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Arthritis

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Donald D. Berg, M.D. P.C.
Orthopedic and Reconstructive Surgery
 Sports Medicine
The Practice of Orthopedics

Serving Southeast Iowa Since 1975

Arthritis

Osteoarthritis, also called "wear and tear" or "degenerative" arthritis, affects 97% of all people over sixty.  Often times, discomfort from Osteoarthritis is mild and little or no treatment is needed.  However, if the illness becomes worse, treatment with special medication, injections or fluid removal can be helpful.  When Osteoarthritis of the knee or hip is advanced, causing pain or loss of mobility, total joint arthroplasty (total joint replacement) is a very successful form of treatment.

Until as recently as 30 years ago there was little an orthopedic surgeon could do for a patient with severe arthritis in the hip or knee.  Then in the 1970's surgeons began to achieve successful results performing total joint replacement on these severe arthritic joints.

Osteoarthritis is a progressive, currently irreversible condition with loss of articular cartilage that leads to pain and sometimes deformity, principally in the weight bearing joints of the hip, knee and the spine.  It is the most common type of arthritis and is the often associated with age, obesity and trauma.  Less common associations include chondrocalcinosis, hemophilia, hemochromatosis, epiphyseal dysplasia and hydroxyapatite degenerative disease.

Protection of the joint from overuse is critical.  Gentle regular joint exercise help maintain function and manage pain.  Water exercise, cycling and non-weight bearing range of motion exercises all help reduce symptoms and preserve muscle support for the affected joints.  Isometric exercises help if patients are unable to tolerate exercises involving joint motion.

Typically joint replacement or arthrodesis, is appropriate when patients have pain at rest, pain at night, or unacceptable loss of joint function.  Hip and knee replacement are especially effective in reducing pain and increasing function. 

 Weight loss is important, especially in the weight bearing joints of the lower extremity, not only to reduce symptoms, but to improve the survival of joint implants placed when symptoms are intolerable.

Pain management with acetaminophen, propoxyphene, or similar medications is often helpful.  Salicylates and non-steroidal anti-inflammatory drugs (NSAIDs) often help, but may cause renal, hepatic, or gastric problems.  In addition, NSAIDs may inhibit joint repair by interfering with prostaglandin synthesis.  Intra-articular corticosteroids often relieve symptoms, but the duration of relief is often short (1 or 2 weeks) in weight bearing joints of the lower extremities, shoulder or elbow.  In the hand, intra-articular steroids may relieve symptoms for months.  A limited number of injections can be given to any joint.

Stiffness, pain and deformity are the common complaints.  Stiffness, rather than swelling, is the most common complaint associated with joint effusions.  The pain associated with Osteoarthritis is usually relieved by rest until the arthritis is advanced.  With advanced arthritis, the osteophytes (spurs) themselves may block joint motion as well.

Diagnosis

There is sometimes swelling of the joint, especially if the patient has noted stiffness.  At the knee particularly, there is often a bowleg and knock-knee effect.  At the hip joint, the patient often "toes out" and walks with the limb externally rotated.  X-rays of the affected joint are required for a complete diagnosis

 

                     

 

  Last Updated February 06, 2007

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