Arthritis is a commonly used term among households to describe a painful condition of joints of the body especially among older persons. It is a result of a wear and tear process on an ageing joint, leading to the loss of lubrication and a frictional grinding of the bones.
In the early treatment of arthritis, a modification of activities like abstinence from running, jogging, sprinting, excessive stair climbing and avoiding vigorous sporting activity is recommended. The use of padded shock-absorbing footwear like sneakers and knee braces needs to be emphasized. Painkillers should be reserved for occasional and judicial usage, though joint lubrication supplements like glucosamine and chondroitin are prescribed. The significance of weight reduction cannot be over emphasized. Muscle building and joint movement exercises and training under the supervision of an experienced physiotherapist are mandatory. Patients are encouraged to exercise regularly in the form of swimming, cycling and yoga.
Arthritis is a universal condition affecting mainly the knee joint. Barring the early stages, arthritis is a painful and crippling condition which does not fully respond to medical treatment. The first line of treatment for arthritis is always conservative non-surgical treatment. However, if conservative treatment does not relieve pain and improve function, your physician may recommend surgery. About one in four people with osteoarthritis of the knee will eventually need surgery. The choice of treatment should be a decision between you and your physician.
The purpose of surgical treatment for osteoarthritis is to reduce pain, increase function, and improve overall symptoms. Patient satisfaction is a fundamental goal in treating arthritis. Surgical treatment options include arthroscopy, osteotomy, and arthroplasty.
Arthroscopy
Arthroscopy is a surgical procedure that uses small incisions and miniature instruments. A tiny telescope, called an arthroscope, is inserted into the joint space, which is then filled with fluids so the surgeon can clearly see the components of the joint. This enables the surgeon to look directly at the bone surfaces and determine how advanced your arthritis is.
Using the miniature arthroscopic instruments, the surgeon can trim damaged cartilage, remove loose particles or debris from the joint (debridement), and clean the joint (lavage or irrigation). If other problems are discovered, such as a torn meniscus (a C-shaped piece of cartilage that cushions the knee) or a damaged ligament, the surgeon can correct them during the same surgery.
Arthroscopy can be helpful if your joint pain results from a tear in the cartilage or meniscus, or if bits of debris are causing problems with bending or straightening the joint.
In people younger than 55 years, arthroscopic surgery may help delay the need for more serious surgery, such as a joint replacement.
Some of the advantages of arthroscopy are:
– tiny cuts and minimal stitches
– day surgery involving no overnight stay
– immediate weight-bearing allowed
– low cost
As with any surgery, there are some risks with arthroscopy due to the use of anaesthesia and the possibility of infection. Other complications include damage to nerves or blood vessels, the development of blood clots in veins, and scarring.
Arthroscopy is not the best option for everyone. Although the incisions are small and pain is minimal, it takes several weeks for the joint to recover fully. Your surgeon will prescribe a specific activity and rehabilitation programme to encourage recovery and protect the future function of the joint.
Surgeons use arthroscopy to help diagnose and treat arthritis of other joints like the shoulder, ankle, hip, elbow and wrist as well.
Apart from arthritis, it can be used for the following conditions too:
* Bone spurs or loose bone fragments
* Damaged or torn cartilage
* Inflamed joint linings
* Joint diseases that cause tissue or bone to break down
* Joint infections
* Scar tissue
* Torn ligaments
* Unexplainable joint pain
Your surgeon may also use arthroscopy to:
collect a joint tissue sample (biopsy) for microscopic examination, as is used, for example, to diagnose rheumatoid arthritis monitor the progression of a disease, or determine whether a treatment is working
Osteotomy
An osteotomy may be recommended if damage to your knee cartilage is primarily in one section (compartment) of the knee. The inside (medial) compartment, where the inner knob of the thighbone (femoral condyle) meets the top of the shinbone (tibia), is most commonly involved.
Osteotomy has an increased risk of infection and nerve/blood vessel injury in comparison to arthroscopy and joint replacement. It is thus hardly advised in the present age.
Joint replacement surgery
An arthroplasty is a joint replacement procedure. If your knee pain is severe and significantly limits your movement, your surgeon may recommend that the diseased bone and tissue be replaced by an artificial joint.
If your arthritis is localized to one side of the knee, an orthopaedic surgeon may recommend a unicompartmental knee arthroplasty. If both sides of the knee are affected, a total joint replacement may be more appropriate. The replacement parts are made of cobalt-chrome or titanium metals and smooth, wear-resistant plastic (polyethylene).
The results of total joint replacement are universally excellent. Patients experience significant pain relief and improved physical functioning. There are some risks with the surgery, and full rehabilitation may take 3 to 6 months. In addition, the prosthesis (artificial joint) may eventually loosen or wear out so that a second surgery is needed. However, at the 15-year mark, the success rate with most prostheses today is about 90 per cent. The benefits of this surgical procedure are startling and extremely gratifying. They are threefold:
* Pain relief up to 100%
* Complete movements of the joint
* Correction of deformities like bow legs
* No restriction of weight bearing
Your orthopaedic surgeon should discuss the type of knee replacement, the potential risks, and the rehabilitation protocol with you before you make your decision.
Although arthritis is a debilitating condition severely restricting mobility, it can be tackled by newer surgical techniques to greater effect than conservative methods. It is unwise to accept arthritis as an old-age hazard, and every effort must be made to explore the above-mentioned modalities towards the improvement of your joint function.
