Patient Education

What is Arthritis?

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage. Inflammation is the body’s natural response to injury. The warning signs that inflammation presents are redness, swelling, heat and pain.

The cartilage is a padding that absorbs stress. The proportion of cartilage damage and synovial inflammation varies with the type and stage of arthritis. Usually the pain early on is due to inflammation. In the later stages, when the cartilage is worn away, most of the pain comes from the mechanical friction of raw bones rubbing on each other.

What are the symptoms of Arthritis

There are more than 150 different forms of arthritis. Symptoms vary according to the form of arthritis. Each form affects the body differently. Arthritic symptoms generally include swelling and pain or tenderness in one or more joints for more than two weeks, redness or heat in a joint, limitation of motion of a joint, early morning stiffness, and skin changes, including rashes.

How can a doctor diagnose Arthritis?

Doctors diagnose arthritis with a medical history, physical exam and x-rays of the hip. There is no blood test for osteoarthritis.

What are the different types of Arthritis?

There are over 100 different types of rheumatic diseases. The most common are: Osteoarthritis. Also called degenerative joint disease, this is the most common type of arthritis, which occurs most often in older people. This disease affects cartilage, the tissue that cushions and protects the ends of bones in a joint. With osteoarthritis, the cartilage starts to wear away over time. In extreme cases, the cartilage can completely wear away, leaving nothing to protect the bones in a joint, causing bone-on-bone contact. Bones may also bulge, or stick out at the end of a joint, called a bone spur.

Osteoarthritis
Causes joint pain and can limit a person’s normal range of motion (the ability to freely move and bend a joint). When severe, the joint may lose all movement, causing a person to become disabled. Disability most often happens when the disease affects the spine, knees, and hips.
Rheumatoid Arthritis
This is an auto-immune disease in which the body’s immune system (the body’s way of fighting infection) attacks healthy joints, tissues, and organs. Occurring most often in women of childbearing age (15-44), this disease inflames the lining (or synovium) of joints. It can cause pain, stiffness, swelling, and loss of function in joints. When severe, rheumatoid arthritis can deform, or change, a joint. For example, the joints in a person’s finger can become deformed, causing the finger to bend or curve.Rheumatoid Arthritis affects mostly joints of the hands and feet and tends to be symmetrical. This means the disease affects the same joints on both sides of the body (like both hands or both feet) at the same time and with the same symptoms. No other form of arthritis is symmetrical. About two to three times as many women as men have this disease.
Fibromyalgia
This chronic disorder causes pain throughout the tissues that support and move the bones and joints. Pain, stiffness, and localized tender points occur in the muscles and tendons, particularly those of the neck, spine, shoulders, and hips. Fatigue and sleep disturbances may also occur.
Infectious arthritis
Arthritis can be caused by an infection, either bacterial or viral, such as Lyme disease. When this disease is caused by bacteria, early treatment with antibiotics can ease symptoms and cure the disease.
Reactive Arthritis
This is arthritis that develops after a person has an infection in the urinary tract, bowel, or other organs. People who have this disease often have eye problems, skin rashes, and mouth sores.
Psoriatic Arthritis
Some people who have psoriasis, a common skin problem that causes scaling and rashes, also have arthritis. This disease often affects the joints at the ends of the fingers and can cause changes in the fingernails and toenails. Sometimes the spine can also be affected.
Systemic Lupus Erythematosus
Also called lupus or SLE, this is an auto-immune disease. When a person has an auto-immune disease, the immune system attacks itself, killing healthy cells and tissue, rather than doing its job to protect the body from disease and infection. Lupus can inflame and damage a person’s joints, skin, kidneys, lungs, blood vessels, heart, and brain. African American women are three times more likely to get lupus than Caucasian women. It is also more common in Hispanic, Asian, and American Indian women.
Ankylosing Spondylitis
This disease most often affects the spine, causing pain and stiffness. It can also cause arthritis in the hips, shoulders, and knees. It affects mostly men in their late teenage and early adult years.
Juvenile rheumatoid arthritis
The most common type of arthritis in children, this disease causes pain, stiffness, swelling, and loss of function in the joints. A young person can also have rashes and fevers with this disease.
Polymyalgia Rheumatica
Because this disease involves tendons, muscles, ligaments, and tissues around the joint, symptoms often include pain, aching, and morning stiffness in the shoulders, hips, neck, and lower back. It is sometimes the first sign of giant cell arteritis, a disease of the arteries characterized by inflammation, weakness, weight loss, and fever.
Polymyositis
Causing inflammation and weakness in the muscles, this disease can affect the whole body and cause disability.
Psoriatic Arthritis
This form of arthritis occurs in some persons with psoriasis, a scaling skin disorder, affecting the joints at the ends of the fingers and toes. It can also cause changes in the fingernails and toenails. Back pain may occur if the spine is involved.
Bursitis
This condition involves inflammation of the bursa, small, fluid-filled sacs that help reduce friction between bones and other moving structures in the joints. The inflammation may result from arthritis in the joint or injury or infection of the bursa. Bursitis produces pain and tenderness and may limit the movement of nearby joints.
Tendinitis
Also called tendonitis, this condition refers to inflammation of tendons (tough cords of tissue that connect muscle to bone) caused by overuse, injury, or a rheumatic condition. Tendinitis produces pain and tenderness and may restrict movement of nearby joints.

