Hip and Knee Arthritis

Background

Osteoarthritis is a common problem for many people.  Osteoarthritis is sometimes referred to as “degenerative joint disease,” or wear-and-tear arthritis.

The main problem in osteoarthritis is wearing-down or loss of the “protective” articular cartilage that covers the ends of the bones in a joint. This results in areas of the joint where bone rubs against bone (“bone-on-bone”). Bone spurs may form around the joint as a result of the arthritis.

Osteoarthritis may result from an injury to the knee or hip earlier in life. Fractures involving the joint surfaces, instability from ligament tears, and meniscus  can all cause abnormal wear and tear of the knee or hip joint.

Not all cases of osteoarthritis are related to prior injury, however. Research has shown that some people are prone to develop osteoarthritis, and this tendency may run in families.

Symptoms / Diagnosis

Typically, the symptoms of osteoarthritis develop slowly over several years:

  • Pain
  • Swelling
  • Stiffness

The pain of osteoarthritis is usually worse after activity. Early in the course of the disease, you may notice that your joints do fairly well while walking, then after sitting for several minutes the knee or hip becomes stiff and painful.

As the condition progresses, pain can interfere with even simple daily activities. In the late stages, the pain can be continuous and even affect your sleep.

The diagnosis of osteoarthritis can usually be made on the basis of the initial history and examination. X-Rays are very helpful in the diagnosis. Only occasionally is an MRI necessary.

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Treatment Options

Non-operative

  • Control pain and inflammation. Aspirin, Advil and Aleve are available over-the- counter.
  • Weight Loss – Even a little weight loss can decrease forces in the knee or hip
  • Glucosamine and chondroitin are over-the-counter products that may provide pain relief in osteoarthritis.
  • Reduce shock by using a walking aid (cane), wearing good shoes, choosing soft surfaces, and keeping the leg muscles conditioned for unexpected stresses.
  • Avoid activities in your fitness and recreational pursuits that cause high impact loads to the joints such as walking, jogging, hiking, stair-stepper machines.
  • Substitute impact activities with low impact activities such as stationary cycle, swimming, cross-country ski machine, rowing machine, elliptical machine.
  • Follow a regular exercise program 2 to 3 times a week to stretch and strengthen the muscles around the joint.
  • Certain injections (corticosteroid or other injections) may be appropriate and can be discussed

Operative

Once non-operative measures have failed, discussion about a joint replacement is appropriate.  This surgery involves removing the “worn-out” cartilage with metal and plastic. While there are risks to a joint replacement, results are generally excellent and the new knee or hip joint can routinely last for many years.  The longevity of the joint replacement is related to the activity level a patient.  For this reason, running or hard labor on a knee replacement is not advised.

Newer minimally invasive techniques may offer an advantage to older more invasive approaches.  Joint replacement is an elective procedure — patients usually know when this level of treatment is necessary.

Results and Risks

The results of joint replacement are excellent. When complications are avoided, near complete relief of pain is typically achieved. In addition to the general surgical risks, the most common risks of joint replacement surgery are stiffness, dislocation, and “wearing-out” of the plastic which may require a revision surgery.

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Further Reading

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