Osteoarthritis is the clinical name for a condition that affects approximately 27 million Americans. You may know it as degenerative joint disease or degenerative arthritis. Osteoarthritis is the most common chronic condition of the joints, occurring most often in the knees, hips, lower back, and neck.
At Pinehurst Surgical, osteoarthritis is often the determining factor behind the majority of our hip and knee replacement procedures. The goal is to relieve the chronic pain and decreasing mobility that osteoarthritis can cause.
What is osteoarthritis?
Colloquially known as “wear and tear” arthritis, osteoarthritis involves the breakdown of the cartilage in the joints. It can occur in most of the joints of the body but is most common in the weight-bearing joints: the hips, knees, and spine. In other joints, osteoarthritis usually only occurs if there was a previous injury to the joint or a problem with the cartilage in the joint. At Pinehurst Surgical Orthopaedic & Joint Replacement Center, we have vast experience with osteoarthritis in the hips and knees.
In healthy joints, cartilage is the firm, rubbery material that covers the ends of the bones. Cartilage acts as a shock absorber, reducing the impact and friction in the joints.
When a person has osteoarthritis, the cartilage breaks down, becomes stiff, and loses its elasticity. As it becomes less malleable, the cartilage is more prone to damage and wear. Now its shock absorbing benefits decrease, and the tendons and ligaments stretch, causing pain. As the deterioration progresses, patients can begin to have bone on bone contact in the joint.
Where are the most common joints for osteoarthritis?
The weight-bearing joints are the usual locations of osteoarthritis: the knees, hips, and spine. This is simply due to the daily stress of the joints handling typical movements such as walking, bending, running, or jumping. Over time, everyone’s joints deteriorate, the degree of deterioration and the accompanying pain and loss of mobility are the signs of osteoarthritis.
Who is at risk for osteoarthritis?
Most people over 60 have some degree of osteoarthritis, although they may simply consider it to be a “ stiff hip or knee.” It is more common in women than men. Younger people can get osteoarthritis, but it’s usually a result of a joint injury (say from football or other sports) or repetitive stress from overuse (dancers and runners).
- One in two adults will develop symptoms of knee osteoarthritis during their lives.
- One in four adults will develop symptoms of hip osteoarthritis by age 85.
- One in 12 people 60 and over has osteoarthritis in his or her hands.
What causes osteoarthritis?
Although the daily use of our knees and hips is really what leads to osteoarthritis, there are certain factors that can contribute to developing the condition.
- Genetics— Some people inherit a rare defect in the body’s production of collagen, the protein that makes up cartilage. This can lead to osteoarthritis in people as young as age 20. Also, defects in the joints and the way the bones fit together can accelerate degeneration of the joints.
- Obesity— Simple physics says that adding weight to a joint increases pressure and wear. Overweight people put much greater loads on their joints, causing the cushioning cartilage to break down faster and earlier than in people at or near their ideal weight.
- Joint overuse— Overuse of certain joints leads to osteoarthritis. For instance, if a person has to continually bend his or her knees for their job, the knee joints will wear more quickly.
- Injury— A past injury in a joint has a higher risk for that joint becoming arthritic. Also, heavy impact sports such as gymnastics lead to a far higher incidence of osteoarthritis in later years.
- Other diseases— People with rheumatoid arthritis (the second most common form of arthritis) are more likely to develop osteoarthritis. Certain other diseases can also increase the odds of developing osteoarthritis.
How would I know if I have osteoarthritis?
Symptoms vary depending on the joint in question and the person, but the most common symptoms of osteoarthritis are pain and stiffness, particularly first thing in the morning or after resting. Some people are seriously debilitated, while others may have few symptoms despite a serious degradation of cartilage in the joint. Osteoarthritis in the knees will begin with a slight limp that worsens as the years pass. Osteoarthritis is the most common reason for knee replacement.
These are the common symptoms of osteoarthritis:
- Pain after activity involving the joint, particularly intensive use
- Stiffness in the joint after periods of inactivity
- Clicking or cracking sounds when a joint bends
- Joint aching and soreness, especially with certain movements
- Mild swelling around a joint
- In the hips, pain may radiate into the groin, buttocks, or the inside of the thigh
- In the knees, a scraping sensation may accompany movement
- In the fingers, bone spurs may make the fingers swollen, tender, and red.
How is osteoarthritis diagnosed?
The first step toward diagnosis is a thorough physical examination of the joints in question, testing range of motion. Special attention is given to areas that are tender, painful, or swollen. Beyond the physical exam, other tests can reveal the condition:
- Joint aspiration— Fluid is drawn from the joint. This fluid is then examined for evidence of crystals or joint deterioration. This can help to rule out other possible causes or medical conditions.
- X-rays— X-rays can show damage and changes in the joint.
- MRIs— Magnetic resonance imaging does a better job than x-rays at showing the cartilage and other structures.
Treatment of osteoarthritis
While Dr. Moore is mainly concerned with joint replacement, particularly of the knees and hips, there are other treatment options for osteoarthritis before the condition requires joint replacement. There is no cure for osteoarthritis, but, short of replacement, these are treatments:
- Weight management for obese patients
- Exercise to strengthen the muscles surrounding and supporting the joints
- Anti-inflammatory medications
- Joint injections
- Hyaluronic acid injections
- Assistive devices such as orthotics, braces, or canes
At a certain point, the chronic pain and decreasing mobility merit a replacement of the joint. Dr. Moore is expert at a variety of hip and knee replacement options. Some patients may need only a partial replacement. In the hips, a resurfacing arthroplasty can delay full replacement for a decade or more. Surgical techniques are continuing to become less invasive, and the life of artificial appliances is expanding dramatically. The important thing to consider is quality of life. Once they have recovered from their surgery, many of our patients wonder aloud why they waited so long to opt for replacement surgery.