What is Osteoarthritis?

According to the American Academy of Orthopedic Surgeons, nearly 15 million people suffer with Osteoarthritis (OA) of the knee. OA is the most common form of arthritis with pain and limited range of motion being the primary symptoms and it is the leading cause of disability worldwide.
OA is a degenerative joint disease characterized by the breakdown and eventual loss of joint cartilage. Cartilage is a protein substance that serves as a cushion between the bones of a joint. A normal knee glides smoothly because cartilage covers the ends of the bones that form the joints. With OA, the top layer of cartilage breaks down and wears away, allowing bones under the cartilage to rub together.
OA generally manifests itself in three progressive stages and most often begins in the inside, or medial compartment of the knee, but may begin in the outside, or lateral compartment (early-stage). Untreated, OA in one compartment may progress into a second compartment of the knee causing increased pain and reduced mobility (mid-stage). When the disease ultimately affects all three compartments of the knee (late-stage), pain is often severe and treatment is generally limited to total knee replacement, an invasive procedure which removes the natural knee joint and replaces it with an artificial joint.
Osteoarthritis is caused by the wearing out of the cartilage covering the bone ends in a joint. This may be due to excessive strain over prolonged periods of time, or due to other joint diseases, injury or deformity. Primary osteoarthritis is commonly associated with ageing and general degeneration of joints.
Secondary osteoarthritis is generally the consequence of another disease or condition, such as repeated trauma or surgery to the affected joint, or abnormal joint structures from birth.
Uric acid crystal build-up is the cause of gout and long-term crystal build-up in the joints may cause deformity.
Some people may have congenital abnormalities of the joints-for example, Perthes’ disease of the hips-that cause early degeneration and subsequently cause osteoarthritis.

Predisposing factors to Osteoarthritis of the hip

Some conditions may predispose the hip to osteoarthritis, It tends to affect people as they get older and particularly affects joints that have to take a lot of stresses and strains.
A previous fracture that involved the hip.
Growth abnormalities of the hip (such as a shallow socket) may lead to premature arthritis.
Some childhood hip problems later cause hip arthritis.*
Inactive lifestyle- Obesity (overweight).**
*For example, a type of childhood hip fracture known as a Slipped Epiphysis; also Legg- Perthe’s Disease
**Your weight is the single most important link between diet and arthritis, as being overweight puts an additional burden on your hips, knees, ankles and feet.

Predisposing factors to Osteoarthritis of the knee

Abnormalities of knee joint function resulting from fractures of the knee, torn cartilage and torn ligaments can lead to degeneration many years after the injury. The mechanical abnormality leads to excessive wear and tear – just like the out-of-balance tyre that wears out too soon on your car.

What you can do

Consult a doctor who will determine the type of arthritis you have.
Rest the joint until the pain subsides to prevent further inflammation.
To ease the pain or stiffness of the joint, apply heat.*
Take painkillers or anti-inflammatories, as recommended by your doctor.
If you are overweight, try to reduce weight to lighten the load on weight-bearing joints.
Participate in regular exercise.
*Apply heat on the joint for about 15 minutes once or twice a day using a hot water bottle, towel or an infrared lamp.

What your doctor can do for you

There is no cure for arthritis, so beware of ‘miracle cures’. Your doctor may prescribe anti-inflammatory medicine. They may recommend occupational therapy or physiotherapy, which includes exercises and heat treatment. In severe cases, surgery may be suggested, such as a hip or knee replacement. The type of surgery will depend on your age and severity of the disease. In the elderly with severe arthritis, joint replacement can give good results.

