What is arthritis ?
Arthritis literally means inflammation of a joint. There can be several causes. The most common cause is osteoarthritis. What really does this mean ? ‘Osteo’ meaning bone and ‘arthritis’ meaning joint inflammation. Osteoarthritis is the result of chronic wear and tear of a joint. This wear causes the surfaces of the joint to slowly wear down, like car tires. Once the ‘tread’ wears down, there is no padding left on the ends of the bones. The loss of the joint surface creates inflammation which in turn causes pain. When the entire surface wears away, the joint is ‘bone on bone’. The body often tries to help and grows ‘bone spurs’ which are a sign of the problem but their removal will not cure the problem.
There are no nerve endings directly in the ends of the bones, but rather in the tissues which surround the joint. The worn cartilage and joint surface creates irritation of the joint, which in turn, leads to joint pain.
What are the treatments for arthritis?
Medications: When the pain is minimal, simple anti-inflammatory medications can be extremely effective. Be use your doctor is ok with you taking these for more than a few days. These stop the inflammation in the joint and decrease the pain.
Steroid Injections:
There are several injections available for arthritis. The most common is a steroid injection. This injection concentrates and anti-inflammatory medication directly into the joint. This also avoids the need to take regular medication which can cause other complications such as ulcers. The simple procedure can be performed by orthopedic surgeon, takes only a few seconds, and can last for many months.
Hyaluronic Acid Injections:
these injections go by many different names. Gel injections. Supartz, Synvisc, OrthoVisc and Hyalgan our old brand names of essentially the same compound. These are typically given once a week for up to five weeks. They are at least as effective as A cortisone shot, however take longer for the effect to build up. They also avoid the need for the steroid injection. You can read more about these here
Platelet Rich Plasma:
On the cutting edge of orthopedics, PRP injections have become much more common. The research data is still limited. Insurance companies typically find this to be investigational. Despite this, there does not appear to be a great risk by injecting one’s own blood product into a joint. Many patients claim notable improvement. It often takes several injections spaced apart by several weeks to know if it will help.
Physical therapy:
There is plenty of research to support the use of physical therapy for arthritis. Keeping the muscles strong around a joint as well as maintaining your range of motion will decrease pain and improve activity level. Pushing a very arthritic joint too hard in therapy, for example, will likely cause additional pain and soreness. Be sure to check with your orthopedist to see if this is a good idea.
Loss of space between bones in osteoarthritis
Arthroscopic Surgery:
When simple techniques have failed, a small outpatient surgery is often considered. The success of this procedure is based on the severity of the arthritis. When your arthritis is bad, the results will not likely be beneficial. This procedure allows the release of scar tissue, clean out of the meniscus and smoothing of cartilage. This does not, however, restore additional joint surface.
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Joint Replacement:
the ultimate treatment for this condition is a joint replacement procedure. This resurfacing procedure removes only small amounts of bone from the services of the joint, and replaces them with new smooth surfaces. The success rate extremely high. When the tire was worn out, this is the only treatment that replaces the tire. The lifespan of a joint replacement continues to improve. If all is well, it will last a lifetime.
Often the nonoperative treatments are ‘good enough’ to get by–sometimes for many years–with a knee that let’s you do what you want. As a joint specialist, my goal is to keep you going and different options are right for people at different times.
Dr. Scott Hacker is a Sports Medicine Orthopedic Surgeon in San Diego, CA, Team Surgeon to the US Olympic Team. He specializes in sports medicine and sports injuries, knee and shoulder surgery.
If you have questions about meniscus tears, or have a meniscus tear, please feel free to contact me at Ask Dr. Hacker or through my office.
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