Arthritis General Concepts Conservative and Surgical Intervention

By Richard A. Sweet, M.D.

INTRODUCTION: Total knee replacement (TKR) surgery has, along with total hip replacement (THR) surgery, become one of the great medical and surgical success stories of the last several decades.  Hundreds of thousands of patients each year benefit from these procedures.  The number of knee and hip replacements performed each year worldwide and in the U.S. climbs.  This is due to a number of reasons.  Our “baby-boom” population is aging.  We are attempting and expecting to maintain active lifestyles much later in life than previous generations.  As athletics have grown in popularity, the incidence of arthritis due to previous injury has climbed.  Americans are indulging in an ever increasing daily dietary caloric intake, and resultant obesity adds stress to the weight bearing joints.  This additional joint stress is contributing to the number of Americans who develop knee and hip arthritis leading to replacement surgery.

Arthritis is defined as the deterioration of the articular or surface cartilage of a joint.  This progressive loss of cartilage is associated with inflammation, joint swelling and fluid, and painful range of motion.  There are many types of arthritis.  The underlying cause is generally unknown.  There are two broad classifications of arthritis. These include inflammatory and non-inflammatory arthritis.  The former is typified by the condition known as rheumatoid arthritis.  The latter is typified by the type of arthritis known as osteoarthritis.

By far the most common type of arthritis is osteoarthritis, also known as degenerative arthritis.  It is the type associated with aging and “wear and tear”.  Its underlying cause is unknown.  It is associated with a characteristic x-ray appearance.  Lab and blood work are non-diagnostic (i.e. there is no positive blood test for this most common type of arthritis).  The diagnosis is made on clinical grounds.  Post-traumatic arthritis is a variant of osteoarthritis.  It is distinguished by a previous history of injury, which has led to the development of the arthritic condition.  It otherwise is usually similar in clinical appearance to osteoarthritis.

Inflammatory arthritis is much less common.  Though inflammatory arthritis is typified by rheumatoid arthritis, there are other variants.  Arthritis associated with other systemic conditions such as psoriasis, ulcerative colitis, lupus and others is of the inflammatory type.  This type of arthritis is associated with an autoimmune disorder where the patient’s own immunologic system attacks the cartilage cells destroying them and creating a painful, inflamed, swollen, and sometimes deformed joint.  Blood work is often diagnostic for these conditions.

NONSURGICAL CARE:  Nonsurgical management of arthritis should always be considered first.  A combination of short periods of rest, ice/heat therapy, physical therapy, medical management, and exercise in moderation can be attempted.  Medical management options include: NSAID’s, Steroid (Cortisone) Utilization, Visco Supplementation Injections, & Chondroitin / Glucosamine Products.   Success largely depends on the severity of the underlying arthritic condition.  As the joint gets closer to “bone on bone”, all conservative measures become less effective, at which point surgical care should be considered.

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Richard A. Sweet, M.D. specializes in total joint replacement; completing the Aufrank Reconstruction Fellowship in joint replacement surgery at the New England Baptist Hospital in Boston.  He has been involved in both clinical and scientific research in this field, which has included implant and instrument development for hip and knee replacement surgery. These research and development efforts have focused particularly on minimal incision techniques. An avid teacher, he often conducts seminars on the subject of total joint replacement for both medical personnel and the community at large.

For further information you can go to www.louortho.com or to schedule an appointment you can contact Louisville Orthopaedic Clinic at (502) 897-1794. Address: 4130 Dutchman’s Lane Suite 300, Louisville, KY 40207

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