Osteoarthritis

Where bones form a joint they are covered with articular cartilage. This articular cartilage cushions the joint against the loads placed upon it. Osteoarthritis is where the articular cartilage wears away. As it does so the joint is less able to absorb the loads and eventually the joint becomes painful. Initially the pain is felt on activity but eventually it is also felt at rest and in bed at night. The pain limits activity and can disturb sleep. Eventually the cartilage wears away completely exposing the underlying bone. This is termed advanced osteoarthritis.

Diagnosis

Diagnosis of osteoarthritis is generally made from the clinical history, physical examination and x-rays. Occasionally MRI scans or blood tests will be part of the investigations required.

Causes

Osteoarthritis usually develops after many years of use. It tends to affect people who are middle aged or older and regarded as a ‘wear and tear’ condition. Other risk factors for osteoarthritis include obesity, previous injury to the affected joint and family history.

Treatment

Non Surgical Treatment

Lifestyle modification

Your doctor may recommend a change in activities which aggravate your symptoms. This includes both leisure and work activities. This may involve switching from high impact to low impact activities. Obesity can also have a big impact on joints and their function. Weight loss may be recommended in order to reduce the load on your joints.

Medication

Anti-inflammatory medication may be used to help control symptoms. Occasionally injections into the joint can be helpful. Dietary supplements called Glucosamine and Chondroitin Sulphate can sometimes help.

Physiotherapy

A balanced exercise program can be helpful in maintaining function and flexibility of the joint as well as helping maintain muscle strength to support the joint. This can be supervised by a physiotherapist. Later on joint supports or walking aids can be helpful. 

Surgical Treatment

Arthroscopy

This is a keyhole technique where the surgeon inserts a camera into the joint and may undertake a number of procedures including removing loose bodies and trimming torn cartilage which may be contributing to the symptoms. This procedure is not usually effective in advanced osteoarthritis.

Osteotomy

This is where the long bones of the lower limb can be realigned to offload the arthritic part of the joint. This is usually recommended in younger patients in order to defer joint replacement.

Joint Replacement

This is where the joint surfaces are replaced with metal components between which there will be a plastic or ceramic bearing. 

The appropriate management of osteoarthritis should be tailored to the individual. Your surgeon will guide you through the options of treatment and all aspects of management should be fully discussed and explained.

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