What is Osteoarthritis?
In a normal joint bone is covered with cartilage, which allows frictionless and pain-free movement. When the cartilage is worn the joint becomes stiff and painful.
Sometimes called degenerative joint disease or degenerative arthritis, osteoarthritis (OA) is the most common chronic condition of the joints. This disease can be summarized as a progressive degeneration of the cartilage layer. OA can affect any joint, but it occurs most often in knees, hips, lower back and neck, small joints of the fingers and the bases of the thumb and big toe.
In normal joints, a firm, rubbery material called cartilage covers the end of each bone. Cartilage provides a smooth, gliding surface for joint motion and acts as a cushion between the bones. In OA, the cartilage breaks down, causing pain, swelling and problems moving the joint. As OA worsens over time, bones may break down and develop growths called spurs. Bits of bone or cartilage may chip off and float around in the joint. In the body, an inflammatory process occurs and cytokines (proteins) and enzymes develop that further damage the cartilage. In the final stages of OA, the cartilage wears away and bone rubs against bone leading to joint damage and more pain.
Although OA occurs in people of all ages, osteoarthritis is most common in people older than 65. Most commonly, the degeneration process is the consequence of a localised joint overload. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes.
Because of the ageing population and the epidemic of obesity, OA is becoming highly frequent. It is estimated that 50% and 25% of people will develop symptoms of knee and hip OA during their lives.
What are the treatments of hip and knee OA?
When knee OA is diagnosed at an early stage in very young patients (<50y), the disease can be slowed and symptoms alleviated by performing conservative joint surgery (osteotomy) aiming at reducing the joint overload. This will temporarily improve patient’s condition and postpone the knee replacement by 10 years on average. In contrast, osteotomy in the context of hip OA has become uncommon because of the very high safety and efficacy of total hip replacement.
When patient’s quality of life is not severely affected and the patient is not eligible to a conservative surgery (osteotomy), the OA patient will be offered a medical treatment (see details below) aiming at reducing symptoms. When medical treatment becomes insufficient, then it is time to perform the joint replacement.
Medical treatment for OA: 1) Physical treatment to reduce loading (weight loss, eviction of impact sports, splint, cane) and stiffness (regular physiotherapy, controlled low-impact exercise) of your joint, and 2) Chemical treatment to reduce pain (painkiller, non-steroidal anti-inflammatory (*), joint injections of lubricant and cortisone) and slow the progression of the disease (glucosamine and chondroitin sulfate(**)).
Ongoing research in the medical treatment of osteoarthritis: The use of PRP (platelet rich plasma) and stem cell injections for arthritis is an exciting new treatment option that is being researched all over the world. The clinical outcomes are variable, but the general consensus is that these injections are significantly BETTER than injections of cortisone or lubricant. Despite the research, these injections are still considered experimental and are not covered by insurance. If this treatment interests you, please discuss with Charles.
(*) Non-steroidal anti-inflammatory (NSAIDs) medications have long been used to treat arthritis pain and symptoms. As with all medications, there are certain potential side effects like gastrointestinal ulcers, kidney damage, and cardiac risks. Regular use of this medication should be discussed with your primary doctor who has better knowledge of your other medical conditions.
(**) Glucosamine and chondroitin sulphate are substances normally found in our bodies and act as building blocks for healthy cartilage and joint lubrication. Over-the-counter supplementation can provide some benefit, but the response is quite variable. These are generally well tolerated without toxic effects.