Arthritis Care/Treatment 

Nearly 70 million Americans, or 1 in every 3 persons, have arthritis. It affects people of all ages, but it most often occurs as a person gets older. Obesity appears to strongly affect females more than males in weight-bearing joints (hip and knee). Arthritis negatively impacts an individual's overall well being. It bears a physical, psychological, social and economic toll on a person. The physical effects include pain, stiffness and loss of joint mobility. Psychological effects, such as depression, anxiety, feelings of helplessness, and reduced self-esteem can result in social isolation. Embarrassment and discomfort in public due to physical changes can reduce community involvement. Economic effects include cost of treatment or loss of income due to disability. Early medical treatment and physical and vocational rehabilitation can help prevent many of the physical, psychological, social and economic effects of arthritis.

Non-Surgical Care | Surgical Care

 


 

Non-Surgical Treatment Options

 

Weight Loss

Too much weight can exacerbate the pain you experience from arthritis and speed the destruction of cartilage. It is important to control your weight to retain your mobility and ease the pressure on your joints. Weight loss helps prevent osteoarthritis of the hips and knees, reducing stress on weight bearing joints, and reduces pain in affected joints. Several studies have indicated that in females, the risk of arthritis is as high as 5-6 times that of men if a woman over the age of 50 is obese.

 

Activity Modification/ Exercise

Various activities make your arthritis worse. In addition, various exercises may help to alleviate the pain that is associated with arthritis. Certain activities such as those that cause pounding upon your lower extremities can make your lower extremity arthritis worse. Examples of these are high impact aerobics, running or jumping. Therefore, in order to maintain your activity level, yet not injure your joint, "low-impact" type activities are advised. These activities include walking, swimming, bicycling and other activities that do not require a lot of stress on your lower extremities. These exercises improve not only your arthritis, but also your heart and lungs. Strengthening exercises using weights or machines improve the strength of your lower extremities and can also be effective in helping to improve the pain associated with arthritis. Some of these activities vary depending upon the type of arthritis. For those special type of strengthening activities you should consult your physician.

 

Bracing

Bracing is the means by which a device is placed upon your knee to help change the way you walk and unloads the area that has severe arthritis. For example, if you walk bow-legged, most of the weight is being borne on the inside (towards the center) of your knee. By wearing a special brace you can shift your weight so that most of the weight is being borne on the outside of your knee, rather than the inside. This "unloads" the area that has severe arthritis and can alleviate pain. Subsequent surgical procedures effectively do the same thing as a brace and often a brace may be an initial step to see if a patient is a candidate for this type of procedure. Although, such a surgical procedure may be effective, however, if the brace alone helps you, that may be all that is needed.

 

Non-prescription Supplements & Medications

Nonsteroidal anti-inflammatory drugs may be used to reduce pain and inflammation caused by arthritis. However, medications do not reverse or slow the progression of joint damage caused by arthritis. Acetaminophen (Tylenol) is recommended by the American College of Rheumatology as the first line treatment for osteoarthritis. Taken in doses of up to 4 grams a day it can provide significant relief of arthritis pain without many of the side effects of some over-the-counter medications. However, do not exceed the recommended doses of Tylenol or take the drug in combination with large amounts of alcohol, because these pose risks for liver damage.

Traditional nonsteroidal anti-inflammatory drugs are also used for the treatment of arthritis. Many of these drugs, such as Motrin, Advil, Naprosyn, and Ibuproten, are available without a prescription. Nonsteroidal anti-inflammatory drugs have four fundamental actions in the body. They act to reduce inflammation, relieve pain, lower fever and prevent blood clotting. Large doses of these drugs should be avoided because they may have many side effects. The most dangerous side effects are the formation of stomach ulcers, bleeding from the digestive tract and kidney damage. Patients with kidney or liver disease or a history of gastrointestinal bleeding should not take these medications without consulting their physician.

 

Glucosamine/Chondroitin

Glucosamine and Chondroitin have been widely promoted as a treatment for osteoarthritis. These form the building blocks for cartilage. Glucosamine, an amino sugar, is thought to promote the formation and repair of cartilage. Chondroitin, a carbohydrate, is a cartilage component that is thought to promote water retention and elasticity and inhibit the enzymes that breakdown cartilage. Early studies indicate that these compounds are quite safe and may improve symptoms relating to arthritis. They are available at health food stores and supermarkets without a prescription. When the combination of these drugs is used, their absorption is improved if manganese is taken at the same time. This can be taken as a separate pill or as a combination that the manufacturer may add to the G/C. 

 

Viscosupplementation (Synthetic joint fluid injections

Viscosupplementation is used to decrease pain and improve joint function. The physician injects a preparation of hyaluronic acid into the knee joint. Hyaluronic acid is a naturally occurring substance found in synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

Osteoarthritis causes a lower than normal concentration of hyaluronic acid in the joints. Currently, vicosupplementation has been approved for use in the knee, but it has also been used effectively in other joints. Several studies have shown that viscosupplementation can lessen the symptoms of mild to moderate arthritis and prolong or eliminate the time needed for a total knee replacement.

 

Prescription/ Non-prescription Medications

A. Cox-1 Inhibitors- Many individuals have heard in the news about "Cox-1" and "Cox-2" inhibitors. Cox-1 and Cox-2 refer to different things within the body that these medications block, thereby providing different effects. Cox-2 effects are mainly anti-inflammatory; therefore, medicines that block Cox-2 help to decrease inflammation. However, many medicines originally also block Cox-1 type of activities. Unfortunately, these include protection of the stomach as well as kidney and liver function. Therefore, many of the classic anti-inflammatory medicines including, Motrin, Advil, Naprosyn, Relafen and many others are very strong anti-inflammatory medicines and help to alleviate anti-inflammatory pain. They also have potential side effects including stomach upset, ulcers and disruption of kidney function. However, taking them with food and having your doctor monitor your blood levels periodically can enable these medicines to be very effective in alleviating the symptoms of arthritis.

