The simple things in life sometimes have the greatest value. Imagine not being able to get down on the floor with your grandchildren to build a wooden block tower, put a train track together or push Barbie around in her pink convertible.
But playing with the grandchildren is one thing that can become impossible for senior citizens when osteoarthritis leads to the deterioration of joints.
Osteoarthritis is also known as degenerative arthritis and affects about 27 million American adults. Of the more than 100 forms of arthritis, it is the most common. What causes arthritis is largely unknown, but what it does to joints is not.
“Osteoarthritis is a complex cellular and biochemical process that results in breakdown of the normal cartilage structure in the joints. As common as it is, the medical profession still cannot really define what exactly causes osteoarthritis,” says Dr. Joseph Alhadeff of Orthopaedic & Spine Specialists of York (717-848-4800; www.orthospinesp.com).
According to Dr. Christopher C. Cooke of Orthopedic Associates of Lancaster (717-299-4871; www.fixbones.com), osteoarthritis most commonly affects the knee, “but it can affect pretty much every joint.”
“In the joint there is a protective cap of cartilage that covers the surface of the two bones that make the joint. In osteoarthritis that protective cap breaks down, we think, because the amount of stress exceeds the cartilage’s ability to repair itself. In the normal state, the cartilage is nice and smooth, like the end of a fresh chicken bone. When osteoarthritis occurs the cartilage looks more like the surface of the moon, with pock marks and crevices. This creates a lot of friction when the two bones try to glide against each other, resulting in inflammation,” Cooke says.
Treatments for osteoarthritis take a variety of forms, from medications to exercise to surgery.
“Since we don’t really know what causes osteoarthritis, most of the treatments are geared towards treatment of the symptoms,” says Alhadeff. “The most effective treatment for symptomatic arthritis of the lower legs, hips, knees or ankles is weight loss. This is the only treatment that has been scientifically shown to alter the progression of arthritis,” he says.
“When we get out of a chair or go up and down stairs, more than four times our body weight is transmitted through the knee joint, so even a modest weight loss of 20 pounds is more like 80 pounds to the knee, says Alhadeff.
For symptomatic arthritis of the lower body, exercise, particularly strengthening of the thigh muscles, is an effective treatment, also, says Alhadeff. “We recommend low-impact aerobic exercises, strengthening exercises and stretching exercises to improve and maintain joint mobility,” he says.
“Those who exercise regularly have symptoms that are much less severe than those who do not,” he says.
Alhadeff says he recommends at least 30-45 minutes a day of exercise, but it doesn’t have to be done all at once. It can be split into 10 or 15 minute intervals. Swimming, water aerobics, cycling on a normal or a stationary bike, and walking on a treadmill or a track are all good exercise choices, he says. Treadmills and tracks tend to be more cushioned than the street or the sidewalk, he says, and using a cushioned shoe helps in being able to do more exercise with less stress on the joints. “Yoga and Tai-Chi are other excellent, low-impact exercises that help relieve pain in patients with arthritis,” he says.
Joint replacement surgery is another option when other measures fail, says Alhadeff. The knee is the most commonly surgically treated joint, with more than 600,000 knee replacements done in the U.S. every year.
There are 500,000 hip replacements each year.
“Joint replacement can provide excellent pain relief and allow patients to resume their desired activities, but as with any surgery there are some risks involved, so it is not a good first line treatment,” he says.
Alhadeff describes the case of a patient who had tried many ways to cope with her knee pain, such as over-the-counter pain relievers, modifying her activity, joint injections and a knee brace.
“She was having terrible pain in her knees that was limiting her activity. She had been an avid walker, 2 miles a day, which she could no longer do because of her knee arthritis. But more important to her, should could not play with her grandchildren like she wanted to. If she got down on the floor, there was no guarantee that she could get back up,” he says.
After Alhadeff performed a partial knee replacement, his patient was walking a mile a day within six weeks.
“More importantly, she was walking without a limp and was now able to get down on the floor and play with her grandchildren,” Alhadeff says.
Cooke performed a hip replacement on a patient who for years had taken care of her ill husband. She had significant osteoarthritis of the hip, he says, and it was very painful, but daily she would transfer her husband from his wheelchair to the bed as part of her care of him.
“We tried every trick in the book to alleviate her pain while this was going on, but I knew she was lying when she said she felt a little better with each change in treatment. Her limp was getting worse. She refused surgery because she wouldn’t leave her husband’s side. After he passed, she agreed to have her hip replaced because, as she put it, she had grandchildren to play with,” says Cooke.
“Two weeks after the operation she commented how she couldn’t believe all of the pain was gone. Six weeks after the operation she was babysitting her grandchildren. I know I can’t take credit for it because I didn’t invent joint replacement. But it did make me feel good to help someone out who had given so much and asked so little,” he says.
Tips for coping with Osteoarthritis
Dr. Joseph Alhadeff of Orthopaedic & Spine Specialists of York has the following suggestions for dealing with arthritis: “Lose weight, exercise and avoid sitting or standing in one position for too long. Get plenty of rest and sleep. Avoid high impact activities like running or jumping. Modify your home to make activities easier. For example, have grab bars in the shower, in the tub, and near the toilet. Take Tylenol or Aleve as needed for flare-ups of your symptoms. If your pain continues, check with your doctor to discuss other treatments.” He also suggests checking out the Arthritis Foundation website at www.arthritis.org.
Rheumatoid Arthritis versus Osteoarthritis
“Rheumatoid arthritis is a form of joint inflammation that results from your body’s immune system getting confused and not recognizing parts of the joint as ‘self,’“ says Dr. Christopher C. Cooke of Orthopedic Associates of Lancaster. “It affects people of all ages and primarily small joints of the hands and feet. But, knees, hips, shoulders, elbows, and the cervical spine are also affected commonly,” he says. “It affects structures other than joints, such as tendons and ligaments. Your immune system will think these structures are foreign and attack them. Destructive enzymes that your immune system releases into the joints break down the cartilage and destroy the joint. What both rheumatoid arthritis and osteoarthritis have in common is the cartilage eventually breaks down so the joint ends up being bone on bone. One is primarily mechanically driven, whereas the other is driven by a confused immune response,” says Cooke.
