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October 11, 2011 > Do Your Knees or Hips Ache? Could It Be Arthritis?

Do Your Knees or Hips Ache? Could It Be Arthritis?

Bone and Joint National Action Week Promotes Awareness of Prevention, Disease Management and Treatments

Bone and joint conditions - including osteoarthritis - are the most common causes of severe long-term pain and physical disability, according to the United States Bone and Joint Initiative. Further, the prevalence of such conditions is predicted to increase as the "Baby Boom" generation continues to age.

"Osteoarthritis is the most common type of arthritis," says Dr. John Dearborn, an orthopedic surgeon and the medical director of the Center for Joint Replacement at Washington Hospital. "Osteoarthritis is caused by the breakdown of cartilage, the material that cushions the ends of the bones in a joint. As the cartilage deteriorates, bone rubs against bone, causing inflammation and pain. Because aging is a primary risk factor for osteoarthritis, we will see these problems become more common as our population ages."

To increase the awareness of musculoskeletal conditions such as osteoarthritis, the Bone and Joint Initiative and other organizations such as the American Academy of Orthopedic Surgeons sponsor the annual Bone and Joint National Action Week on the same dates every year - October 12 - 20.

There is no single known cause of osteoarthritis, but there are various risk factors in addition to age, including joint injury, muscle weakness and being overweight. Women generally are more likely to develop osteoarthritis than men. A small percentage of people may have a genetic predisposition. Osteoarthritis develops most frequently in weight-bearing joints such as the knee and hip, but it also is common in the neck, lower spine and the small joints of the hands and feet.

"Osteoarthritis can cause pain, stiffness and swelling in whatever joint is affected," says Dr. Alexander Sah, an orthopedic surgeon at the Center for Joint Replacement. "In the lower extremities, it can cause more pronounced pain and a loss of motion, especially with weight-bearing activities."

Oftentimes, people with osteoarthritis in the knees and hips will avoid weight-bearing activities that cause the pain, and they may become sedentary.

"It's a double-edged sword," says Dr. Sah. "Resting may make the joints feel better, but lack of physical activity can lead to weight gain and loss of muscle tone - both of which can make the condition worse."

Just as there is no known cause for osteoarthritis, there also is no known cure.

"You can't reverse the process of arthritis, but you can treat the symptoms and slow the progression," Dr. Sah explains. "Physical therapy and regular exercise can help reduce pain and maintain range of motion. Exercise also can help maintain a healthy weight, which puts less strain on the joints. It's important to note, however, that those benefits quickly go away when you stop exercising."

Various medications may help patients suffering from arthritis, including the pain reliever acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, which can be purchased over the counter. Other NSAIDs are available as prescription drugs, and people who take such medications should do so only under the supervision of a physician.

"These medications can be very effective in treating mild to moderate arthritis," Dr. Dearborn says. "For more severe pain, patients can get short-term relief with injections of cortisone into the joint. Another option is injections of hyaluronic acids, which are a component of the normal lubricating fluid found in healthy joints, to provide cushioning for the joint."

In a case where there is a dramatic loss of cartilage, the patient may be a candidate for either partial or total knee replacement. Total replacement would generally be performed if the patient's cartilage is badly damaged on both sides of the knee and under the kneecap or on one side of the knee and under the kneecap. Partial replacement would be an option for patients who have cartilage damage on only one part of the knee.

"Partial knee replacement is a great option for younger patients whose arthritis has not spread throughout the knee," says Dr. Sah, who completed a fellowship at Rush Hospital in Chicago where they did a high volume of partial knee replacement surgeries. "It also is a good option for elderly patients who have other conditions that might limit their ability to recover from total knee replacement. Partial knee replacement is less invasive, and the ligaments in the center of the knee are left intact, so it feels more like a natural knee."

For arthritic damage to the hip joint, Dr. Dearborn believes total hip replacement is a less invasive and more effective option than "resurfacing" procedures that involve grinding down the surface of the femoral bone and inserting an implant.

"Resurfacing implants are cemented on the femoral side, so they are not as durable as total hip implants and are more prone to loosening," he explains. "Resurfacing implants also require a metal-on-metal bearing, which also have been shown to be problematic in recent reports from Britain and Australia. Some patients have a hypersensitivity to the metals in resurfacing implants, leading to early pain and bone erosions. After five years, the failure rate of hip resurfacing is at least five percent, and with some implant designs, over 12%. With total hip replacement, the failure rate is close to zero percent after five years."


Center for Joint Replacement Ranked #1 in California

In April 2011, Washington Hospital's Center for Joint Replacement was named the top joint replacement program in California by Healthgrades. The center has been ranked among the top 10 in California for six years in a row and among the top five percent in the nation for five years in a row. Surgeons at the center will perform over 1,400 knee and hip replacements this year. A new facility for the Center for Joint Replacement will open in the spring of 2012.

"Our new facility will have the potential for 40 inpatient beds, as well as our outpatient office and dedicated areas for pre-op testing and patient education," says Dr. Dearborn. "We also will be able to conduct clinical research and hold conferences for visiting physicians in the same building. The new facility will be more convenient for patients and will place our office space just upstairs from the care unit, allowing us quicker access."

For more information about the Center for Joint Replacement, visit www.whhs.com/joint or call 888-494-7003.

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