What is Arthritis: Inflammation or swelling of one or more joints.
The term “Arthritis" can be used for more than 100 conditions that affects the joints, tissues around the joint and other connective tissues. Specific symptoms vary depending on the type of arthritis and usually includes joint pains with stiffness, loss of function and deformities.
There are two (2) major distinctive groups of arthritic conditions:
The most common joints affected that cause patients to seek opinions and help are the knees, the hips and the shoulder joints. The presenting complaints are usually pain, loss of normal function of the joint and possible deformity that is visible to the patient. Once the process has started, it continues to deteriorate with time.
There are several ways of diagnosing arthritic conditions. In the inflammatory group, blood tests may be available but in the normal degenerative osteoarthritis: x-rays, CT scans and MRIs become the mainstay of diagnosis. Patients can be treated by many groups of physicians but the patients with moderate-to-severe disease in either group tend to be referred to specialist orthopaedic surgeons.
The treatments vary depending on the degree of arthritic conditions with the mainstay of early treatment involving medications: either pharmaceutical anti-inflammatory drugs or nonpharmaceutical anti-inflammatory drugs and treatment to general conditions that may be part of an inflammatory arthritis. The usual recommendations in the early stages are behavior modification which will include activity changes, loss or optimization of weight and reduction of impact loading depending on the activities in which the patient is involved. Exercises are used and follow the same guidelines. The exercises to strength the muscles result in improvement of muscle function around the arthritic joint and therefore improves the efficiency of motion and the efficiency of action of the joints. If patients fail to respond adequately to the early stages of treatment and their condition deteriorates rapidly over time, then the patient will be and is normally referred to a specialist orthopaedic surgeon.
There are minimally intrusive measures that may sometimes help in treating some focal arthritic conditions of the joints and there are also injectables of various types that can be used to help to decrease the inflammation in the joint. In recent times, there are injectables that are said to promote or have some regenerative capacity to the cartilage surfaces of the joint and includes gels and stem cell preparations.
In patients who fail to get any sustainable or long-term relief from the above, these patients will then require more intrusive measures. Intrusive measures are operative and vary in nature depending on the time of presentation and the degree of arthritic changes. In early cases, it is possible to have joint preservation procedures. These procedures are mainly designed to unload areas of a joint that are being overloaded and therefore degenerate and become painful. These are usually alignment procedures which are done mainly around the knee ( to correct bow legs or knock knees) and sometimes around the hip with less successful results.
With regards to severe arthritic changes, once the cartilage surfaces have been worn completely and therefore there is very little surface residual to either recover or regenerate, then replacement surgery becomes necessary. Replacement particularly in the knees can be partial where only the damaged surfaces are replaced. This is extremely common in doing what is called “unicompartmental” knee replacement which is a minimally invasive procedure and can give maximum returns but is confined to patients with single compartmental disease. In patients who have more panoramic disease, they require a total or full joint replacement where all the surfaces that are damaged are replaced in their entirety. The materials that are used are metals and plastics mainly and in some instances, ceramic. This can give good overall outcomes.
In patients who have had joint replacements and the replacement then fails for whatever reason, these replacements can be revised and therefore, revision joint replacements can be done. This drives home the fact that a single replacement does not negate a patient having further replacements in the future.
At the end of the day, these recommendations for treatments are well established and are good outcome procedures particularly in the operative environment. The overall outcomes exceed 90% success rates.
If you feel you have a condition that may be amenable to treatment, please contact your doctors for further advice and direction.