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 does osteoarthritis typically occur in the body?
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.
Rheumatoid arthritis vs. Osteoarthritis
When people hear the term “arthritis” they assume osteoarthritis and rheumatoid arthritis are similar. They’re not. The only commonality is that they both affect the joints.
As mentioned above, osteoarthritis is due to degeneration of the joints caused by the wear and tear of normal life. It is the most common form of arthritis. Osteoarthritis is more likely in joints where the person has had a prior injury to the joint or a problem with the cartilage in the joint. It is more likely in those who have participated in impact-related sports and activities.
Rheumatoid arthritis is the second most common form of arthritis, but it is completely different in cause. Rheumatoid arthritis is an autoimmune disorder where the body’s immune system attacks the tissues in the body. These attacks affect the synovium, a soft tissue in your joints that produces a fluid that nourishes the cartilage and lubricates the joints. This form of arthritis invades and destroys a joint.
Risk factors 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.
What Our Patients Have to Say
“Dr. Moore is very knowledgeable. He was able to describe my symptoms before I told him what they were. He is immediately engaged with you once he enters the exam room, and he is very compassionate. His office is busy but they make time to be available for all questions!”
Signs and symptoms of 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.
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.
What can happen if Osteoarthritis is left untreated?
There’s one sure thing with osteoarthritis — if you don’t change your activities or otherwise treat the pain in some way, it will only get worse. You have to remember that osteoarthritis is the breakdown of the cartilage that is responsible for providing the cushioning in your joints. That degradation is only going to continue; cartilage doesn’t regenerate. If you’re not having bone-on-bone contact yet, you will.
Again, this really comes down to the amount of pain you’re willing to tolerate, as well as how much of your life you want to eliminate in order to handle the pain. Joint replacement today is highly successful, and it involves far easier recovery periods than just a decade ago. Plus, today’s prosthetics have longer and longer lifespans. There’s really no reason to tolerate the pain when you have such great joint replacement options.
Treatment Options for 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
Does Physical Therapy Help Osteoarthritis?
Physical therapy can be an effective treatment to buy time before surgery. Generally, if a patient is suffering from chronic pain due to the breakdown of the cartilage in a joint, the condition will only worsen with time. Physical therapy, however, can work to strengthen the muscles surrounding the joints. This can help take some of the burden off the joint. Unless the person is willing to stop the activities that place loads on the joint or joints in question, physical therapy is likely to decrease the patient’s pain for a period of time. Dr. Moore believes in putting all possible treatments into play prior to opting for surgery, and physical therapy is definitely one of them.
When is Surgery Necessary for Osteoarthritis?
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.
Should I avoid certain activities with osteoarthritis?
That depends. If you’ve loved playing tennis your entire life, but your knees can’t take the impact any longer, it would be a good idea to maybe switch to pickleball or doubles tennis where you don’t have to run so much. You could replace running with cycling or swimming to eliminate the pounding on your joints. Activities that involve lots of impact, such as aerobics, could need to go away.
When Dr. Moore sees patients and tries to determine just how much their joint degeneration is impacting their lives, he usually asks what you’re not doing any longer that you formerly loved doing. For instance, if you’ve always loved hiking in the woods around Pinehurst, have you had to give that up due to your hip or knee pain? This often starts the process of whether the person should begin to entertain the idea of knee or hip replacement.
Whether or not you need to avoid certain activities is really a question of how much pain you’re willing to endure to keep doing them. Adjustments such as wearing a knee brace could help. But when your pain becomes such that everyday activities, such as walking the dog around the block, are getting so painful that you’re having trouble doing them, then it’s time to consider joint replacement.
What are the four stages of osteoarthritis?
Osteoarthritis is classified by its severity. Although these stages aren’t set in stone with specific markers, they are general classifications of the advancing deterioration of the patient’s joints.
The four stages of osteoarthritis are:
- Stage 1 — Minor. Minor wear and tear in the joints. Little to no pain in the affected area. Just about anyone over the age of 40 or 50 probably qualifies as a Stage 1 case.
- Stage 2 — Mild. More noticeable bone spurs. The affected are feels stiff after sedentary periods. Patients may need a brace for certain activities.
- Stage 3 — Moderate. Cartilage in the affected area begins to erode. The joint becomes inflamed and causes discomfort during normal activities.