Treatment Options

Initial treatment for osteoarthritis of the hip or knee is conservative, consisting of rest, avoidance of vigorous weight bearing activities, and the use of non-narcotic analgesic and or anti inflammatory medications. With worsening symptoms a cane or a knee brace may be helpful. For more severe symptoms, an injection of cortisone into the joint is frequently advised and can be quite helpful. When conservative measures have been exhausted and are no longer helpful, and the arthritis has become disabling, surgery may be recommended.

Treatment of osteoarthritis focuses on decreasing pain and improving joint movement, and may include:

Exercises to keep joints flexible and improve muscle strength
Many different medications are used to control pain, including corticosteroids and NSAIDs.
Glucocorticoids injected into joints that are inflamed and not responsive to NSAIDS.
For mild pain without inflammation, acetaminophen may be used.
Heat/cold therapy for temporary pain relief
Joint protection to prevent strain or stress on painful joints
Surgery (sometimes) to relieve chronic pain in damaged joints
Weight control to prevent extra stress on weight-bearing joints

Does exercise really help those who have Arthritis?

Exercise is very important because it increases lubrication of the joints and strengthens the surrounding muscles, putting less stress on joints. Exercise in heated swimming pools-hydrotherapy-can bring enormous relief from pain and stiffness. Also studies have shown that exercise helps people with arthritis by reducing joint pain and stiffness and increasing flexibility, muscle strength and energy. It also helps with weight reduction and offers an improved sense of well-being.

Can special diets treat Arthritis?

But what if you have arthritis – are diet and nutrition still such a simple matter? Can what you eat cure your arthritis? Can food prevent it from occurring? Are there foods that can cause your arthritis to ‘flare’ or go into remission? What role do vitamins and nutritional supplements play in the treatment of arthritis? Will losing (or gaining) weight help ease your symptoms? Will taking powerful anti-arthritic medications affect your appetite or your ability to eat certain foods?
These are the sorts of questions that people with arthritis often ask, and they’re valid questions. Some questions “Can what you eat cure your arthritis?” have simple answers “No”. Some questions “Are there foods that can cause your arthritis to ‘flare’ or go into remission?” aren’t so straightforward. “Perhaps…”
Most of what you need to know about diet and nutrition is common sense; healthy eating is pretty much the same for anyone, whether you have arthritis or not. But there are exceptions.

Anterior Hip Replacement

Nearly 300,000 Americans undergo hip replacement surgery each year, followed by an extensive, activity-limiting recovery process. But not all hip surgeries are the same. Surgeons access the hip joint from the front, or anterior. Known as the “anterior approach,” the technique minimizes the pain and time from surgery to recovery. A wider range of patients—including larger, heavier patients—may be candidates for minimally invasive or anterior hip surgery. With the Anterior Approach to hip replacement, orthopedic surgeons use one small incision on the front of the hip. This technique allows the surgeon to work between the muscles and tissues without detaching them from either the hip or thighbones, sparing these tissues from trauma and a lengthy healing process. Keeping these muscles intact may also help prevent dislocations. Since the incision is in front, patients avoid the pain of sitting on the incision site.

Partial Knee Replacement

Osteoarthritis may affect all three sections of your knee—the femur (thigh bone), tibia (shin bone) and patella (knee cap). However, it may only affect one or two of these, in which case you may be an appropriate candidate for a partial knee replacement, in which only the damaged section of the knee is replaced. A minimally invasive alternative to total knee replacement, the partial knee involves fewer mechanical parts – leaving more natural knee in place.

What is the American Board of Orthopedic Surgery

The American Board of Orthopedic Surgery, Inc. was founded in 1934 as a private, voluntary, nonprofit, independent organization to serve the best interests of the public and the medical profession. These interests are achieved through the ABOS by establishing standards for the education of orthopedic surgeons. These standard are evaluated by the ABOS through examinations and practice evaluation.
The American Board of Orthopedic Surgery is one of twenty-four certifying boards that have met the educational and organizational requirements necessary for membership in the American Board of Medical Specialties. The Directors of the American Board of Orthopedic Surgery are distinguished orthopedic surgeons who are active in patient care, education and research.

Shoulder Joint Replacement

Although shoulder joint replacement is less common than knee or hip replacement, it is just as successful in relieving joint pain.

Shoulder replacement surgery was first performed in the United States in the 1950s to treat severe shoulder fractures. Over the years, shoulder joint replacement has come to be used for many other painful conditions of the shoulder, such as different forms of arthritis.

