Better Health 2016 > Bone Health Treatments > When traditional surgery is not enough to treat osteoarthritis

When traditional surgery is not enough to treat osteoarthritis

Treatment of osteoarthritis

For many elderly people, Osteoarthritis can be a debilitating illness that makes everyday activities fraught with anxiety, fear, and severe pain. Most commonly affecting the hips and knees, Osteoarthritis can force patients to endure constant pain with every movement.

The good news is that relief may be in sight. Highlighting the causes, symptoms, and treatment of osteoarthritis, orthopedic surgeon Sr. Gp. Capt. Dr. Chumroonkiet Leelasestaporn informs Better Health readers about new hope for patients with this condition.

What causes osteoarthritis?

“Osteoarthritis is age-related joint deterioration,” says Sr. Gp. Capt.Dr. Chumroonkiet. “After years of use, it’s inevitable for joints to wear out. As the population’s average age increases, we see more affected patients. Symptoms of knee osteoarthritis can appear in people as young as 45 to 50 years of age but is more common in patients 65 and older. Hip osteoarthritis usually occurs later, at around 60 to 75.”

In addition to age, there are several other factors that can accelerate osteoarthritis. These include excessive weight, bone and cartilage weakness, and muscle atrophy. Behavior-related causes, such as squatting, sitting with legs folded to the side, sitting crossed legged, and kneeling exacerbate the condition.

Signs you might have osteoarthritis

Osteoarthritis develops slowly over decades, so most patients do not feel symptoms in the early stages. “In knee osteoarthritis, the joint pops or cracks whenever it’s in use, not just sporadically,” says Sr. Gp. Capt. Dr. Chumroonkiet. “Often, infection in the knee joint causes it to swell with fluid.

Doctors can drain the joint, which helps relieve the pain, but does not cure the osteoarthritis.”

Severe knee osteoarthritis deforms the joint, causing it to bend. It hurts to walk because the cartilage shock absorber has worn out. The bones in the joint then start to rub directly against each other, which causes excruciating pain for the patient.

In hip osteoarthritis, swelling of the hip joint is not visible, but the pain is present. Any simple movement – like sitting down or getting up – hurts. As the disease progresses, patients lose agility, then their general freedom of movement. They walk with short steps to minimize the pain. Left unattended, the degenerated hip joint gets stuck making movement even more painful and challenging.

Treatment of osteoarthritis

No treatment currently exists that restores worn out joints back to their healthy condition. Instead, treatment focuses on trying to slow deterioration, while preserving patients’ existing knee and hip joints for as long as possible. Doctors commonly recommend corrective actions to counteract behaviors that led to the condition. Lowering one’s weight, changing sitting positions, frequent exercise of knee and hip joint muscles, and promoting habits to strengthen bones all help minimize the disease’s progression.

For pain management, doctors usually recommend:

  • Drug treatment to reduce inflammation, pain, and muscle spasms;
  • Bone stimulants or medication that suppress joint cartilage damage, such as glucosamine sulfate, glucosamine mixed with chondroitin, and diacerein.

Sr. Gp. Capt. Dr. Chumroonkiet notes that for surgery, doctors must consider the following indications:

  1. Patients must have been treated with non-surgical methods, but with no success.
  2. X-rays must definitively show the necessity for joint surgery. Although patients may feel acute pain, if joint degeneration is not severe enough, doctors may decline to operate.
  3. The patient’s age is within the appropriate range. Artificial joints have a useful life of about 10 to 20 years. Doctors are unlikely to perform joint replacement surgery for patients under 50 years of age because artificial joints would likely wear out requiring more operations. However, some patients like those with rheumatoid arthritis may need surgery regardless of their age.



When joint replacement is necessary

Surgery for osteoarthritis can involve osteotomy to correct deformities such as bow legs or knock knees with no joint replacement.

There are several joint replacement surgical methods:

  • Conventional surgery: Its success relies on the surgeon’s expertise and skill, but errors can impact the artificial joint’s effectiveness and how long it lasts;
  • Minimally invasive surgery: A procedure with less impact on surrounding muscles, a smaller incision, and a chance for faster recovery in comparison to conventional surgery.
  • Computer-assisted surgery (for knee and hip joints): The computer helps the surgeon place the artificial joint in position with up to 94 percent accuracy. Conventional surgery’s accuracy rate is only 78 percent. This method also promotes more precise equilibration of the joint muscle function.
  • MAKOplasty® (robotic-arm assisted surgery): For partial knee joint replacement and artificial hip

replacement, this technology helps doctors place the artificial joint in the exact optimum position, with less bone loss from resurfacing the joint. Consequently, it’s more likely that the artificial joint will last for the patient’s life. Additionally, the small incision enables a quick recovery.

Patient expectations are key

To choose the appropriate joint replacement surgery method, apart from assessing the patient’s condition, doctors must also consider his or her expectations. “Today, patients have increasing expectations to not only get rid of pain, bowlegs or just being able to walk again, but also expect the outcome to be as near perfect as possible,” says Sr. Gp. Capt. Dr. Chumroonkiet. “Those who played sports expect to do so again. From a study, we found that 20 percent of patients who received joint replacement are not satisfied with the results, due to their high expectations.”

Doctors must strive to deliver surgical results that meet patient expectations, whether through a particular surgery technique or choice of the most suitable artificial joint. Doctors must also use treatments that take into account patients’ future needs. For example, where the knee joint is not completely degenerated, replacing only the affected part of the joint might be the best course of action. If the patient needs a total joint replacement in the future, the foundation is already in place. Replacing the whole joint, when a partial replacement is possible can make future surgeries more difficult and more expensive. “Joint replacement is not just a solution for today,” says Sr. Gp. Capt. Dr. Chumroonkiet. “Successful artificial joint replacement means not only a safe surgery but also a procedure that helps patients regain a high quality of life today and in the future.

 Sr. Gp. Capt. Dr. Chumroonkiet Leelasestaporn


“Today, patients have increasing expectations to not only get rid of pain but also expect the outcome to be as near perfect as possible.” Sr. Gp. Capt. Dr. Chumroonkiet Leelasestaporn


Joint Replacement Center

Bumrungrad’s Joint Replacement Center

The Joint Replacement Center at Bumrungrad International Hospital is a JCI-certified medical center under the Clinical Care Program Certification of Knee Replacement. This accreditation ensures that the center provides joint replacement medical services with the same standards as other leading world-class hospitals.

The Joint Replacement Center offers joint replacement surgery performed by a team of physicians and medical specialists using the latest medical tools and technologies. We emphasize providing world-class care at every stage of treatment, from patient registration to post-procedure follow-up. Our commitment enables us to help patients enjoy their lives again. After a safe procedure, we strive to meet each patient’s post-surgery expectations, such as minimal post-operative pain, the ability to return to most normal activities, and only using artificial joints that last a lifetime.

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