THE SOURCES OF JOINT PAIN
Joints are where two bones are joined by connective tissue called cartilage. Cartilage acts as a protective cushion to allow the joint to support body weight and move comfortably. But when the cartilage is damaged by disease, infection, wear-and-tear or injury, the result is often painful inflammation, stiffness and reduced mobility. “While there are many causes of joint pain,” explained Dr. Sitthiporn, “Osteoarthritis and other degenerative joint diseases are among the most common. These conditions cause a breakdown in the cartilage that affects the normal workings of the joint. As the cartilage wears away, the two bones rub against each other, causing great pain.”
Aging is a key risk factor for developing osteoarthritis, especially after the age of 50. Obesity, a family history of osteoarthritis and being in overall poor health also increase one’s risk.
“The first symptoms people usually notice are pain, stiffness, and reduced flexibility of a joint,” Dr. Sitthiporn noted. “The area around the joint may become swollen as an unusual fluid builds up, and that can worsen the pain each time weight is exerted on the joint.” Osteoarthritis is a progressive disease whose symptoms and severity worsen over time, so early detection is very important to successful treatment.
also leads to serious joint damage. This condition causes chronic inflammation of the joint resulting in pain, stiffness, and swelling. “The repeated inflammation causes damage to the bone and cartilage,” Dr. Sitthiporn added. “While joint pain and stiffness caused by osteoarthritis usually affect one knee or one hip, the pain and stiffness from rheumatoid arthritis tends to affect both hips or both knees at the same time.”
DIAGNOSIS AND TREATMENT
To diagnose the cause of joint pain, your doctor will usually begin with a thorough physical examination and ask about your medical and family histories. Specialized tests, such as a biopsy, X-rays, MRI scans, and arthroscopy help confirm the diagnosis and determine the severity of the condition. Blood tests are sometimes used to check for the presence of rheumatoid arthritis or infection
Patients diagnosed with mild to moderate osteoarthritis can usually be treated without surgery. Doctors may recommend a combination of options including:
- Weight reduction for overweight or obese patients
- Rest or activity modification
- Medication to relieve pain and inflammation
- Using a brace or walking aid
THE JOINT REPLACEMENT REVOLUTION
More serious cases may require the complete replacement of the damaged joint. As Dr. Sitthiporn explained, “For many people, joint problems become so severe to the point where the patient suffers a serious decline in quality of life. In many of these cases, a good option is to replace the damaged knee or hip with an artificial joint.”
Ten years ago, the idea of replacing a real hip or knee joint with an artificial one may have seemed quite radical. Today, joint replacement is among the most successful treatments for serious joint conditions. It has already brought great relief to thousands of long-suffering patients. Here’s a detailed look at knee and hip replacement procedures.
The knee joint is formed where the lower part of the thighbone (femur) connects with the upper part of the shinbone (tibia)
and the kneecap (patella)
. Shock-absorbing cartilage covers the surfaces of these bones.
During a typical knee replacement surgery
, the damaged areas of the thighbone, shinbone and kneecap are first removed. The surgeon then smoothes and reshapes the ends of the remaining bones to ensure an optimal fit of the artificial knee components.
Major knee surgery used to require long hospital stays and up to a year of recovery time. That’s no longer the case, as Dr. Sitthiporn explained: “Knee replacement usually requires four to seven days in the hospital. The recovery period depends on a patient’s general health, age, and other factors, but many patients resume their normal activities within three months.” Once the knee has sufficiently healed, patients are often advised to incorporate a comprehensive exercise program into their daily routine. Low-impact activities like swimming and walking are highly recommended, as they can help improve blood circulation, endurance, flexibility and muscle strength, without putting too much pressure on the knees.
The hip is a large “ball-and-socket” joint that bears much of the body’s weight and movements. The ball of the joint at the top of the thighbone (femoral head) moves within the hollow socket (acetabulum) of the pelvis. A layer of cartilage allows the ball to glide smoothly inside the socket.
During the total hip replacement procedure
, the surgeon removes the ball part of the joint and replaces it with a prosthetic ball. The ball is attached to a stem that fits into the hollowed-out space in the thighbone. Damaged cartilage and bone are removed from the socket, and a cup-like component is inserted in its place. Hip replacement surgery has rapidly become a leading choice for treating severe hip problems, with shorter hospital stays and faster recovery times compared to traditional hip surgery.
Younger patients with less-serious hip problems are also benefiting from major advances in technology and techniques through a procedure called hip resurfacing. According to Dr. Sitthiporn, “Hip resurfacing is a less-invasive, bone-conserving surgical technique that has already allowed thousands of people in their 40s and 50s to resume active lives and delay or eliminate the need for total hip replacement.”
Unlike the prosthesis used in total hip replacement, the resurfacing prosthesis allows the head to be preserved and reshaped. The resurfaced bone is then capped with a metal prosthesis. As with total hip replacement, the socket is fitted with a prosthesis.
IS JOINT REPLACEMENT RIGHT FOR ME?
As people pursue active lifestyles well into their 60s, 70s and 80s, joints need to stay strong and healthy. But the added years means more wear-and-tear on knees and hips, and increased risk of serious disease and injury. Joint replacement surgery has established an impressive record for safety and successful post-treatment results, eliminating pain and restoring mobility in patients who don’t respond to other treatments. All medical procedures, including joint replacement and resurfacing, involve some level of risk and may not be suitable for every patient. Your doctor will explain the treatment options and recommend the best course of treatment for your individual situation.
“It’s important for patients to have realistic expectations about joint replacement surgery,” said Dr. Sitthiporn. “While most patients are able to resume most normal activities without pain, it won’t enable them to run a marathon! Not all patients are good candidates; for example, people who are obese may have to be excluded.”
Exercise and Healthy Joints
The right exercise is essential for keeping bones and joints healthy. Even for people being treated for joint problems, regular exercise can still help reduce joint pain and stiffness. Be sure to consult your doctor before starting any exercise program.
It’s best to choose non-weight bearing, low-impact exercises like walking or swimming as they are safer for joints compared to more vigorous high-impact exercises such as jogging.
Warm up by gently stretching the muscles in the front of the thigh (quadriceps), the side of the thigh, and the back of the thigh (hamstrings); stretching reduces pressure on the knees and hips that occurs during exercise.
Strengthening exercises increase muscle strength, a key to supporting bones and joints.
Swimming is an ideal exercise for those with arthritis as it can increase mobility and build muscle strength. And unlike exercise on dry land, the water helps reduce the amount of stress on the body’s hips, knees and spine.
You don’t have to be a fitness fanatic or “gym rat” to reap the benefits of regular exercise. Look for opportunities in your daily routine to add some exercise and increase your level of activity. Take the stairs instead of the elevator, or try a nightly after-dinner walk with your family. Your bones and joints will be glad you made the effort.
Posted by Bumrungrad International
January 20, 2008