What Can You Do About Osteoarthritis?

By Dottie Evans

Since osteoarthritis is a disease that once contracted, won’t go away, information on the newest options for treatment is always eagerly awaited.

This common condition occurs when the lubricating fluid within a hip or knee joint that ought to cushion the bones loses its viscosity and thins. At the same time, the bones begin to wear down and the joint lining becomes irritated.

Bone spines or spurs may actually grow from bones surrounding the osteoarthritic joint.

“It’s a chronic disease that can be progressive,” said Dr Thomas P. Nipper, a 27-year practicing orthopedic surgeon affiliated with Brookfield Orthopedics.

He spoke Tuesday, April 19, at the monthly Lunch and Learn program at Lockwood Lodge of Ashlar.

“People are living longer, and we are seeing patients suffering a lot of joint destruction. Osteoarthritis can be very painful and it can limit mobility,” he said. “What most patients want to do is keep up with their age group. So let’s talk about what options are available to help them do that.”

More than 40 million Americans each year are treated for osteoarthritis, and while the knee and the hip are the most common sites, doctors see a lot of hand, wrist, elbow, and even spine problems as well.

While osteoarthritis occurs in 98 percent of arthritis cases, Dr Nipper listed several less common forms of arthritis. Crystalline arthritis is a gout disease, Lyme arthritis and polymyalgia are associated with the bite of an infected deer tick, and rheumatoid arthritis is a severe form that occurs in only one or two percent of cases.

There are many causes of osteoarthritis. They can range from early joint injury, obesity, genetics, overuse, and misuse to the passage of time. But the symptoms seem to be universal and consistent.

“Patients come in and tell me it hurts. It’s stiff. I can’t bend it. I find there is loss of range of motion and weakness. So what can you do?” Dr Nipper asked.

Start With The Usual Options

Many treatments may be suggested in the orthopedist’s office and carried out at home, he began. After taking a series of X-rays to determine the extent of the damage, there may be several recommendations depending upon the severity of the problem.

“Weight loss, physical therapy, and light aerobic exercise are nearly always recommended,” he said. “The weaker your muscles are, the more the joint gets destroyed. It’s a vicious cycle.

“Then there are the nutritional supplements that in some cases help –– like taking chondroitin and glucosamine. But it takes at least six months to see any positive effect.”

Taking acetominophine (Tylenol) is one way to control the pain, but Dr Nipper warned his audience of mostly senior citizens that aspirin cannot be combined with a blood thinner such as Coumadin. In addition, the Cox-2 inhibitors like Vioxx and Celebrex are currently under question because of possible side effects including stroke and heart attack.

“In this case, the physicians were poorly served by the government and the pharmaceutical industry,” Dr Nipper commented.

A final option with only short-term benefits would be the administration of a cortisone shot, but patients are advised to get only two injections a year, and the positive effects of the shot may last for only two weeks or so.

Consider Surgical         Intervention

Arthroscopy, or knee joint surgery, is the most common surgical option for treatment of mild osteoarthritis among patients between the ages of 40 and 70 who are experiencing chronic knee pain, Dr Nipper said.

“We estimate that this year alone more than 350,000 arthroscopies were performed.”

He listed the most common symptoms leading to surgery, which included a variation on the common osteoarthritis theme.

“The knee may be swollen. It locks or it gives way. It is stiff and, again, range of motion is limited,” he said.

He explained that arthroscopy can be performed in a physician’s office as outpatient surgery and that recovery is relatively quick.

“We make three incisions in the front of the knee, go in, remove loose debris and repair torn cartilage where necessary. Within days or weeks the patient is feeling much better and back to an active schedule again.”

The insertion of an artificial knee or total knee replacement is another option recommended for more severe forms of osteoarthritis.

Dr Nipper noted that the “new knees” are now made of ceramic and may last 20 to 25 years, where the “old knees” were made of chrome cobalt and lasted 20 years or less.

After arthroscopy and knee replacement, hip replacement is the most common form of surgical intervention, and artificial hips are an increasingly common option among older patients.

“The procedure has improved over time. Now the patient stays in the hospital three, maybe four days and is soon moved onto a walker and into physical therapy and rehab. We’ve got better anesthetics now, so you don’t have to wake up feeling like a zombie,” he added.

But there is a new, nonsurgical option on the horizon. Can you say viscosupplementation?

Replacing Joint Fluid

Dr Nipper then introduced his audience to a relatively new treatment option known as viscosupplementation, which he explained was exactly what it sounded like –– supplementing and replacing the diseased joint fluid with a synthetic fluid that has lubricating and cushioning qualities.

Viscosupplementation is accomplished using a product called Synvisc, which is an FDA-approved therapy that has already been administered in more than 1.6 million knees in the United States. The FDA is currently studying whether it can be used in the shoulder and hip.

“My group has adopted it and we find it is generally well tolerated. The series of three injections of Synvisc may be repeated after a period of six to 12 months, and patients notice an immediate improvement. They have better joint support and there is less pain. Function is improved,” Dr Nipper said.

The only constraint would be if the patient were allergic to poultry, he added, since Synvisc is a protein sequence or long molecular chain discovered in a substance taken from a chicken’s comb.

“It was first discovered in the 1970s by a Hungarian vet working at a racetrack,” he said.

“The insurance companies are covering the injections and there is no limit to their number, but you have to get preapproved,” he added.