Today, about 53,000 people in the U.S. have shoulder replacement surgery each year, according to the Agency for Healthcare Research and Quality. This compares to more than 900,000 Americans a year who have knee and hip replacement surgery.

If nonsurgical treatments like medications and activity changes are no longer helpful for relieving pain, you may want to consider shoulder joint replacement surgery. Joint replacement surgery is a safe and effective procedure to relieve pain and help you resume everyday activities.

Whether you have just begun exploring treatment options or have already decided to have shoulder joint replacement surgery, this article will help you understand more about this valuable procedure.

Anatomy
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The shoulder is a ball-and-socket joint: The ball, or head, of your upper arm bone fits into a shallow socket in your shoulder blade. This socket is called the glenoid.

The surfaces of the bones where they touch are covered with articular cartilage, a smooth substance that protects the bones and enables them to move easily. A thin, smooth tissue called synovial membrane covers all remaining surfaces inside the shoulder joint. In a healthy shoulder, this membrane makes a small amount of fluid that lubricates the cartilage and eliminates almost any friction in your shoulder.

The muscles and tendons that surround the shoulder provide stability and support.

All of these structures allow the shoulder to rotate through a greater range of motion than any other joint in the body.

Cause
Several conditions can cause shoulder pain and disability, and lead patients to consider shoulder joint replacement surgery.

Osteoarthritis (Degenerative Joint Disease)
This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the shoulder softens and wears away. The bones then rub against one another. Over time, the shoulder joint slowly becomes stiff and painful.

Unfortunately, there is no way to prevent the development of osteoarthritis. It is a common reason people have shoulder replacement surgery.

Rheumatoid Arthritis
This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened. This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.”

Post-traumatic Arthritis
This can follow a serious shoulder injury. Fractures of the bones that make up the shoulder or tears of the shoulder tendons or ligaments may damage the articular cartilage over time. This causes shoulder pain and limits shoulder function.

Rotator Cuff Tear Arthropathy
A patient with a very large, long-standing rotator cuff tear may develop cuff tear arthropathy. In this condition, the changes in the shoulder joint due to the rotator cuff tear may lead to arthritis and destruction of the joint cartilage.

Avascular Necrosis (Osteonecrosis)
Avascular necrosis is a painful condition that occurs when the blood supply to the bone is disrupted. Because bone cells die without a blood supply, osteonecrosis can ultimately cause destruction of the shoulder joint and lead to arthritis. Chronic steroid use, deep sea diving, severe fracture of the shoulder, sickle cell disease, and heavy alcohol use are risk factors for avascular necrosis.

Severe Fractures
A severe fracture of the shoulder is another common reason people have shoulder replacements. When the head of the upper arm bone is shattered, it may be very difficult for a doctor to put the pieces of bone back in place. In addition, the blood supply to the bone pieces can be interrupted. In this case, a surgeon may recommend a shoulder replacement. Older patients with osteoporosis are most at risk for severe shoulder fractures.

Failed Previous Shoulder Replacement Surgery
Although uncommon, some shoulder replacements fail, most often because of implant loosening, wear, infection, and dislocation. When this occurs, a second joint replacement surgery — called a revision surgery — may be necessary.

Is Shoulder Joint Replacement for You?
The decision to have shoulder replacement surgery should be a cooperative one between you, your family, your family physician, and your orthopaedic surgeon.

There are several reasons why your doctor may recommend shoulder replacement surgery. People who benefit from surgery often have:

Severe shoulder pain that interferes with everyday activities, such as reaching into a cabinet, dressing, toileting, and washing.
Moderate to severe pain while resting. This pain may be severe enough to prevent a good night’s sleep.
Loss of motion and/or weakness in the shoulder.
Failure to substantially improve with other treatments such as anti-inflammatory medications, cortisone injections, or physical therapy.

Orthopaedic Evaluation
Your family physician may refer you to an orthopaedic surgeon for a thorough evaluation to determine if you can benefit from this surgery.

An evaluation with an orthopaedic surgeon consists of several components:

Medical History
Your orthopaedic surgeon will gather information about your general health and ask you about the extent of your shoulder pain and your ability to function.

A Physical Examination
This will assess shoulder motion, stability, and strength.

X-rays.
These images help to determine the extent of damage in your shoulder. They can show loss of the normal joint space between bones, flattening or irregularity in the shape of the bone, bone spurs, and loose pieces of cartilage or bone that may be floating inside the joint.