B. Cox-2 Inhibitors- Over the last few years, a new category of medicines called "Cox- 2" inhibitors has been marketed. These include Celebrex, Bextra, Vioxx, and Mobic. Although these medicines were reported to alleviate only the anti-inflammatory effects and not have the side effects associated with the original anti-inflammatory medicines, many of these medicines can also cause stomach upset, stomach bleeding, and kidney and liver function abnormalities. However, many of these medicines, both Cox-1 and Cox-2, are safe when taken with food and if your doctor closely follows your blood work. Again, these medicines in conjunction with activity modification, exercise and other non-prescription medicines may be an effective course to help relieve the pain associated with arthritis. As was mentioned earlier, Bextra and Vioxx have now been taken off the market, and Celebrix can still be used but cautiously under a doctor's supervision. Mobic is still available with the usual NSAID precauations.

 


 

Surgical Treatment Options

When arthritis pain is not controlled with conservative methods, surgery may be an option to reduce pain and restore function. There are various surgical procedures available.

 

Minimally invasive surgery for Sports Medicine arthritis. Arthroscopic related procedures:

  • Shoulder: Patients in 2003 may now have the majority of surgical procedures for their shoulder performed arthroscopically at the University of South Alabama. Small incisions around the shoulder are performed rather than making a large incision to accomplish what needs to be performed within the shoulder. Procedures that can be performed arthroscopically include removal of the end of the collarbone, subacromial decompression, rotator cuff repair, securing of the biceps tendon within the shoulder, as well as transplantation of cartilage to the ball of the shoulder joint. These procedures are performed as an outpatient and often can be done in less than one hour. Postoperatively, patients receive a pain pump which is placed within their shoulder, as well as prescription medication for home. As a consequence of these small incisions, patients are able to go home comfortably and their rehabilitation is accelerated. In addition, athletes who have instability (ball slipping in and out of the joint) are also capable of undergoing arthroscopic procedures to stabilize their shoulder. Similar to other arthroscopic procedures, these patients are able to go home the same day and are able to begin initial rehabilitation much quicker.
  • Elbow: Arthroscopic, or small incision surgery, is also performed in the elbow at the University of South Alabama. Such procedures include debridement of certain bony fragments within the elbow as well as releases of soft tissue within the elbow joint as well. The elbow joint arthroscopic procedures are limited compared to the shoulder and knee, however these can substantially improve the patient's outcome and enable the patient to go home the same day as surgery.
  • Knee: A multitude of procedures can be performed arthroscopically within the knee. These include ligamentous reconstruction, cartilage transplantation, meniscal transplantation and/or debridement as well as removal of fragments and pieces of bone and cartilage within the knee. The University of South Alabama Sports Medicine/Joint Restoration Service performs hundreds of arthroscopic procedures within the knee each year. The majority of these procedures are done on an outpatient basis, enabling the patient to undergo a quicker rehabilitation and limited pain after surgery.
  • Ankle: The ankle joint can also be evaluated arthroscopically. Debridement, as well as removal of loose particles in the ankle, can be performed with a small camera and instruments that are placed within the ankle. If a patient has a cartilage lesion in the ankle, it can also be transplanted. The University of South Alabama is one of the few centers in the country where cartilage transplantation within the ankle is performed.

If you believe you are a possible candidate for cartilage transplantation within the ankle or any other joint, please contact: University of South Alabama Sports Medicine & Reconstruction Service at (251) 665-8200.

 

Minimally Invasive Joint Replacement (Arthroplasty)

Arthroplasty, also known as joint replacement, is when the arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis. A partial or total joint replacement may be performed depending on the severity of the joint damage. Currently, the University of South Alabama is one of a handful of Centers throughout the United States that performs minimally invasive total knee arthroplasty. With this technique, the patient's incision is approximately 6-7 centimeters long, and patients have significantly less pain after surgery. The majority of patients are able to go home with 48-72 hours after their replacement. Minimally invasive total knee arthroplasty has been performed at the University of South Alabama for nearly 2 years on nearly 100 patients.

 

Partial Joint Replacement of the Knee

Patients that exhibit osteoarthritis in one compartment may not need a total joint replacement to relieve pain and restore function of the joint. An alternative treatment is a unicondylar implant. Unlike total joint implant surgery, this less invasive procedure replaces only the damaged or arthritic part of the joint. Instead of cutting the ends off the bones that join to form the joint and replacing them with a prosthetic joint, the new procedure reshapes only the damaged portions of the joint and replaces them with a special metal and plastic surface.

 

Total Joint Replacement

If two or more components of the joint are damaged, a total joint replacement may become necessary. Knee and hip replacements are more common, but other joints including the shoulder can also be replaced. The surgeon makes an incision along the joint, moves aside muscles, and removes damaged bone and cartilage. The remaining bone is prepared to receive the prosthesis and the new plastic and metal joint is placed in position. Depending on the type of prosthesis, the surgeon may use cement to hold one or both parts of the artificial joint. The incision is closed with sutures and staples, which are removed during your postoperative visit. Once the new joint has completely healed you should experience reduced or no joint pain, increased movement and mobility, correction of angular deformity, increased strength, improved quality of life and the ability to return to normal activities and work.

Currently the University of South Alabama is one of a handful of institutions implanting total joints with metal that allows bone to grow into the prosthesis.

 

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