can also help. For OA with mild pain and few or no functional problems, nonprescription pain relievers like acetaminophen may be tried. If this therapy does not suffice, a prescription strength anti-inflammatory drug, such as naproxen or cortisone injections, or stronger pain relievers, such as narcotic analgesics may be needed. Finally, a variety of surgical procedures are available for the management of severe OA.
Today, there's a lot that one can do to help keep OA form interfering with daily life. Let's take a closer look at each type of treatment.
Physical therapy and exercise
Controlled exercise is an important OA treatment. “Controlled” is the key word here, and that's why seeing a physical therapist is so important. Physical therapists can determine what the most suitable conditioning exercises are for a given patient, then show the patient how to perform them correctly. Regular exercise will not only make joints feel better it can give patients a psychological boost to know that they're making a difference through their own efforts.
Shedding excess weight can be stressful, frustrating, and seemingly impossible for some people, but it can make a big difference in how the knees feel. Excess weight puts extra stress on already painful joints, making exercise that much more difficult. Inability to exercise due to pain can lead to depression and overeating, starting the cycle all over again. Some people with OA will be able to successfully control pain with a combination of exercise and weight loss alone.
Acetaminophen and paracetamol and other products are recognized as an effective medication for OA of the knee. It is generally well-tolerated, without the side effects of prescription arthritis drugs like naproxen and ibuprofen, which we'll talk about shortly. Rarely, high dose of acetaminophen can cause liver damage when large amounts of alcohol are consumed. Acetaminophen is often used in combination with other medications.
Topical treatments include rubs, hot and cold packs, and TENS, which uses electricity applied to the skin to stimulate nerve endings. These are valid methods that give many people significant pain relief. These can be tried either before starting medication or in addition to medication.
The newest class of injected products for the pain of OA of the knee are the hyaluronate preparations that are injected directly into the knee. Hyaluronate is a natural substance that acts like an “Oil” and is believed to help cushion and lubricate joints such as the knee.
Anti-inflammatory medications (NSAIDs)
NSAIDs are very effective pain relievers. They include aspirin, ibuprofen, naproxen, and other drugs that relieve inflammation and pains. As we mentioned earlier, NSAIDs often cause stomach upset. However, for some people, long-term use of these drugs can sometimes cause more serious problems, such as stomach ulcers and kidney damage.
Corticosteriod, like cortisone, or prednisone, are powerful drugs that relieve pain and inflammation. Special formulations are available for injection into the knee so that they remain in the knee and maintain their effect. Pain relief from a typical corticosteriod injection lasts 4 to 6 weeks. However, frequent use of these drugs can damage joint tissues.
Narcotic pain relievers
For people with severe, unremitting pain, there are a variety of narcotic pain relievers. These drugs are effective against severe pain, but have no effects on inflammation. However, most patients and physicians will resist using narcotics for very long because of the potential side effects associated with these products, including addiction.
To correct minor or major mechanical problems, treat advanced disease, or relieve pain / improve mobility when nonsurgical treatments are not adequate.
- Arthroscopic surgery - Osteotomy - Arthrodesis (fusion) - Total Knee Replacement (TKR)
If OA becomes impossible to live with, surgery may be the answer. There are many types of surgical procedures, from arthroscopy to total knee replacement. However, there are limits to what surgery can achieve. Strenuous exercise such as downhill skiing after total knee replacement may not be possible. Pain relief and greater freedom of motion are likely outcomes. A strict treatment and rehabilitation program after surgery is in large part dependent upon active participation by the patient. Now let's look at the various surgical options available today.
- For repair of damaged cartilage
- For removal of loose bits of cartilage and bone
- To drain infected or excess synovial fluid
- May be performed in the office or in the hospital, depending upon nature of the surgery.
An arthroscope is a pencil-sized fibreoptic instrument attached to a small camera viewer that is used to look inside the joint. During surgery, special slim instruments are passed through the arthroscope to remove bits of bone and cartilage from the joint cavity, drain excess synovial fluid, or repair small tears in the meniscus, a pad of special rubbery cartilage in the knee. The arthroscope is inserted through a very small incision, which leaves little scarring. Arthroscopic surgery can, in many cases, be done in the office.
This surgery does not require general anaesthesia and is done under local anasthesia. It does not involve any blood loos. The patient usually walks home in two hours. This is a highly advanced form of surgery and requires a very high level of costly instrumentation systems. There are very few centres in India with a proper set-up offering this service.
May be an option when OA involves a single, weight bearing compartment of the knee joint.
- To correct deformities by selective trimming away of bone.
- Improves joint alignment
- Generally preferred for young and active patients.
Osteotomy literally means “bone cutting”. Even slight bone deformities can put pressure and strain on joints, and contribute to OA. The deformity is corrected by removing or adding triangular wedges of bone. Osteotomy can be useful in preventing the deterioration of joints with OA due to a preexisting deformity such as bowleggedness. Osteotomy is generally preferred for young, active patients.
Reserved for patients who cannot undergo total knee replacement.
- Relieves pain
- Leg is left permanently rigid
- Interferes with walking, sitting, driving, and other movement
The word arthrodesis means 'fusion of a joint'. When this surgery is performed on the knee, the thigh and shin bones are fused to become one bone. Pain is relieved, but the leg is left permanently rigid, which interferes with walking, sitting, driving, or moving in a narrow space. For these reasons, arthrodesis is used only when certain infections or ligaments loss make it unsafe to implant a prosthesis.
Total Knee replacement
A man-made prosthesis is used to replace the damaged joint when medical management is not effective.
- Relieves pain - Corrects alignment
During total knee replacement, or TKR, man-made materials are used to replace the damaged end of the knee bones. About 160,000 total knee replacements are performed each year in USA. There are many kinds of prostheses, each with subtle differences. prosthetic knees are strong and last on an average 15 to 20 years.
The word "total" gives the impression that the whole knee joint is cut out and replaced by a heavy metal model. However, this is not the case. In reality, only the roughened surface of the bones forming the knee joints is taken out as thin slices and replaced by an artificial surface. The muscles and ligaments are realigned. Once the implants are seated, the patient is able to walk well, and do a wide range of activities like cycling, swimming, dancing and playing light sports. This surgery has become popular all over the world because of its ability to give back a highly active life style to a patient handicapped by pain and deformities. There are many factors contributing to the success of this surgery starting from the surgeons detailed understanding and experience of the surgery, the quality of implants, the quality of operation theatre environment with a high level of instrumentation systems, as also post operative care in the form of focused para medical staff to care for patients after the operation.
There is no cure..... but you can live comfortably with Osteoarthritis
- Physical therapy and exercise - Medical management - Surgical management
The future ???
In summary, we've talked about OA of the knee and the various treatments available today. There's no cure as of yet. But with careful use of these treatment option, and those that are likely to come in to use over the next few years, it is possible to live comfortably with OA.