Other Tests.
Occasionally blood tests, a magnetic resonance imaging (MRI) scan, or a bone scan may be needed to determine the condition of the bone and soft tissues of your shoulder.

Shoulder Replacement Options

In shoulder replacement surgery, the damaged parts of the shoulder are removed and replaced with artificial components, called a prosthesis. The treatment options are either replacement of just the head of the humerus bone (ball), or replacement of both the ball and the socket (glenoid).

Shoulder Replacement Options:

Anatomic Total Shoulder Replacement

The typical total shoulder replacement involves replacing the arthritic joint surfaces with a highly polished metal ball attached to a stem, and a plastic socket.

These components come in various sizes. They may be either cemented or “press fit” into the bone. If the bone is of good quality, your surgeon may choose to use a non-cemented (press-fit) humeral component. If the bone is soft, the humeral component may be implanted with bone cement. In most cases, an all-plastic glenoid (socket) component is implanted with bone cement.

Implantation of a glenoid component is not advised if:

The glenoid has good cartilage
The glenoid bone is severely deficient
The rotator cuff tendons are irreparably torn

Patients with bone-on-bone osteoarthritis and intact rotator cuff tendons are generally good candidates for conventional total shoulder replacement.

Reverse Total Shoulder Replacement

A conventional shoulder replacement device mimics the normal anatomy of the shoulder: a plastic “cup” is fitted into the shoulder socket (glenoid), and a metal “ball” is attached to the top of the upper arm bone (humerus). In a reverse total shoulder replacement, the socket and metal ball are switched. The metal ball is fixed to the socket and the plastic cup is fixed to the upper end of the humerus.

A reverse total shoulder replacement works better for people with cuff tear arthropathy because it relies on different muscles to move the arm. In a healthy shoulder, the rotator cuff muscles help position and power the arm during range of motion. A conventional replacement device also uses the rotator cuff muscles to function properly. In a patient with a large rotator cuff tear and cuff tear arthropathy, these muscles no longer function. The reverse total shoulder replacement relies on the deltoid muscle, instead of the rotator cuff, to power and position the arm.

Reverse total shoulder replacement may be recommended if you have:

A completely torn rotator cuff that cannot be repaired
Cuff tear arthropathy
A previous shoulder replacement that was unsuccessful
Severe shoulder pain and difficulty lifting your arm away from your side or over your head
Tried other treatments, such as rest, medications, cortisone injections, and physical therapy, that have not relieved shoulder pain

Stemmed Hemiarthroplasty

Depending on the condition of your shoulder, your surgeon may replace only the ball. This procedure is called a hemiarthroplasty. In a traditional hemiarthroplasty, the head of the humerus is replaced with a metal ball and stem, similar to the component used in a total shoulder replacement. This is called a stemmed hemiarthroplasty.

Some surgeons recommend hemiarthroplasty when the humeral head is severely fractured but the socket is normal. Other indications for a hemiarthroplasty include:

Arthritis that only involves the head of the humerus with a glenoid that has a healthy and intact cartilage surface
Shoulders with severely weakened bone in the glenoid
Some shoulders with severely torn rotator cuff tendons and arthritis

Sometimes, surgeons make the decision between a total shoulder replacement and a hemiarthroplasty in the operating room at the time of the surgery.

Studies show that patients with osteoarthritis get better pain relief from total shoulder arthroplasty than from hemiarthroplasty.

Summary

From learning about the importance of exercising regularly to fully understanding your arthritis medications, the information contained in this section is meant to provide you with insights, information and tips that can be used by you to help make living with arthritis a little bit more manageable.

For people with arthritis, learning to make it part of your life can be difficult. But learning as much as you can about your particular type of arthritis and actively working with your arthritis treatment team are two very effective ways of regaining control over your life. There is plenty of information, some specific to arthritis and some not, that can be very helpful to someone facing the challenges associated with having a chronic or lifelong disease.

Our suggestion is – don’t let arthritis beat you. Take control. How? Arm yourself with as much information as possible. Learn from the experiences of others in similar circumstances. What we’re presenting here is a virtual toolbox of tips for living well with arthritis. Some may work for you one day and not the other. Some may work for you but not others. That’s why we’ve tried to cover several topics. There are plenty of tools or tips here. Use them or refer to them when you need them. Call upon them when you require help.

Helpful Links

Informational Whitepapers - Hip

Informational Whitepapers - Knee

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