Joint Replacement: Get Back in the Game – Broward Health North

Osteoarthritis is the most common form of arthritis affecting more than 25 million people. It is genetic and causes pain, stiffness and destruction within the joint. Common sites of osteoarthritis include the hip, knee, fingers and shoulders. Some patients develop post-traumatic arthritis, which is arthritis that develops months or years after a major injury or fracture in or around a joint. Other forms of arthritis include rheumatoid arthritis and psoriatic arthritis. These are inflammatory diseases which affect the lining of the joints and often affect multiple joints in the arms and legs.

Osteoarthritis symptoms can be managed by anti-inflammatory medicines such as ibuprofen and naproxen. Physical therapy can help maintain flexibility in the joint and can strengthen the muscles around the arthritic joint. At its most advanced stages, Osteoarthritis causes severe pain and stiffness. Once the pain interferes with your daily activities and is no longer responding to conservative treatment, surgery is the treatment of choice.

A recent patient was suffering from a weak knee for nearly 40 years after developing post traumatic arthritis and stiffness after two initial surgeries when he was in the military. He underwent a successful total knee replacement in 2019 using computer-assisted navigation. He participated in inpatient physical therapy and went home two days after surgery. Seven weeks after surgery, this patient has no pain in his knee, he has much better flexibility and has just returned from a two week hike in the Smokey Mountains. A successful total knee replacement has restored his quality of life.

Total joint replacement (TJR) is one of the most commonly performed, elective surgical procedures in the United States, and the volume of primary and revision TJR procedures has risen continuously in recent decades. According to PubMed.gov, hip replacements are projected to grow 71% by 2030 and total knee replacements are projected to grow 85%, by 2030.

Joint replacement or other surgeries are sometimes considered the “treatment of last resort” for people with osteoarthritis. Doctors frequently tell patients to wait as long as possible before joint replacement, but to get the best results, it should also not be delayed too long. How do you know when it’s time to seek joint replacement surgery?

If you’ve unsuccessfully attempted conservative treatment or if damage to the cartilage or bone is beyond repair, remember that joint replacement is proven to be safe and highly effective in the right patient. Dr. Janke says this is still often your best option. Newer techniques in the hip and knee can give patients excellent pain relief and improved function.

Talk with your doctor about the best options and long-term strategies for you and understand what’s available for your specific problem. Preserving your joints and your activities and lifestyle is the basis for a partnership that is best for you.

If you need an orthopedic surgeon near you, visit BrowardHealth.org/Find-Doctor. To learn more about Broward Health North’s Joint Replacement Center, call 954.712.4274.

https://pubmed.ncbi.nlm.nih.gov/30180053/

https://aaos-annualmeeting-presskit.org/2018/research-news/sloan_tjr/

Osteoarthritis: Treatment

Treatment of osteoarthritis has two goals as its main objectives.

decrease the pain and discomfort you may be experiencing and increase function

decrease any disability

Methods of treating osteoarthritis vary according to each individual’s needs. In some cases non-pharmacological treatment may be started, with the patient educated in physical and occupational therapy programs to achieve the goals of decreasing pain and disability.

More involved cases of osteoarthritis may require pharmacological management with regular monitoring by your physician as well as physical and occupational therapy programs. In several cases, especially those involving the weight bearing joints, surgery may become necessary to decrease the pain and disability.

Treatment methods for patients include:
(click on a heading for more information)

Joint Management Progams

Lifestyle changes – education of patients and family members and weight loss can be effective.

Physical therapy – with emphasis on maintaining the patients joint motion, muscle strength, and ambulation.

Occupational therapy – to assist patients in maintaining independence and self reliance in performing activities of daily living.

Many times a physical and occupational therapist will work together with the patient to not only supply the necessary instructions needed, but also the equipment and ideas to simplify tasks for patients.

Pharmacological (Drug Treatment)

Because osteoarthritis is a degenerative process and not an inflammatory one, pharmacological treatment can be managed in several ways.

Acetaminophen (Tylenol) – initially, this may be the drug of choice and clearly has a lower incidence of side effects than other agents which may be used.

Aspirin or NSAIDS (non-steroidal anti-inflammatory medications) are frequently used if patients do not respond to Tylenol. Gastrointestinal complications are more likely to occur in this group, with this risk being increased threefold in patients treated with these medications.

Pain medications such as Darvocet, Codeine, or in some cases other narcotic agents, can be helpful in short term management of acute flares.

Intra-articular injections – not usually recommended in early treatment, joint injections may be helpful to elderly patients or patients in which other medications are ineffective or unsafe to use.

Nutritional Supplements

There are many over-the-counter nutritional supplements that claim they can improve the symptoms of arthritis. These supplements should be discussed with your physician. Many of these supplements have not been scientifically studied or proven to be of benefit to the patient.

Recently, much interest has been generated in the use of glucosamine, chondroitin sulfate, or the combination. Laboratory and clinical studies have suggested that these materials, which are the building blocks for cartilage, may have a positive effect on cartilage and arthritis.

One nutritional supplement, Cosamin DS, is a patented combination of these two materials. In a small clinical study, this combination was shown to improve the pain and function in patients with mild to moderate osteoarthritis. We are currently involved in a larger study to evaluate this further.

Electrical Stimulation Therapy

Several studies that we have participated in have evaluated the application of electrical stimulation to the treatment of patients with osteoarthritis and rheumatoid arthritis of the knee and hand.

