New advancements in surgical treatment for painful arthritic hip and knee joints
In this blog post, we will talk about adult reconstruction and arthritis, the treatments for the disease, both non-operative and operative treatments, as well as new advancements in surgical procedures.
We will also briefly describe the history of adult reconstruction, where we are now and potentially - where we're going in the future.
What is adult joint reconstruction/total joint replacement surgery?
Adult reconstruction is an orthopedic subspecialty that focuses on surgical treatment of painful hip and knee arthritis. It's also known simply as total joint replacement surgery.
What is Arthritis?
Arthritis is a generic term that describes a process in which normal joint cartilage breaks down over time.
Arthritis can be separated into three major categories.
The first category is an inflammatory process like rheumatoid arthritis or psoriatic arthritis.
The second, one that commonly exists, is the wear and tear arthritis that a lot of people have. That's considered osteoarthritis.
And then there is post-traumatic arthritis which is very similar to osteoarthritis.
So why do I have arthritis?
A lot of patients ask me, "So why do I have arthritis? Is it something I did? Did I injure myself? Is it family?"
If you break it down into three categories, rheumatoid arthritis is an inflammatory process that unfortunately, some people may be genetically predisposed to obtain and get. The immune system attacks the synovial lining of the joint. The exact cause is unknown, but it is believed to have some type of genetic component.
There is also some type of environmental component such as a potential virus or bacteria that may start this cascade of rheumatoid arthritis. Some of the associated risk factors for rheumatoid arthritis is being a woman. It's most common in women aged 40 to 60 years of age, but it can happen at any age.
Young children can get rheumatoid arthritis, and even very healthy individuals can get it as well. A family definitely predisposes you to have rheumatoid arthritis.
Osteoarthritis
The most common cause of arthritis is osteoarthritis, which means the cartilage is wearing out. It's breaking down and progressively worsens over time. The most common joints to get osteoarthritis are the working joints in our hands, our hips, our knees, and our low back or our spine.
Over 100 years ago, we really had minimal treatments for arthritis. Most patients were severely debilitated. The ones with rheumatoid arthritis specifically were very diseased and disfigured.
A brief history of arthritis treatment
In 1891 in Germany, Professor Gluck started trying ivory to replace the joint. Then in 1925 in the U.S., Dr. Smith Peterson started using glass. In 1953, Dr. McKee started using metal on metal implants in England. Sir John Chamley is considered the father of the modern total hip. In 1960 in England, he created the low friction hip replacement which is basically the metal and plastic implant that we use today.
The history of knee replacements falls into a similar timeline.
In 1860, they started using interposed soft tissue in France.
Then in Sweden in 1947, they started to design hinged knee replacements.
In England, in 1958 they started using acrylic to replace the knee joint. In Canada, in 1963 they started using metal and plastic.
It wasn't until 1973 when Dr. Insall of New York started to design and implant the total condylar prosthesis, which is the modern total knee replacement. He's considered the father of modern total knee.
Rheumatoid Arthritis and Joint Replacement Surgery
Rheumatoid arthritis is really the reason joint replacement surgery initially started 100 years ago. However, modern treatments for rheumatoid arthritis, which includes medication, are making it rarer to see the severe deformity and the debilitation we sometimes see with rheumatoid arthritis.
The advancements in rheumatoid medications have minimized my surgical treatment of rheumatoid arthritis. These medications are managed by a rheumatologist who specializes in inflammatory joint diseases.
Osteoarthritis is the major diagnosis for joint replacement surgery
Thus osteoarthritis is now the major diagnosis for joint replacement surgery. And while a lot of the treatments do help slow the progression of arthritis, unfortunately, no cure exists for arthritis.
Basically, the most important thing is to begin doing low impact aerobic exercises such as swimming, biking, elliptical machines.
This not only maintains a healthy cardiopulmonary status - the heart and lungs - it also decreases the forces felt across the joint. It's those forces that cause the pain in the joint.
Keep Your Joints Moving!
The most important thing to know is that arthritis hurts, but it's essential to keep your joints moving. You either use it or lose it. If you don't move the joints, they end up becoming stiffer and more painful. So it's crucial to maintain healthy, low impact aerobic exercises.
Anti-Inflammatory Medications
Another important tool to help combat arthritis is over the counter non-steroidal anti-inflammatory medications. There is a wide variety of mediations you can get over the counter from any pharmacy.
Non-steroidal anti-inflammatory medications like Aleve, Advil, and ibuprofen help fight the underlying inflammation that's occurring inside the joint.
Many people ask for narcotics. While narcotics can be helpful to treat the painful flare-up that occurs, it really only masks the pain. It doesn't treat the underlying pain.
Steroids and Viscosupplementation
Other treatment options for osteoarthritis are intra-articular steroid injections or what's called viscosupplementation. Viscosupplementation is a lubricant put directly into a joint. It's like putting oil in your engine; it provides lubrication.
Some patients prefer steroids, while others prefer viscosupplementation. There's really no way for me to tell you which one's going to work best for you until we try, so it's a little bit of trial and error until we find one that works.
Unfortunately, some patients don't get relief from either of these treatments.
Maintaining a Healthy Diet
Maintaining a healthy diet not only keeps you healthy but also provides essential nutrients in the joint and the surrounding soft tissues. The other thing that's incredibly important to stress – although not necessarily a problem in the mountains of Colorado - is maintaining healthy body weight.
I trained in Pennsylvania, where morbid obesity was becoming the norm. For patients who become morbidly obese, it increases the forces or pain felt across the joint. The best thing to do is try to maintain healthy body weight to minimize pain felt across the knee joint or the hip joint.
When Should You Have a Joint Replacement?
Overall, it's vital to exhaust all non-operative treatments before pursuing any type of surgical intervention. Routinely patients who tell me they had surgery and it still hurts say they feel they may have had surgery too soon.
However, once non-operative treatments start to fail and are no longer beneficial for you, that's when we start talking about total hip replacement and total knee replacement. It's important to remember - comparing medicine as a whole and looking at all subspecialties in medicine - total hip and total knee replacements have some of the best track records in all of medicine.
Goals for a total joint replacement are to provide you with a painless functional joint that allows you to return to enjoying the things you love to do. Candidates for total joint replacement traditionally were low demand, debilitated, elderly patients.
But as modern advances have improved our technology, anyone over 65 with end-stage arthritis is a candidate for a joint replacement.The reason why we separate the 65 from the 45 years old age group is that knee replacements typically last ten years. Some studies say 80 percent last 20 years.
So that's why we want to try and get patients a little farther along before they have a joint replacement. Some patients need joint replacement surgery very early on in life because of the hand they were dealt.
Again, the most important thing is that they have tried and exhausted non-operative management.
Nathan L. Cafferky MD, FAAOS
Hip, Knee, Total Joint Replacement, Joint Replacement Revision Surgeries, Fracture Care and Trauma
Board Certified and Fellowship Trained
Adult Reconstruction and Trauma
US Ski Team Physician
Team Summit Colorado Physician