Arthritis is the most prevalent long-term health condition in Canada, impacting about six million people. It can affect people of all ages, but the incidence increases with age.
In this blog I am going to share my personal observations on current osteoarthritis treatment trends as examined from a physiotherapy/chiropractic perspective.
Disclaimer: I am not a surgeon and by no means attempting to persuade anyone towards or away from surgery. My role is to help patients prevent joint damage, manage symptoms caused by osteoarthritis, and recover from surgery if required.
Firstly, let’s educate ourselves on the topic … What is Osteoarthritis?
Osteoarthritis is a type of arthritis (joint inflammation) that affects the whole joint, particularly the deterioration of the articular cartilage (the cartilage that lines the ends of the bone). Although there is currently no way to regenerate this cartilage once it deteriorates, there are ways to keep your joints healthy and manage the condition, thus enjoy a better quality of life.
Osteoarthritis can affect any synovial joint in the body (joints with capsule containing synovial fluid). It can affect the small joints of the hands or feet, the large hip or knee joints, the shoulder or spine. It can even affect the jaw (temporomandibular joint or TMJ).
Other Types of Arthritis
There are various other types of arthritis such as rheumatoid, psoriatic, polymyalgia rheumatica etc. These are inflammatory or autoimmune conditions which would be treated under management of a rheumatologist with immunosuppressant medication, along with physical therapy when needed.
Treatment of Osteoarthritis
The key components for management of mild to moderate osteoarthritis are exercise, education, and weight loss.
Early management of osteoarthritis is ideal. Treatment can include various modalities, such as ice, ultrasound, current and gentle exercise. Long-term management involves keeping our muscles (shock absorbers) strong, preserving range of motion, and maintaining a normal gait pattern and alignment. Educating yourself and refraining from activities that are hard on joints is also key to minimizing injury.
For more advanced osteoarthritis, surgery may be necessary.
Now let’s talk about current osteoarthritis treatment trends …
Joint Preservation Surgery
When Needed: Joint preservation is a surgical option for younger people if conservative measures (ie. physiotherapy) have failed. Since joint replacements have a given lifespan, they are not the ideal choice in a young individual.
What is it: This form of surgery delays or prevents the onset of arthritis in some congenital conditions or off-loads the pressure on the area of the joint that has arthritis to an area that has not been affected by osteoarthritis. For the younger population joint preservation is advisable to preserve as much as possible of the patient’s own joint.
Developments over time: Early in my career some of these procedures were not always successful, but with computers, MRI, bone fixation and better understanding of joints and biomechanics the outcomes are better. A good post-operative rehabilitation routine will ensure optimum recovery.
Arthroscopic Surgery with Osteoarthritis
What is arthroscopic surgery: This is a type of surgery that involves the use of fiber-optics, only two small incisions (pin holes) and one drain. It does not involve opening the joint.
When needed: This procedure for the hip and knee is most successful for meniscus and ligament repairs in the younger population with no underlying arthritis.
Studies have shown arthroscopic debridement (tidy up of knees or hips) does not produce any overall benefit in an older person with underlying arthritis. For the older population, evidence to date supports exercise, education, and weight loss as best practice.
Developments over time: The GLA:D program (Good Life with Arthritis in Denmark) developed in Demark, has extremely positive results. It is a standardized active program for hips and knees. I have been instructing this program since it launched in Canada in 2017 and patients at varying levels of fitness have found it to be highly beneficial to managing their condition.
Total Hip Replacement (THR)
What is a THR: This involves replacement of the femoral head and acetabular components of the hip joint (both joint surfaces).
When needed: If there is significant osteoarthritis to the joint that results in consistent pain, loss of range, ability to walk and general enjoyment of life.
Developments over time: The surgical procedure recently introduced for THR is the anterior approach (incision over the front of the hip joint). This approach has no limitations after surgery, although it is not suitable in certain cases.
The lateral surgical approach (outside aspect of the hip) is still utilized but has some restrictions post-surgery, as there is risk of hip dislocation for the first few weeks. Therefore, no hip abduction is allowed (actively moving the leg to the side), and you cannot bend the hip past 90 degrees (thus requiring raised toilet seat etc.).
With the change in surgical technique there is also a change in how I rehabilitate the patient. With the lateral approach there is aways more weakness to the hip abductors (lifting leg to the side). I am finding as I see more patients after the anterior approach, they are weaker on hip flexion (lifting the leg forwards for example performing stairs).
Total Knee Replacement (TKR)
What is it: TKR involves the replacement of the femoral, tibial and possibly the patella (all joint surfaces).
When needed: Similar to the THR.
Developments over time: The knee is “architecturally” a more difficult joint to perform replacement on. Compared with the hip joint that is a ball and socket, the knee is a hinge joint, with the patella (kneecap). Fortunately, with MRI and computer calculation the angles needed to correct alignment outcomes are much better.
Shoulder and Ankle Surgery
Shoulder replacement surgery is performed when there are no other options. It is a difficult surgery as the shoulder is an unstable joint that has 180 degrees of movement relying significantly on the soft tissues for stability. The outcome from surgery became significantly better with “reverse shoulder replacement”.
I have seen a few ankle replacements but this surgery is rare. Due to the joint configuration, ankle replacements are not always successful. The ankle is a very tight joint, it is difficult to access, and correct angulation of the prothesis is difficult. Joint fusion is sometimes the only option in a severely arthritic ankle.
What We Offer at Our Clinic
- Treatment of pain and functional limitations of all types of arthritis in the acute or subacute phase
- Pre- and post-rehabilitation before or after any surgical procedure which was the result of arthritis
- GLA:D (Good Life with Arthritis in Demark) now in Canada, is a standardized active program focusing on osteoarthritis in the hip or knee.
Do you have questions about osteoarthritis?
Please send any questions you may have about osteoarthritis to Margaret Russell at email@example.com.
If you prefer to speak with us directly, feel free to call us weekdays between 9 a.m. – 6 p.m. at (416) 481-6100