Dealing with Arthritis: Do You Need Joint Replacement?

One in three Rhode Islanders over the age of 65 has arthritis. Osteoarthritis (the most common form of the disease) is also one of the main reasons why many patients seek total joint replacement surgery. In fact, the number of Baby Boomers (particularly women) who are seeking this surgery continues to grow with the desire to lead and active (and pain-free) life. According to experts at the Miriam Hospital, approximately 1/3 of replacements are done in individuals between the ages of 45-63, and 4.5 million Americans currently live with total knee replacement in at least one knee. GoLocalProv spoke with two orthopedic surgeons at Miriam’s Total Joint Center--Gary Ferguson, MD, clinical director, and John Froehlich, MD, program director, about this pervasive disease and when someone should consider surgery.

Who suffers the most from arthritis?

Ferguson: about 14% of the population over age 25 suffers from arthritis, with about 34% over 65 also afflicted. This means that about 27 million Americans over age 65 are affected by arthritis. Data specific to the state of Rhode Island is not as complete, but there is no reason to suspect that Rhode Islanders, given how our lifestyle and general health status compares to the nation, should be much different. Therefore about one out of three Rhode Islanders over age 65 is likely affected. In those of us under age 55, it affects women and men equally. If over age 55, the condition affects women more frequently.

Froehlich: Since we all are living longer, the likelihood that we may suffer from some of the effects of arthritis is greater than in past generations. Trauma to a joint (fracture, cartilage injury, ligament tears) also can predispose to arthritis. Some medical conditions and their treatment can also result in later arthritis formation.

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What are the differences between rheumatoid and osteoarthritis, in terms of who suffers, and at what age?

Ferguson: Rheumatoid arthritis is a special form with strong features of an autoimmune condition. This means that the body's immune system is not in balance, and in particular, a more aggressive form of cartilage destruction is present, driven by this imbalance. Osteoarthritis also involves cartilage destruction, but is slower to develop, has strong features related to both aging and mechanical wear and tear. Osteoarthritis is far more common than rheumatoid arthritis. In either condition, the wearing away or destruction of cartilage is the common feature. Rheumatoid arthritis most commonly affects middle-aged women, but men can also be affected. There is a special even less common juvenile form that can affect very young adults and even young children, and is typically very aggressive.

As for osteoarthritis, what is the course of therapy? And at what point is a joint replacement necessary?

Froehlich: Unfortunately, we currently have no cure for arthritis; most treatments help lessen the effects of arthritis (pain, stiffness, etc.). These early treatments include Tylenol or over the counter anti-inflammatory medicines, icing if there is swelling, and frequently physical therapy to improve joint mobility. Prescription medications are also frequently used but must be monitored to avoid side effects. Cortisone shots also are very effective but again can only be done at certain intervals. Lubricant shots in the knee also have been shown to be helpful in reducing the effects of arthritis on the joint. When these treatments become less effective, then consultation with your orthopedic surgeon may be indicated to consider replacement options.

Ferguson: For every patient, the decision to have a joint replacement is always customized together with the surgeon. Every patient and surgeon will vary, but there are probably three essential features that provide a useful guide. First, joint replacement might be considered if a persistent trial of therapy without surgery has proven inadequate. Second, x-ray studies of the joint would demonstrate typical, more advanced arthritis. Third, from the patient's point of view, the condition has become unmanageable or difficult to manage. With these three things in place, any patient should feel confident at least considering joint replacement surgery.

What are the risks of joint replacement?

Froehlich: Joint replacement surgery is generally very successful with good to excellent results in the range of 90-95%. Risks of surgery do exist and the help and cooperation of the patient's primary care physician can help to lessen some of the risks. Some of the major risks include blood loss, infection and blood clots. At the Total Joint Center at The Miriam Hospital, we have many programs and processes in place to lessen these and other risks. As patients are having replacements at a younger age and also living longer, we must also consider loosening and wear of the replacement parts, which may necessitate revision surgery (the need to redo the replacement) in the future.

How does a person decide when it's time to take surgical versus therapeutic action for osteoarthritis?

Ferguson: As we mention, treatment without surgery is almost always the best place to start. When it becomes clear to both the patient and the surgeon that nonsurgical treatment is no longer helping, an x-ray confirms advanced arthritis, and the condition has become relatively unmanageable, replacement surgery is very appropriate.

Froehlich: When pain becomes more persistent and mobility becomes more impaired, then replacement surgery should be more seriously considered. We do know that patients who maintain an active, healthy lifestyle tend to tolerate the effects of arthritis better. As such, maintaining one's overall health is important, including appropriate weight/diet and some regular exercise.

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