The latest study indicated that treatment with Bionicare® Electrostimulation was effective in delaying the need for prosthetic reconstruction in patients with severe OA of the knee. As this treatment becomes available, it may be a useful method for certain types of arthritis.

Surgery

Various surgeries may be beneficial to patients with osteoarthritis, especially when the joints of the lower extremities, or weight bearing joints, are involved.

Surgeries which can be performed are:

Arthroscopic debridement
Cartilage resurfacing
Hemi arthroplasty
Osteotomy of the hip or knee
Total hip replacement
Total knee replacement
Synovectomy

Other Treatments

Heat/Cold Therapy

Ultrasound

References

3. Altman, R., Alarcon, G., Appelrouth, D., et al., The American College of Rheumatology Criteria for the Classification and Reporting of Osteoarthritis of the Hip, Arthritis Rheum., 34 (5): 505-514, 1991.

4. Altman, R., Asch, E., Block, D., et al., Development of Criteria for the Classification of Osteoarthritis of the Knee, Arthritis Rheum., 29 (8): 1039-10.

Osteoarthritis: Diagnosis

As mentioned earlier, there are over 120 types of arthritis. Correctly diagnosing the type of arthritis a patient has may take several visits to a physician and perhaps a referral to a rheumatologist, a physician who specializes in the diagnosis and treatment of people with various forms of arthritis.

While OA can be slow to cause any noticeable symptoms, once symptoms occur, it is important that a physician be involved in your care. By seeking medical attention early, you may prevent or decrease serious joint damage.

You also will be able to work with your physician in developing a treatment plan which is individualized for your needs and tailored to your lifestyle.

Signs and Symptoms of Osteoarthritis^2,3

Joint pain
Morning stiffness
Buckling or instability
Loss of function
Bony enlargement
Limitation of range of motion
Crepitus on motion
Tenderness on pressure
Pain on motion
Joint Swelling
Malalignment and/or joint deformity

Resources

2. Hochberg, M.C., Altman, R.D., Brandt, K.D., et al., Guidelines for the Medical Management of Osteoarthritis, Arthritis Rheum., 38 (II): 1535-1546, 1995.

3. Brunton, S., Clinical Evaluation of the Patient with Osteoarthritis, Postgraduate Medicine Special Report, McGraw-Hill Healthcare Information Programs, August 1998.

Osteoarthritis: The Facts

Who develops osteoarthritis?

Osteoarthritis is seen in both females and males in a 3:2 female/male ratio. Occurrence is usually noted between the ages of 45-90, and affects more than 20.7 million Americans today.

What exactly is osteoarthritis?

Osteoarthritis is the type of arthritis involving the cartilage of a joint. The cartilage of a joint is a tough, gristle-like material which is found on the ends of the bones. It forms the surface of the joint on either side. Cartilage is durable and somewhat elastic. It does not have a blood supply and therefore gets its oxygen from the joint fluid surrounding it.

When you use a joint, fluid and waste products are removed from the cartilage by the pressure involved. When pressure is relieved, oxygen and other nutrients are returned to the cartilage. Cartilage also has no nerve supply. It is this characteristic that allows large forces to be transferred without pain.

Over time, the cartilage may become worn. The bony surface of the joint may begin to grate against the bone on the other side and the elasticity of the cartilage may be decreased. Eventually the cartilage may wear away entirely. This cartilage deterioration is, in fact, what defines osteoarthritis. Unlike some other types of arthritis, OA does not affect the whole body. However, the changes which it can cause may limit patients due to pain and loss of movement.

Where does OA occur?

OA can occur in any joint and may occur only on one side of the joint. Usually, it is seen in the joints of the fingers, spine, hips, and knees. These joints fall into three common types of osteoarthritis.¹

The first and usually mildest is the OA which affects the hands, causing knobby enlargement of the finger joints. When this occurs at the end joints of the fingers, these enlargements are called Heberden’s nodes. Growths in the middle of the fingers are called Bouchard’s nodes. This type of OA may cause stiffness and changes in the cosmetic appearance of the hand.

The second type of OA involves the spine. This can involve the neck area as well as the back. Bone spurs are symptoms of arthritis not necessarily the cause of pain.

The third type of OA commonly seen involves the weight-bearing joints, most frequently the hips and knees. This form of OA can become quite severe and limiting, or may only periodically cause symptoms. In extreme cases, walking may become extremely difficult or impossible. This type of OA frequently involves both sides of the body, and may cause a deformity in the lower extremity due to the degeneration process.

View our videos on Osteoarthritis of the Hip and Knee below to learn more.

When does OA occur?

OA can develop as a natural process of aging or it may occur as a result of a traumatic injury such as a fracture. Patients who have a congenital malformation of a joint also tend to develop OA at an earlier age than normally seen.

A common idea in past years was that osteoarthritis developed because of “wear and tear” or over-use of a joint. Research studies of people who participate in strenuous activities have failed to show a relationship between these activities and the development of arthritis.

Furthermore, most experts agree that a patient, even when diagnosed with OA, needs to continue a program of exercise to maintain optimal function of the joint.

Why does OA occur?

No one knows for sure what causes osteoarthritis. Some experts believe that people are born with defective cartilage or abnormalities in their joints which lead to the changes seen in OA. Others believe that OA develops as a result of over-using an already injured joint or because of joint damage caused by other arthritic conditions.

Research into the causes, prevention, and treatment of OA as well as other types of arthritis continue to provide improved methods for the relief of symptoms and will continue to aid in the understanding of these disease processes.