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Treatments for Osteoarthtitis18th April 2018
It has been estimated that the number of people in the UK with osteoarthritis is around 8.75 million with almost half that figure suffering from knee OA. This means that a third of the population aged 45 and older have sought treatment for their condition.
Osteoarthritis is a degenerative condition affecting the soft tissue (cartilage) which surrounds and protects the articular surface of the bones in our joints. This connective tissue acts a cushion between the bones which move together to allow movement in our joints.
As we age the normal wear and tear on our joints can gradually reduce the thickness of the cartilage. Injuries earlier in life can speed the onset of the condition.
As the protection wears away the bones begin to rub together when the joint is used. Common symptoms are pain, swelling, stiffness (especially in the morning) and a grinding sensation in the joint.
Fortunately for sufferers of osteoarthritis more and more information is becoming available online about the condition and various ways to ease the symptoms. While there is no cure for OA currently research continues and helps provides sufferers with various approaches to reducing their symptoms.
A great source of information are the guidelines on health and care published by The National Institute for Health and Care Excellence (NICE).Established in 1999 as an independent organisation responsible offering for guidance on health and care. The NICE guidelines provide an extensive source of information to guide and advise patients on the management of specific conditions.
Using the guidelines from NICE (National Institute for Health and Care Excellence) the types of treatment can be classified under 4 categories.
- Self-Management: advice offered by your doctor after diagnosis of OA. These treatments encourage patients to modify their lifestyle to assist in the management of their symptoms and can cover physiotherapy and fitness to diet and weight management.
- Pharmacological management: advice on various pain management using over-the-counter and prescription painkillers and topical creams NSAIDS or intra-articular injections of corticosteroids or hyaluronic acid (Viscosupplementation).
- Non-Pharmacological management: advising on assistive devices, braces, sleeves and shoe supports
- Surgical management: – advice on the surgical options available to partially repair or replace the affected joint.
When first diagnosed our doctor will evaluate general health, fitness and lifestyle and then offer appropriate options that we can apply ourselves to manage the condition and slow its progress.
Initial advice should focus on exercise and activities. Doctors will often recommend physiotherapy as an ongoing treatment to pursue. Unfortunately, there are no clear guidelines on when the NHS should provide this healthcare, however doctors will encourage OA sufferers to pursue this option themselves.
Physiotherapy promotes general aerobic fitness which helps to address factors like weight which can increase if OA pain starts to limit activity. Increased body weight adds to the stresses our joints experience.
Physiotherapy also increases the strength of the muscles holding and supporting the joint. A stable joint can slow the deterioration of OA.
Increasingly research is showing that offloading knee braces are proving a very effective means of both reducing knee pain and reducing cartilage wear, which can delay the need for surgical intervention.
“Offloading” braces address unicompartmental OA. The cushioning layers of cartilage within the knee may have worn down prematurely or been damaged on either the inside or outside of the joint. Alternatively, one of the shock absorbing discs of cartilage in the knee (menisci) may have thinned or been damaged.
An offloading knee brace applies gentle pressure across the knee at three points which helps spread the load more evenly over the joint and reduce the load on the affected compartment. This also reduces the amount of bone on bone contact on the affected/damaged compartment.
The same offloading principles are now being applied to address OA in the hip.
Arthrodesis is the name of the process of fusing together the two bones within a joint. This option is to relieve pain in joint which cannot be managed. The procedure can be applied to -
As well as reducing pain the procedure may also aid joint stability.
Total Knee Replacement
Once a joint has reach the point where the treatments listed are no longer working then surgery would then be considered. Unfortunately pain and stiffness may still be experienced.
The hips and knees are the most common joints replaced. Joint replacement surgery is called Arthroplasty. This is an operation to remove the affected joint and replace it with an artificial one (prosthesis made of metal and special plastics)
Replacement surgeries generally last 10 years before a revision (another replacement) is required. As a rule, there is a limit to the number of revisions that can be done making surgery a last option. Surgeons will try to avoid beginning this process for as long as possible.
It is a common misconception that little can be done with the onset of osteoarthritis but advice from your doctor will advise you of the best options and decide with you on the best course of treatment to follow. With an early diagnosis steps can be taken early to minimise the effects of OA and keep our joints in good working order for years to come.