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Osteoarthritis: Hip and Knees

What is arthritis?

Arthritis is not just a single disease. It is a term used to describe over 100 different conditions that affect the joints in the body. The word arthritis usually means inflammation of a joint. Although many types of arthritis have common aspects, each type has its own pattern of symptoms and affects people in different ways. Two major forms of arthritis are Rheumatoid Arthritis and Osteoarthritis.

Rheumatoid Arthritis

In cases of Rheumatoid Arthritis, the body’s immune system appears to go awry and attack healthy parts of the body, particularly the joints.

Osteoarthritis

By far the most common form of arthritis, osteoarthritis is also called degenerative joint disease. It most frequently occurs in weight-bearing joints, mainly knees, hips and ankles. This form
of arthritis gradually breaks down the cartilage that covers the ends of each bone in a joint. Normally cartilage acts as a shock absorber, providing a smooth surface between the bones. But with osteoarthritis, the smooth surface becomes rough and pitted. In advanced stages, it may wear away completely. Without normal gliding surfaces, the bones grind against one another, causing inflammation, pain and restricted movement.

In osteoarthritis of the knee, the shape of the bone and appearance of the leg may change over the years. Many people become bow-legged or knock-kneed. In people who have osteoarthritis of the hip, the affected leg may appear shorter.

Treatment Options

There is no cure for arthritis, but the past decade has seen the development of dramatic new ways to manage the pain, lack of mobility and fatigue that are among arthritis' most disabling symptoms.

Hyaluronate Injections — Hyaluronate is a natural element of joint fluid. Injections appear to be advantageous for patients with a history of NSAID intolerance, patients who are of advanced age, or those with active or a history of ulcer disease.

Medicines — Coated aspirin helps relieve pain and has few side effects. Non-steroidal anti-inflammatory drugs (NSAIDs), like Voltaren®, Feldene®, Naprosyn® and Clinoril® are for pain and inflammation.

Cortisone Shots — Cortisone shots are given for inflammation and may provide pain relief for variable periods of time. Generally, repeat injections should be limited to three or four per joint, per year.

Thermal Therapy — Superficial heat such as heating pads, hot water bottles and saunas may relax the muscles to help decrease pain and stiffness. Cold therapy, such as ice packs, may help de- crease muscle spasm and the associated pain and may help raise the pain threshold.

Exercise and Rest — Prolonged rest and days of inactivity will increase stiffness and make it harder to move around. At the same time, excessive or improper exercise can overwork your arthritic joint and cause further damage. A balanced routine of rest and exercise is best. Your physical therapist will instruct you in walking and rehab exercises starting the day after your surgery.

What are the symptoms?

The number one symptom is pain, often described as deep and aching. Osteoarthritis pain is typically of slow onset, initially occurring after activity, with relief after rest. As the disease progresses, pain may occur with even minimal motion; in severe cases, there is pain at rest. Joint stiffness is also common, usually occurring upon awakening or after inactivity. The stiffness lasts from 20 to 30 minutes. Other symptoms include crackling of the joint, joint tenderness, joint enlargement and limitation of motion in joints.

How is it diagnosed?

A simple weight-bearing x-ray and examination by your doctor will determine if you have osteoarthritis. Time-consuming and costly diagnostic procedures are not required.

Surgical Procedures

Osteotomy — This is a surgical procedure where the surgeon removes a wedge of bone either above or below the affected joint. Osteotomy surgery changes the alignment of the joint so that weight is shifted off diseased or deformed cartilage to healthier tissue in order to relieve pain and increase stability.

Arthroscopy — Pencil-sized instruments that contain small cameras and lighting systems to magnify and illuminate joints are inserted inside via two or more small incisions. This can help surgeons identify and repair damage and injury that radiographic exami- nation may not capture. Recovery is easier and it is not uncommon for patients to go back to work or school or resume daily activities within a few days.

Joint Replacement — This procedure removes a damaged joint and replaces it with a new (prosthetic) joint. A successful joint replacement may relieve and restore most of the joint’s movement.

Wear and Tear Arthritis of the Knee — In healthy knees and hips, cartilage covers the ends of the bones, creating a cushion between the bones. When you have osteoarthritis, the cartilage has worn away, causing pain when bone rubs on bone.