Osteoarthritis is a familiar ailment to many seniors

If you live long enough, odds are some body parts are going to show wear and tear.

That’s sometimes due to osteoarthritis.

“About half of people by age 80 will have arthritis in one of their knees,” said Ralph Cook IV, MD, an orthopedic surgeon with Cape Cod Healthcare’s Falmouth Orthopedic Center. “The next most common is the hip and after that it’s the shoulder. Unsurprisingly, hip and knee replacements are some of the most common surgeries that orthopedic surgeons do.”

Osteoarthritis happens when the hyaline cartilage in the joints wears away. That can happen because of wear and tear from age; an injury that affects the joint; repetitive stress; or genetics – some people just seem to be predisposed to the cartilage wearing away, Dr. Cook said. There are other factors, as well.

“Women tend to have a higher risk of arthritis. Another significant factor is high body mass – being overweight or obese. The reason for that is rather simple: You’re just experiencing more force across that joint,” he said.  

Dr. Cook, who does knee and shoulder replacements, among other surgeries, at Falmouth Hospital, recently answered some of the basic questions about osteoarthritis and its treatment. Here are his answers, edited for length.

What would make me suspect I had osteoarthritis in a joint?

The most common symptom would be pain – typically a dull achy pain. It can be sharp as the arthritis progresses or if you're in an acute flare. Other things to look for would be decreased range of motion of your joints. When that cartilage wears away, we don't have that smooth motion and we can start getting stiff. Sometimes people can't fully straighten their knee. ​​In the shoulder, you can get “cog-wheeling” when you move your arm from your side by your hip all the way up to over your head and you can literally feel clicks as those uneven cartilage surfaces rub past one another. And then finally, joint swelling can be a sign of arthritis as we get older.

Who should I consult if I suspect arthritis?

A lot of people will initially ask their primary care doctor, and their primary care doctor can do a number of the non-operative treatments that orthopedists also do. We typically try to maximize non-operative treatment before we even consider surgery. If we don't need to do surgery, why do it? And, we find that surgical outcomes are typically better for patients who have more advanced degenerative changes.

What are some of the options for non-surgical treatments?

The mainstays of treatment would be non-steroidal anti-inflammatory drugs like Advil, Naproxen, Aleve, ibuprofen. We have clinical-strength anti-inflammatories. Another option, specifically for the lower extremity, is weight loss. Decreasing your weight by just 10 pounds can actually offload the patellofemoral or kneecap joint by eight fold – that’s 80 pounds off that kneecap joint. Physical therapy is another thing we'll commonly do, and this is meant to strengthen the muscles around the joint, which can help offload it, encouraging proper biomechanics. Finally, there are other medications such as tramadol, which is an opioid analog, that has pretty good evidence for treating knee osteoarthritis.

Are there injections that can help?

One would be a steroid injection, and this is oftentimes a cocktail of a numbing medication and a steroid. The numbing medication typically works rather quickly, but it can wear off after a couple hours. The steroid can take a couple days to really kick in. Other injections are viscose supplementation, which is a fancy term for supplementing some of the natural proteins which are in your joint. That is a series of three injections which you administer once a week for three weeks. You're kind of injecting a little WD-40, in layman's terms, into the joint to help it slide smoothly past the other bone.

Are there any other non-surgical techniques for relief?

The very last thing that we can do non-operatively is bracing to shift the weight load. Patients who have isolated arthritis to one of the knee compartments – there's a medial compartment and a lateral compartment – you can give them a brace. It basically changes the alignment and offloads that medial compartment and puts more pressure through the lateral compartment. Patients would wear that while walking. It's called an unloader brace.

What are some of the advances in osteoarthritis surgeries?

One thing gaining in popularity is a partial knee replacement for those folks who have arthritis in that isolated medial compartment or lateral compartment or even the kneecap compartment. It’s a smaller surgery and is just replacing that diseased compartment with metal and plastic. Otherwise, the big advances may not be felt by patients initially but the replacement joint materials just continue to improve every year. The main benefit is decreased risk of implant failure over time.

You mentioned that hospital stays are shorter for knee surgeries?

We’re doing same-day surgery for many folks. People get their knee replacement and go home the same day. And this is largely credited to advances in our anesthesia and pain management as well as multidisciplinary post-operative care: setting people up with visiting nurses before the surgery and with a physical therapist who will come to their home for the first week or two after surgery. Patients find that they're much more comfortable in their own homes. It's something they've started to institute here at Falmouth Hospital and they're really making a big push to make most joints ambulatory or same-day surgeries. As we get more advanced in our ability to control patients' post-operative pain, we find that their outcomes are also improving and they're more satisfied with their experience with these same-day surgeries.