- Stage 4 — Severe. The patient is in a good deal of pain. The cartilage is almost complete gone, leading to an inflammatory response from the joint. Overgrowth of bone spurs may cause severe pain.
Is osteoarthritis painful?
Pain is the most common symptom with osteoporosis. As osteoarthritis advances and the cartilage in the joint becomes more and more damaged, the pain associated with it may become more intense. In addition to pain, it’s likely the joint will swell, creating discomfort.
Can osteoarthritis cause other disabilities?
Osteoarthritis in and of itself is not a disability; it is a condition. But it certainly can lead to disability. Over 30 million Americans, roughly one tenth of the population, has some stage of osteoarthritis, and it is a leading cause of disability.
Plus, it depends upon your definition of “disability.” If you consider your joint pain to be bad enough that you can no longer take a three-mile hike, you could consider that you are now disabled to the extent that you can no longer perform that activity. Of course, this gauge of severity could end up with the person basically house bound or in need of assistance when walking.
Is there anything I can do on my own to treat or slow osteoarthritis?
Osteoarthritis is so prevalent that there is a spectrum of treatment, from exercising to strengthen the surrounding muscles all the way up to joint replacement with Dr. Moore.
Here are some at-home treatments and lifestyle changes meant to help you manage your osteoarthritis:
- Exercise — Physical activity strengthens the muscles around your joints and may help relieve stiffness. Aim for at least 20 to 30 minutes of physical movement at least every other day. Stick with low-impact activities, such as walking or swimming. Yoga also can help with joint flexibility and pain management.
- Weight loss — When you are overweight, it’s simple physics — you’re putting more stress and strain on your joints, leading to more damage to cartilage. Shedding excess pounds helps relieve this pressure and reduces pain.
- Adequate sleep — Getting enough sleep helps your joints to calm down and reduce irritation. During sleep and rest, your joints are not loaded, and pain typically goes away.
- Heat and cold therapy — For many people hot or cold therapy can help to relieve muscle pain and stiffness. Apply a cold or hot compress to sore joints for 15 to 20 minutes several times a day. Experiment if hot or cold works better for you.
- Physical therapy — Physical therapy may be prescribed to attempt to forestall surgery. PT is similar to the results gained with exercise, but it targets individual muscle groups more specifically.
- Wearing supportive devices — Things such as knee sleeves, braces, or splints may be used to help keep a joint from moving to the degree where it is painful.
What is recovery like after osteoarthritis treatment?
There is really only recovery after joint replacement surgery. Other treatments such as corticosteroid treatments or physical therapy don’t involve recovery time.
For hip replacement surgery, it’s amazing, but the hospital will have you up and walking the day of your surgery. This helps decrease the development of blood clots. You’ll also have on compression stockings or an inflatable air sleeve on your lower legs for the same purpose. You’ll work with an assigned physical therapist to regain use of your hip and the surrounding muscles. You’ll move from walking with a walker to increasing independence. After from 6-12 weeks, if you’re progressing well, you’ll be cleared for to resume some normal activities, but you won’t feel fully recovered for from 6-12 months.
For knee replacement, you’ll be amazed at how quickly you are encouraged to walk on your new knee. This will start with minimal walking, and will slowly progress to resuming other household activities, such as using the stairs. Physical therapy will be crucial here, just as with hip replacement. With knee replacement, you cannot pivot or twist your knee for at least 6 weeks. No kneeling or squatting, either. From there, you can return to many activities, such as low-impact activities or sports, in anywhere from 6-12 weeks.
As you would assume, these are only estimates; every patient’s situation is unique. As Dr. Moore charts your progress during recovery after joint replacement, he will give you much more specific estimates on your return to normal activity.
How long does it take for joint replacement surgery to heal completely?
As you would assume, your rate of healing is completely individual. But there are some general timelines. Most patients, particularly if they enter the process in better physical condition, are typically 90 percent recovered at 90 days after their surgery. You can have pain and swelling for up to six months, and you may consider full recovery (free of any pain or unusual feeling) to take up to one year.
Schedule a Consultation Today!
If you are living with osteoarthritis, Dr. John Moore and his team of professionals at Pinehurst Surgical Orthopaedic & Joint Replacement Center can help relieve your symptoms. To request a consultation, please call us at 910-295-0224 or submit an online contact form.
Our practice looks forward to serving you!