Arthritis

The Hip and Knee joints, like most joints in our body, are comprised of bones lined up with a smooth shinny layer of ‘polish’ known as cartilage. This cartilage allows for a low friction and high resilience movement to occur between two bones.

To protect the polish(cartilage) from premature wear during movement, we have been given ‘shock absorbers’ between the two polished surfaces. In the Hip, this is known as the acetabular labrum and in the Knee they are called the meniscus.

Further, some ‘lubrication oil’ known as synovial fluid is secreted by the lining of the joint making movement in the joint extremely efficient often making the joint last five or six decades or more before arthritis sets in.

Arthritis or Arthrosis is a term commonly used to describe inflammation and degeneration of a joint. Whilst there are various causes for arthritis, the most common form that we see in our community is degenerative, or simply ‘wear and tear’. This is commonly known as Osteoarthritis.

This usually involves the polish (cartilage) getting eroded away. Sometimes it may start much earlier with a tear in the meniscus causing its shock absorber ability to fail and overload the cartilage which, over time wears away. This often manifests as pain, swelling, stiffness and limitation of activity. Swelling, cysts and spurs are all part of the same process and usually seen in arthritis.

Normal Hip

Arthritic Hip

Normal Knee

Arthritic Knee

Treatment

Treatment of arthritis depends on the level of symptoms a person is experiencing and that should be the absolute guide to treatment.

Lifestyle & Activity Modification

As with every other condition prevention is the best cure. Whilst one cannot stop the wear and tear process, we can often slow it down by addressing factors that speed up the wear and tear. Most importantly weight control and avoidance of impact activity (running, jogging and jumping).This may improve symptoms in the early stages of the disease. Non impact activities such as swimming and cycling are much more gentle on these joints.

Physiotherapy

Physiotherapy works by strengthening the muscles around the joint. These muscles have somewhat weakened due to lack of activity to avoid pain. Physiotherapy also helps maintain a range of movement that is commonly lost due to stiffness seen in arthritis. Strong muscle act like a brace on the inside.

Medications

Common pain relieving medications and anti-inflammatories are often very effective in controlling symptoms of mild to moderate arthritis. As the disease progresses, these medications become less effective. Stronger pain killers can help ease pain but come at the cost of increased side effects.

Para-conventional Medications

These have been very successfully marketed worldwide and most people are familiar with them. They include medications like Glucosamine, Chondroitin, fish oils, krill oils etc.

THEY DO NOT REGENERATE CARTILAGE.

However, there are studies showing that they may have an anti-inflammatory effect. There are also studies showing that they are no better than a placebo. Therefore, if they help they may be worthwhile. If they don’t, they don’t.

Treatment with medications should always be supervised and monitored by your family physician or general practitioner.

Braces

Braces usually help by making one more aware of smaller movements around the joint and enhancing the patient’s ability to feel more guarded. This is known as proprioception. Therefore, they may or may not help and varies from person to person. The only type of brace that has been shown in the literature to help arthritis is an UNLOADER Brace. This can be effective in specific patients that have arthritis limited to the inner part of their knee.

Traditionally, compliance levels with this brace have been low due to costs (around a $1000 AUD) and size of the brace. In Australia, it is supplied by at least two companies.

Injections

Cortisone injection- This is the most common and readily available form of injectable. ‘Cortisone’ or steroids are an anti-inflammatory that are injected into an inflamed joint to relieve symptoms. Whilst it is not indicated for stable arthritis, a flare up of arthritis can often be improved and relief (often partial) may be expected for weeks or months. They are very variable and at times may not work for a meaningful period of time. Further, the more advanced the arthritis, the less likely it is to work. There is small risk of introduction of infection.

Other Injectables- Visco-supplementation (Synvisc/Durolane) Viscous lubrication jelly, Stem Cells, Platelet Rich plasma (PRP) all have a place in management of arthritis symptoms but do not regenerate cartilage. Some of them have an anti-inflammatory effect. They all vary in their effectiveness (from individual to individual) and costs.

Radio frequency Ablation (RFA)

This is an evolving technique used to temporarily disable sensory nerves that convey pain perception and thereby reduce the pain associated with arthritis. Geniculate nerves which are small sensory nerves around the knee can be ‘ablated’ using cooled radiofrequency probes and have been shown to achieve reduction in pain for many months. It is however temporary and not always as effective. The advantage is that GNRFA is a minor procedure and does not require surgery. In situations where a joint replacement is not being considered (either because the joint is not bad enough to need replacement or because the patient is not contemplating a replacement for whatever reason and the arthritis is very symptomatic), Geniculate nerve Radio Frequency Ablation adds another option that may improve symptoms for a period of time.

All the above are temporary measures to control symptoms and do not cure arthritis. When these measures are no longer effective, surgery may be considered.

Surgery

Surgery is indicated when symptoms of arthritis are not being controlled by non-operative measures and they are intrusive in one’s lifestyle. There are various surgical options that may be appropriate given individual circumstances but the definitive treatment for Hip and Knee arthritis is a replacement. Fortunately, joint replacements have excellent results but should always be the last resort.

Further, there is no such thing as “you need a hip or knee replacement!”. Need is something the patient determines and should be guided strictly and only by the patient’s level of symptoms and after non operative measures have been exhausted. If surgery is delayed, apart for the symptoms, the patient will not be disadvantaging themselves in terms of outcome of their operation. In Australia in today, it would be extremely unlikely that someone ‘will end up in a wheelchair’ if they delayed their operation.

There is also no such thing as being too old for this operation. However, fitness for anaesthetic is a prerequisite.

Facts about modern hip & knee replacements

Joint replacements are some of the most successful operations of the 21st century
They successfully alleviate pain and restore lifestyles
Short term functional recovery (day to day activities and return to work) can be expected in weeks (Hip Replacements) to a couple of months (Knee Replacements)
Modern joint replacements are expected to last a few decades.

Regular running and other major impact activity, though possible, is NOT recommended due to effects on longevity. Return to Yoga, Pilate, Aerobics and general gym work along with most non- impact sports (including gentle tennis and skiing, horse riding, bushwalking etc., ) are all realistic expectations post replacement.
They are only recommended when one’s symptoms are intrusive in their lives and simpler non operative measures are no longer effective

SuperPATH

SuperPATH is a revolutionary new hip replacement technique that is the least invasive and most preserving method when considering the soft tissues around the hip joint. Pioneered in Australia by Associate Professor Sol Qurashi at the Hip and Knee Clinic, this technique has enjoyed excellent results in short to midterm. Our clinic was the first in the world to publish on the quick short term functional recovery, excellent patient satisfaction and very safe and low complication profile of SuperPATH.

More about SuperPATH

Arthritis

Treatment

Lifestyle & Activity Modification

Physiotherapy

Medications

Para-conventional Medications

Braces

Injections

Radio frequency Ablation (RFA)

Surgery

Facts about modern hip & knee replacements

SuperPATH

More about Assoc. Prof Sol Qurashi

Our Procedures

SuperPATH