Hip Joint Replacement
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Arthritis Management

Arthritis

What is Arthritis?

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

There are different types of arthritis. The most common are

Osteoarthritis

Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.

Osteoarthritis causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees, and hips.

Fibromyalgia

This chronic disorder causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Fatigue and sleep disturbances may also occur.

Gout

When a person has gout, they have higher than normal levels of uric acid in the blood. The body makes uric acid from many of the foods we eat. Too much uric acid causes deposits, called uric acid crystals, to form in the fluid and lining of the joints. The result is an extremely painful attack of arthritis. The most common joint gout affects is the big toe. This disease is more common in men than in women.

Ankylosing Spondylitis

This disease most often affects the spine, causing pain and stiffness. It can also cause arthritis in the hips, shoulders, and knees. It affects mostly men in their late teenage and early adult years.

Juvenile Rheumatoid Arthritis

The most common type of arthritis in children, this disease causes pain, stiffness, swelling, and loss of function in the joints. A young person can also have rashes and fevers with this disease.

Bursitis

This condition involves inflammation of the bursa, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint, injury, or infection of the bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.

Tendinitis

Also called tendonitis, this condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.

What Causes Osteoarthritis?

Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury, or deformity.

Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.

Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.

Predisposing Factors to Osteoarthritis of Hip

Some conditions may predispose the hip to osteoarthritis; it tends to affect people, as they get older and particularly affects joints that have to take a lot of stresses and strains.

  • A previous fracture that involved the hip
  • Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis
  • Some childhood hip problems later cause hip arthritis (for example, a type of childhood hip fracture known as a Slipped Epiphysis; also Legg-Perthe’s Disease)
  • Inactive lifestyle- e.g., Obesity (overweight) Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet

Predisposing Factors to Osteoarthritis of Knee

Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear – just like the out-of-balance tyre that wears out too soon on your car.

What are the Symptoms of Arthritis?

There are more than 100 different forms of arthritis; symptoms vary according to the form of arthritis. Each form affects the body differently.

Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness, or heat in a joint, limitation of motion of a joint, early morning stiffness and skin changes, including rashes.

How can a Doctor Diagnose Arthritis?

Doctors diagnose arthritis with a medical history, physical exam, and x-rays of the hip. There is no blood test for osteoarthritis.

What your Doctor can do for you ?

There is no cure for arthritis, so beware of ‘miracle cures’. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested, such as a hip or knee replacement. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.

Treatment Options

  • Initial treatment for osteoarthritis of the hip or knee is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti-inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful
  • For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended

Treatment of Osteoarthritis focuses on decreasing pain and improving joint movement, and may include

  • Exercises to keep joints flexible and improve muscle strength
  • Many different medications are used to control pain, including corticosteroids and NSAIDs
  • Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS
  • For mild pain without inflammation, acetaminophen may be used
  • Heat/cold therapy for temporary pain relief
  • Joint protection to prevent strain or stress on painful joints
  • Surgery (sometimes) to relieve chronic pain in damaged joints
  • Weight control to prevent extra stress on weight-bearing joints