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How did I get arthritis and is it curable?
This morning Professor James from the local community college came to my office complaining of knee pain. His knee was not quite right since taking a hard hit playing football decades ago. He had knee surgery back in the day, and since then was able to play golf and live a regular life – until fairly recently, that is. Over the past several years he often felt pain and grinding. He told me his knee now felt crooked and he just doesn’t trust it not to give out on him. When I looked at his x-rays, it was obvious he had advanced arthritis.
The typical questions I hear following a diagnosis are:
What exactly is arthritis? How did that happen? Is there a way to fix the problem without surgery or is a joint replacement the only option?
What exactly is arthritis?
Arthritis is the progressive degeneration of the cartilage between joints. While there are different kinds of joints throughout the body that are supported by ligaments and muscles, they all function to move our arms and legs. The cartilage present at the end of the bones can wear out or accrue damage over time. At times ligaments, tendons, meniscus, or other important structures wear out in the process as well.
How does arthritis actually happen?
Multiple factors can cause cartilage damage and arthritis. Some people are born with a genetic predisposition or a variation of their anatomy that causes more stress on a joint than the average person. Others may wear their joints out faster because they carry extra weight, work heavy labor jobs or play intense contact sports like football. Sports injuries or other accidents can jumpstart the process even if the initial injury is no longer an issue. Whatever the cause or underlying condition, the cartilage wear adds up over time.
When the cartilage wears out
Healthy cartilage is a smooth, white, resilient rubber-like padding that absorbs stress and protects the ends of long bones at the joints and nerves. Cartilage damage may start as a small tear, chip or crack, but eventually becomes a large defect such that bone rubs on bone. This defect causes pain, inflammation, bone spur formation, stiffness, grinding, instability, and even deformity of the limb.
Arthritis is often diagnosed with the assistance of x-rays; we can see when joint spaces become narrower, indirectly revealing cartilage loss. Alternatively, we can diagnose arthritis with an MRI which shows the injury in higher definition. With minimal and localized cartilage loss, it may be possible to transplant cartilage from one part of a joint to another.
Our bodies are not able to naturally repair arthritis or damage within our joints because it has no blood vessels. This means oxygenated red blood cells can’t reach the damaged tissue.
But, that doesn’t mean there is no hope.
How to treat arthritis
Although there’s no cure for arthritis, treatments in recent years improved greatly. A number of viable treatment options exist for arthritis before you need to consider surgery.
Read on to find answers to the question, “How to treat arthritis?”.
Losing excess weight takes stress away from joint movement with each step and both relieves pain and slows down the progression of arthritis. In fact, one pound of weight loss actually takes 4 pounds of stress off the knee during each step. Sometimes, losing weight is an essential step before surgery becomes a consideration; the risk of complications after surgery is higher with obesity.
Physical therapy helps support joints starting to wear out by improving flexibility and strengthening muscles.
In certain cases where a knee becomes bow-legged or knock-kneed, a brace can help correct the deformity.
Anti-inflammatory medications like Ibuprofen, Aleve, Meloxicam, or Celebrex can help with pain caused by arthritis inflammation.
Injections are another option and come in several different varieties.
Steroids or cortisone
Steroids or cortisone type medications are my go-to for a first time injection. They are inexpensive, relatively low risk, and covered by insurance.
If steroids or cortisone medications are not appropriate for a patient or don’t work, I consider injections with a chemical called hyaluronic acid, also known as the “rooster comb” injection, Hyaluronic acid was originally harvested from roosters, but is now made synthetically in a lab. It mimics a naturally occurring chemical thought to possibly lubricate the joint, decrease inflammation and pain.
A newer and more expensive option is platelet-rich plasma, or PRP. This procedure involves taking the patients blood and harvesting the healing factors, then reinjecting it into a specific area or joint.
The last option is stem cells. Advocates of stem cell treatments hypothesize stem cells can transform to accommodate a certain need when placed into a certain environment. For example, stem cells placed near damaged cartilage may develop into cartilage tissue. While there is a lot of promise associated with this therapy, at this point there is no proven benefit and the cost is often prohibitive.
X-rays before and after knee replacement
When is it time to consider surgery?
For many people, arthritis is an annoyance that flares up now and again. Often we successfully treat the condition with one of the methods above. Sometimes, though, the pain won’t subside as it did in the past, or the instability, deformity, and grinding increasingly gets worse. Once patients begin to run out of options or have to cut back on activities important to their lifestyle, surgery becomes a part of the conversation.
A number of viable joint replacement options exist for fingers, elbows, shoulders, hips, knees, ankles, and even toes. The rehab process and implant quality has improved in recent years and patients now get joint replacements earlier in life. Implant longevity is hard to predict, and like tire wear on a car, how long a joint lasts depends on how it is used. Generally speaking, there is about 0.5-1% chance each year a patient will need another surgery on a replaced joint. That means even 80% of joint replacements that are 20 years old are still in place and working decades later.
Surgery is a big decision, but when it’s the right time, it can be life changing.
Professor James tried injections, therapy, braces, weight loss and anti-inflammatory pills, but still, his walks around campus became more difficult and stairs increasingly dangerous. It was therefore time to consider surgery. He made the decision to have knee replacement surgery over the holiday break. He was back to teaching by the time school was back in session – with a straight knee and a newfound endurance!
The bottom line
If arthritis bothers you, be encouraged that excellent options are available prior to surgery. But if it turns out you do need a joint replacement, don’t despair. The current technology is very good and continues to improve all the time.
There are always new techniques to keep arthritis from holding you back!
Adam Wright, M.D.
Adam Wright, M.D. is a fellowship-trained orthopedic surgeon specializing in both routine and complex joint replacement of the hip and knee at the Plano Orthopedic & Sports Medicine Center in Plano, Texas. He is proficient in emerging and innovative techniques in primary and revision artheroplasty including minimally invasive surgery, anterior hip replacement, outpatient and rapid recovery total joint replacement, patient-specific or custom implants, robotic assisted surgery, computer navigation, infection, and fracture management. Learn more about Dr. Wright.