According to the Centers for Disease Control and Prevention, 22 percent of people in the U.S. have doctor-diagnosed arthritis. Accounting for 2,547,000 of those 54.4 million people, about 28 percent of Ohio’s population has doctor-diagnosed arthritis. Healthy New Albany Magazine spoke with four local doctors from Joint Implant Surgeons about this widespread disease with no cure.
Healthy New Albany Magazine: Could you elaborate on the different kinds of arthritis and the associated symptoms?
Adolph V. Lombardi, Jr., MD, FACS: In simple terms, arthritis is inflammation within a joint. There are many types of arthritis, which can affect people of all ages, sexes and races. It is reported to be the leading cause of disability in the U.S., with more than 50 million adults suffering from arthritis. However, children are not immune. There are approximately 300,000 children who have some type of arthritis. The weight-bearing joints of the lower extremities are more frequently involved. There is a higher incidence of arthritis in women, with knee involvement greater than hip, while men have more hip involvement than knee involvement. The symptoms of arthritis are specifically localized to your joint. Stiffness and loss of motion are usually the initial symptoms, followed by swelling and pain. At the onset of arthritis, the symptoms are generally mild and intermittent. Unfortunately, as the arthritic condition progresses, the number of bad days outweighs the number of good days.
HNA: What are the risk factors that contribute to the development of arthritis? Is there a demographic most likely to develop arthritis?
AL: Because of child-bearing, women tend to have wider pelvises than men. This affects the overall standing position and alignment of the lower extremities, resulting in different loading patterns in females versus males. Additionally, women tend to have more flexibility than men. This causes hypermobility and is believed to result in repetitive minor trauma, especially in the knee, which ultimately leads to the arthritic condition. There is also a hormonal association in females, with arthritis more common in post-menopausal females. However, estrogen replacement therapy has not been shown to decrease the incidence of arthritis. The most controllable risk factor for the development of arthritis in both males and females is calorie intake control. It is intuitively obvious that we are becoming a larger society. This increased body habitus places significant demands on the lower extremities and is directly associated with increased development of arthritis.
HNA: How can arthritis impact a patient’s everyday life? If there is no cure, what can be done to lessen this impact?
AL: In the early stages of osteoarthritis, symptoms can be managed with rest, ice and heat applications; exercise that promotes range of motion; muscle strengthening to enhance the stability of the joint; use of an assistive device to offload the joint; weight reduction to decrease the load on the joint; and over-the-counter medications such as acetaminophen and non-steroidal anti-inflammatories. As symptoms progress, injection therapy can be administered in the form of either corticosteroid injections, platelet-rich plasma injections or stem cell injections. Finally, when significant pain limits activities of daily living, joint replacement is an appropriate option.
Hips
HNA: What is hip dysplasia? How is it related to arthritis?
Keith Berend, MD: Hip dysplasia is a congenital or developmental condition in which the ball of the hip joint is not completely covered by the socket of the joint. Today, when severe, it is almost always diagnosed and treated at birth. However, very mild forms of dysplasia can go undetected and eventually cause damage to the hip joint resulting in arthritis. Hip pain, particularly in the groin or crotch, with weight-bearing, impact-loading or extremes of motion can be early symptoms of damage caused by undiagnosed dysplasia.
HNA: How severe does hip arthritis need to be for a patient to get replacement surgery?
KB: For arthritis, there is no such thing as partial hip replacement. There is partial knee, which we favor, and occasionally, a partial hip will be performed in elderly patients with hip fractures. Total hip replacement is warranted when the pain and dysfunction of arthritis impact quality of life. If X-rays demonstrate significant disease, and the signs and symptoms are not controlled with medications, activity modifications, injections or regenerative medicines, then surgery may be indicated.
HNA: What other options does a person with hip arthritis have?
KB: Conservative treatments involve activity modification, medications and possibly injections with steroid or a biologic treatment such as stem cells (or stem cell-like materials). Arthritis, or the degeneration of the joint, is actually not curable, so management of symptoms is the choice prior to surgical intervention.
HNA: What sort of motion or activity should someone with hip arthritis avoid?
KB: We call this activity modification, and it basically relates to how much pain and discomfort certain activities cause. Impact loading, such as running, can be very painful and should be reduced or avoided if the arthritis is significant. Non-impact activities such as swimming, biking, elliptical trainer and even Stairmaster are frequently better tolerated.
Shoulders
HNA: What causes shoulder arthritis? What type of arthritis is most common in the shoulder?
Jason Hurst, MD: Most shoulder arthritis occurs without any specific reason or underlying condition. There is believed to be a genetic reason why people get wear and tear arthritis, but the specific gene has not been identified. While there is no association of shoulder arthritis with overhead sports or frequent shoulder use, shoulder arthritis is clearly associated with traumatic events such as shoulder dislocations and injuries to certain structures within the shoulder joint. Another very common cause of shoulder arthritis is chronic tears of the rotator cuff. When the rotator cuff is torn, the biomechanics of the shoulder joint is altered significantly and this leads to eventual arthritis of joint.
