Written By: James O. Merritt, IV, MD
Arthritis of the hips and knees is a debilitating condition that affects millions of Americans on a daily basis. Arthritis is defined as a pathologic inflammation in a joint. There are many types of arthritis which include degenerative, gouty, rheumatoid, osteoarthritis, septic, traumatic, and infectious, just to name a few. Osteoarthritis is the most common form of arthritis, often attributed to the “wear and tear” that we have subjected our bodies to through the years. The smooth, articular cartilage becomes frayed and rough. Eventually, as the osteoarthritis progresses to the later stage, the joints will become “bone on bone” when the cartilage has completely worn out.
The symptoms of osteoarthritis are directly related to the inflammation created in the joint. Inflammation is the body’s normal response to injury or disease. The symptoms that one may experience vary from mild to disabling. The most common symptoms include pain, swelling, stiffness, loss of motion, and weakness.
To diagnose osteoarthritis, and to determine the extent to which it has progressed, a physician relies on the patient’s history physical examination, and x-rays. The past medical history focuses on the location and character of the symptoms, severity of the pain, aggravating activities, limitations created by the symptoms, and previous treatment. The physical exam focuses on the range of motion of the affected joint, crepitus or “cracking noise” with motion, pain with motion, atrophy of the muscles, stability of the joint, and alignment of the joint. X-rays are taken to determine the extent of the joint deterioration. Findings on x-rays of arthritic joints include loss of cartilage or joint narrowing, erosion of bone, fluid within a joint, bone spurs, and other abnormalities. Lab tests are generally not needed to diagnose arthritis, but may be used to rule out other diseases.
Treatment of knee arthritis generally begins with conservative, non-surgical management. Treatment options include lifestyle modifications such as weight loss, switching from high-impact exercises to low-impact, and minimizing aggravating activities. Strengthening, flexibility, and range of motion exercises are also beneficial. Supportive devices, including the use of a cane or walking stick and knee braces or sleeves, can also be used. Several oral medications can be used to treat arthritis. These include, but are not limited to, many anti-inflammatory medications, as well as glucosamine and chrondriton sulfate. Injections are another option that includes the use of cortisone, as well as several visco-supplementation injections.
When non-surgical treatment is no longer effective, surgical options include total or partial knee replacement, arthroscopy, and occasionally, osteotomies.
Conservative treatment of hip arthritis is treated in a fashion similar to that of the knee, with the exception of injections, which are more difficult to perform. Surgery for hip arthritis is generally reserved to total hip replacement.
The results of total joint replacement are considered excellent. Patients experience significant pain relief and improvement in function. The surgery involves 3 + days of hospitalization and 6-12 weeks of rehabilitation. There are some risks involved with this surgery, as there are with any surgery, which should be discussed with your physician prior to surgery. If you have debilitating joint pain, make an appointment with your physician to discuss the best option for you.