General Arthritis
Understanding Arthritis
Osteoarthritis (OA) is one of the most common causes of joint pain. Sometimes called degenerative arthritis or degenerative joint disease, it is a condition that involves the breakdown of joint cartilage. Cartilage is a rubbery tissue that covers the ends of moving bones in joints. It acts as both a shock absorber and a lubricant, protecting your bones from damage and providing smooth, pain-free movement.
As joint cartilage wears away, the bones begin to make painful bone-on-bone contact. The early stages of osteoarthritis can be treated with a variety of conservative, non-surgical treatments. However, as the joint cartilage continues to wear away and the symptoms of osteoarthritis become more severe, surgery may be recommended to correct the damaged bone and cartilage.
To diagnose your condition, an orthopedic physician will observe your movement and review your health history. An X-ray of the affected joint will show signs of cartilage wear, and the severity of the cartilage destruction can help determine the best course of treatment.
Often the cause of arthritis is unknown, but osteoarthritis may develop as a result of injury to the joint, excess body weight, or years of wear and tear on the joint cartilage. There is no known cure. The best that doctors can do for patients is to restore motion and reduce pain. Fortunately, total joint replacement has generally proven quite effective at accomplishing these goals.
The joints most commonly affected by osteoarthritis are the knees, hips, fingers, and shoulders. Symptoms of osteoarthritis include, but are not limited to:
- Joint pain while standing or moving
- Giving out or locking of joint
- Near constant pain
- Decreased activity
- Abnormal stance or walk
There are a number of non-surgical treatments for osteoarthritis. Moderate doctor-prescribed exercise and physical therapy are excellent ways to keep your joints moving and to help relieve moderate joint pain. Joints that are not regularly exercised can become tight and painful.
Excess body weight places extreme pressure on the joints. If you are overweight, your doctor may recommend weight loss to help relieve unwanted stress and pain in your joints.
Pain relievers, such as acetaminophen or medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), can help control swelling and pain. It is important to consult your doctor before taking medication for joint pain.
Assistive devices, such as a cane or walker, can help reduce the pressure placed on joints and alleviate some pain. Resting after activity can also help control moderate joint pain.
The technique of joint replacement uses prosthetic implants to replace the damaged sections of bone and cartilage in the joint. The purpose of the procedure is to restore function and mobility and to provide relief from joint pain.
The most common reason joints are replaced is osteoarthritis, which is the diagnosis in 90% of patients receiving a new joint. However, patients may be candidates for joint replacement if they suffer from any of the following conditions:
- Rheumatoid Arthritis (RA) This is significantly less common than osteoarthritis, affecting 2.1 million Americans, mostly women. Rheumatoid arthritis is an autoimmune disease, the cause of which is unknown. The body’s immunological system attacks healthy tissue, causing inflammation of the joint lining and subsequent joint damage.
- Avascular Necrosis (AVN) Also known as osteonecrosis, this is a disorder where the blood supply to the bone is compromised, causing weakness and potential bone collapse. Mostly occurring in people between the ages of 30 and 60, AVN most commonly affects alcoholics, people suffering from rheumatoid arthritis or systemic lupus, and people ingesting high doses of steroids.
- Post-Traumatic Arthritis (PTA) Injuries to the joint and cartilage which do not fully heal may lead to an arthritic condition.
- Paget’s Disease A disorder whereby bone formation accelerates, creating changes in the shape and strength of the bone.
Diagnosing Arthritis
To help diagnose osteoarthritis, your physician will take a complete medical history and will also take a series of x-rays to examine your hipbones. On an x-ray, a healthy hip joint appears as if there is a space between the bones in the joint. Although you cannot see the cartilage on an x-ray, in the healthy hip, the cartilage is working to cushion and smooth the movement of the thighbone (femur) against the hip socket (acetabulum). On the x-ray of a hip with osteoarthritis, there is bone on bone contact because the cartilage between the femur and acetabulum has been worn away.
Treating Arthritis
There are a number of non-surgical treatments for osteoarthritis. Moderate doctor-prescribed exercise and physical therapy are excellent ways to keep your joints moving and to help relieve moderate joint pain. Joints that are not regularly exercised can become tight and painful.
Excess body weight places extreme amounts of pressure on the joints. If you are overweight and able, your doctor may recommend weight-loss to help relieve unwanted stress and pain in your joints.
Pain relievers, such as acetaminophen or medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), can help control swelling and pain. However, it is important to consult your doctor before taking medication for joint pain.
Assistive devices, such as a cane or walker, can help reduce the pressure placed on joints and alleviate some pain. Resting after activity can also help control moderate joint pain.
As osteoarthritis and rheumatoid arthritis become more severe and the cartilage continues to wear away, the increased pain and limited movement can affect many everyday activities such as walking, driving, and sitting. When non-surgical treatments fail to provide adequate relief from the symptoms of arthritis, your orthopedic surgeon may recommend joint replacement. The technique of joint replacement uses implants typically made from polyethylene (plastic) and metal alloy to replace the damaged sections of bone and cartilage in the joint. The purpose of the procedure is to restore function and mobility and to provide relief from joint pain.
Preparing Yourself and Your Home for Surgery
When you and your orthopedic surgeon decide that joint replacement surgery is the best option to relieve pain and restore motion, you will begin the normal preparation for surgery. You should notify your surgeon about any of the medications you are presently taking because some medications must be stopped before surgery. All surgeries carry certain risks and possible complications. Before surgery, your surgeon will explain the possible complications. Your orthopedic surgeon may ask you to see your primary care physician to make sure that you do not have any health conditions that may complicate your surgery.
You may be asked to donate blood before your surgery. There are several options regarding blood donation and surgery, and all of these options should be explained to you. Surgery also requires anesthesia.
There may be some options regarding anesthesia and they will be explained to you. Your options will be based on your health history, the medications you presently take, and the results of your physical examination.
Your surgeon may also recommend that you start a strengthening program before surgery. The prescribed exercises are designed to help add strength, flexibility. Strengthening your muscles before surgery can assist your postoperative recovery.
After surgery, your surgeon will give you a specific recovery plan that you should carefully follow. Do not attempt exercises that are not prescribed by your surgeon, and do not attempt to alter your recovery schedule. It takes time for your joint to heal properly.
Planning ahead for your return home:
- Launder all of your dirty clothing before your surgery. Have loose, comfortable clothing set aside for your recovery time.
- Prepare single-serving meals before your surgery. These meals can be heated quickly in a microwave and there is less to clean up.
- Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls. If necessary, widen furniture paths to accommodate a walker or cane.
- To simplify accessibility, place regularly used items such as remote controls, medications, and reading materials in easy-to-reach locations.
- Un-tuck bedding to allow for easier access in and out of your bed. If your bedroom is on a second floor, it may be helpful to temporarily relocate your sleeping arrangements to a single floor. This will avoid having to climb stairs when you are not feeling your best.
- Having some assistance after total joint replacement can also be very beneficial. Contact family members or friends ahead of time so they may make the necessary arrangements to assist in your recovery.