There are a myriad of options for the treatment of osteoarthritis that may be offered to you by your doctor. This can be very confusing. Its often difficult to decide whether to go through with a major operation like a total joint replacement. Could you be making a mistake? This article briefly looks at osteoarthritis and then explores the different treatment strategies available, helping you decide What's best for you?
What is actually happening to the joint?
In a joint, the bones that form the articulation are normally covered with a layer of cartilage, which is extremely smooth and well lubricated. It is also a perfect fit. In osteoarthritis areas of cartilage are damaged or missing and the chemical environment inside the joint is abnormal. The joint gradually becomes deformed so that it does not fit so well through a normal range of movement. This leads to abnormal loading of the joint and further cartilage damage.
Who is at risk of osteoarthritis?
Demographics Anyone can get osteoarthritis but it is more common with advancing age and female gender. Lifestyle Anything that leads to excessive repetitive impact across a joint will increase your risk. Therefore obesity, some manual occupations and high impact sports could lead to osteoarthritis. Inherited There is a genetic predisposition to the development of osteoarthritis although this is still being investigated. If you have joint deformities, this will increase your risk. Trauma Fractures extending into joints may increase your risk of osteoarthritis. Also, soft tissue injuries to a joint such as a rupture of the anterior cruciate ligament (ACL) in the knee can increase your risk of early osteoarthritis. Surgery Some surgical procedures carried out on joints increase your risk of osteoarthritis such as the removal of part of a meniscus (a specialized cartilage in the knee). Related conditions Other forms of arthritis such as rheumatoid arthritis can cause damage to the joint which resembles osteoarthritis.
Anyone can get osteoarthritis but it is more common with advancing age and female gender.
Anything that leads to excessive repetitive impact across a joint will increase your risk. Therefore obesity, some manual occupations and high impact sports could lead to osteoarthritis.
There is a genetic predisposition to the development of osteoarthritis although this is still being investigated. If you have joint deformities, this will increase your risk.
Fractures extending into joints may increase your risk of osteoarthritis. Also, soft tissue injuries to a joint such as a rupture of the anterior cruciate ligament (ACL) in the knee can increase your risk of early osteoarthritis.
Some surgical procedures carried out on joints increase your risk of osteoarthritis such as the removal of part of a meniscus (a specialized cartilage in the knee).
Other forms of arthritis such as rheumatoid arthritis can cause damage to the joint which resembles osteoarthritis.
Physiotherapy One of the things which makes osteoarthritis painful and progressive is the abnormal loading of a joint. Specific exercises that improve the basic stability of a joint can improve both the symptoms from osteoarthritis and could affect its progression. Orthotics Surgical appliances such as special insoles to improve the mechanics of standing and walking and therefore improving the loading of joints can reduce the pain from osteoarthritis. Weight loss Achieving and maintaining an appropriate weight can reduce pain and slow progression of osteoarthritis. Lifestyle Change in occupation and sporting activities to avoid impact across a joint can decrease the pain and progression of osteoarthritis. TENS TENS machines apply a current across a painful joint and have been shown to give effective pain relief. Alternative Acupuncture and electro-acupuncture can improve pain from osteoarthritis. Electro-acupuncture is not considered to be cost-effective for use on the NHS but there is some evidence that it works, at least on a temporary basis. Other Massage and the application of hot and cold packs to a painful joint can be helpful.
One of the things which makes osteoarthritis painful and progressive is the abnormal loading of a joint. Specific exercises that improve the basic stability of a joint can improve both the symptoms from osteoarthritis and could affect its progression.
Surgical appliances such as special insoles to improve the mechanics of standing and walking and therefore improving the loading of joints can reduce the pain from osteoarthritis.
Achieving and maintaining an appropriate weight can reduce pain and slow progression of osteoarthritis.
Change in occupation and sporting activities to avoid impact across a joint can decrease the pain and progression of osteoarthritis.
TENS machines apply a current across a painful joint and have been shown to give effective pain relief.
Acupuncture and electro-acupuncture can improve pain from osteoarthritis. Electro-acupuncture is not considered to be cost-effective for use on the NHS but there is some evidence that it works, at least on a temporary basis.
Massage and the application of hot and cold packs to a painful joint can be helpful.
Paracetamol and non-steroidal anti-inflammatory pain killers such as diclofenac are effective pain-killers for use in osteoarthrtits. Your doctor can advise you on an appropriate regime.
Anti-inflammatory painkillers can be applied as a topical gel onto the affected joint.
Glucosamine and chondrotin have become popular in recent years but have very little evidence to show they work. However there is good evidence that they are not harmful. It is not offered on the NHS but can be bought from a pharmacy and should be taken for at least 3 months before deciding whether it works for you.
Steroids are drugs that block the production of inflammatory chemicals. They are often effective in controlling pain from osteoarthritis over a short period. However most surgeons will not operate on a joint for at least 6 months after a steroid injection due to the risk of infection.
Over the last 10 years new agents that restore the internal environment of a joint have been trialed as a joint injection for osteoarthritis (eg hyaluronic acid analogues). These injections do have evidence to support their use but are not cost effective and so not available on the NHS.
Surgical treatments
Key hole surgery may be of use in some patients with osteoarthritis but at best gives temporary relief of pain. It has specific uses in patients with true mechanical symptoms such as true locking of the knee or debridement of bony lumps from the hip in early osteoarthritis affecting a young person. Your orthopaedic surgeon can advise you whether arthroscopy is of use for you.
This is an operation involving breaking and realigning bones to make the loading across a joint more acceptable. It is normally used in young patients with severe osteoarthritis to limit progression and symptoms.
Joints can be surgically fused by making the bones on either side heal together to become one bone. This relieves the pain from the joint itself permanently but can be disabling due to the loss of movement. It can also have a negative effect on the loading of adjacent joints and increase the risk of osteoarthritis in them. It is most useful in the toes, the foot and ankle as well as the spine.
In joint excision the bone forming one side of a joint can be partly removed, effectively rendering the joint absent and useless but pain free. This is most effective at the base of the thumb and the joint between the clavicle (collar bone) and scapula (shoulder blade) called the acromioclavicular joint. Joint excision of larger joints (eg the hip) is occasionally done but is generally a salvage procedure with a relatively poor outcome.
Joint replacements can be very successful treatments for osteoarthritis restoring near normal function. They are used when conservative and medical treatments have failed. They are most effective in the hip, knee and shoulder. They are also available for the elbow, spine, ankle and small joints of the hands and feet. Apart from the risks of surgery, the main disadvantage is that they eventually fail. In the hip and knee, joint replacements can last for 15 to 20 years but other joints fail earlier.
Resurfacing is really just a type of joint replacement. It has become popular due to the belief it is bone conserving. However it is not suitable for all patients. There are pros and cons to these types of joint replacements and you should discuss these with your surgeon.
Surgical procedures are very effective for the treatment of painful osteoarthritic joints but the risks are considerable. Getting an infection in a joint replacement (about 0.5 to 1% of people get this) is a disaster. You will suffer for a whole year with pain and immobility as its being rectified. Therefore surgery should be reserved for patients who really have no other option and have failed non-surgical treatments.