HNA: What symptoms are associated with shoulder arthritis? Is it possible to have arthritis of the shoulder without any symptoms?
JH: The most common early symptom of shoulder arthritis is stiffness and mild discomfort. As the arthritis progresses, the shoulder gets increasingly stiff, overhead function is compromised and reaching behind the back is very difficult. Another very common complaint is shoulder pain at night with difficulty sleeping. While this shoulder pain at night is not specific to shoulder arthritis, it is a common reason why patients seek advice from a doctor. It is common to have no symptoms at all in early shoulder arthritis. In these cases, the patients are typically very active and have excellent shoulder motion despite the early onset of arthritis that might be seen on X-ray.
HNA: To what other injuries is a person susceptible once he or she has shoulder arthritis?
JH: The presence of shoulder arthritis does not predispose patients to injury. However, because of the constant presence of inflammation associated with an arthritic shoulder, patients can get the sudden onset of painful flare-ups with minor trauma that an otherwise normal shoulder would be able to tolerate.
Knees
HNA: Of all the joints that can be ridden with arthritis, is the knee influenced the most by a patient’s weight?
Mike Morris, MD: The knee is one of the most common joints afflicted with arthritis. Studies have demonstrated obesity is a major risk factor for the development of arthritis, especially in the knee. Since the knee bears four to six times one’s body weight during many activities of daily living, it endures an increasingly significant amount of force and load when one is overweight. Modest weight loss has been shown in studies to reduce with risk of developing arthritis. For those individuals who already have arthritis in their knees, modest weight loss can lessen the pain by decreasing the forces and load across the knee.
HNA: What types of arthritis are most common in the knee? Can one be affected by more than one type of arthritis in the same joint at once?
MM: The most common type of arthritis is the knee is osteoarthritis, which is often called “wear and tear” arthritis. Other common types of arthritis are post-traumatic, such as from a fracture or anterior cruciate ligament injury; rheumatologic, such as rheumatoid arthritis or psoriatic arthritis; and crystalline arthropathy, such as gout. Interestingly, it is possible to be afflicted by more than one type of arthritis in the knee. For example, one might have osteoarthritis in one’s knee and develop gout, too.
HNA: What are the treatment options for a person with knee arthritis? Is surgery the only long-term solution?
MM: Currently, there is no cure for arthritis. Arthritis can cause pain, stiffness, swelling, warmth and limited function. The goal of treatment is to alleviate the symptoms of arthritis and improve the quality of life of the patient. There are a multitude of surgical and non-surgical treatment options. Non-surgical options include joint-friendly exercise such as swimming, walking, yoga and cycling. There are vitamin supplements such as glucosamine-chondroitin sulfate, fish oil and turmeric. Over-the-counter pain medicine such as Tylenol or acetaminophen can be helpful. Non-steroidal anti-inflammatory medication can help reduce inflammation, swelling and pain. Injection therapy such as cortisone, hyaluronic acid and biologics might have a role in alleviating some of the symptoms of arthritis. Often, these non-surgical measures can improve the symptoms of arthritis. However, for those patients with end-stage radiographical arthritis that is recalcitrant to non-surgical modalities, knee replacement surgery is an excellent, durable, long-term solution.
About the Experts
Dr. Adolph V. Lombardi, Jr. of New Albany, Ohio, received his medical degree from Temple University. He completed postgraduate training in orthopedics at Albert Einstein Medical Center, in Philadelphia, Pennsylvania. He joined the practice of Joint Implant Surgeons in 1987 and is now its president. Dr. Lombardi is considered a world leader in the development and use of minimally invasive hip and knee replacements. He is currently president of the Knee Society and is the past president of the Hip Society.
Dr. Keith Berend completed his medical doctorate and orthopedic residency at Duke University in Durham, North Carolina. Berend completed a fellowship in adult reconstruction of the hip and knee at Joint Implant Surgeons, joined the practice in 2003 and is a founding physician of New Albany Surgical Hospital. He has performed more Oxford partial knee replacements than any other surgeon in the world and is a member of both the Knee Society and the Hip Society.
Dr. Jason Hurst received his medical degree from Georgetown University, where he was a member of the Alpha Omega Alpha Honor Medical Society. He completed his orthopedic residency training at Duke University,where he also worked in sports medicine research. Hurst is a member of the American Orthopedic Society for Sports Medicine, the American Association of Hip and Knee Surgeons, and the Piedmont Society, and he is board-certified by the American Board of Orthopedic Surgeons.
Dr. Michael Morris received his medical doctorate, with honors, from Jefferson Medical College in Philadelphia. He completed orthopedic residency training at Duke University where he received the John M. Harrelson Chief Resident Teaching award. Morris subsequently completed a fellowship in adult reconstruction of the hip and knee with Dr. Lombardi and Dr. Berend at Joint Implant Surgeons. He is board certified by the American Board of Orthopedic Surgery and is a Fellow of the American Academy of Orthopedic Surgeons, the American Association of Hip and Knee Surgeons, and the International Congress of Joint Replacement.
Jenny Wise is an assistant editor. Feedback welcome at adeperro@cityscenemediagroup.com.
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