Nearly one in three adults suffers from the swollen, stiff and painful joints of arthritis. Arthritis is the most common chronic ailment among the elderly, although it can affect people of any age, including children.
There are over 100 different types of arthritic diseases. The most common is osteoarthritis, a degenerative joint disease in which the cartilage protecting the bone ends wears away. Rheumatoid arthritis is a chronic condition in which the body's own immune system attacks the joint lining.
Treatment typically involves a combination of anti-inflammatory medication and devices to relieve stress on the joint (canes, crutches or splints). Regular exercise, weight loss for overweight patients, and cortisone injections may also be helpful. In severe cases, orthopaedic surgery such as joint replacement may be the only way to improve or restore function and relieve pain.
Rheumatoid arthritis (RA), a type of inflammatory arthritis, is a chronic condition in which the body's own immune system attacks the joint lining, causing it to swell. This autoimmune disorder can cause pain even when the joints are not being moved. RA is the most common inflammatory arthritis affecting the hips and knees. Because of the systemic nature of the disease, it tends to affect joints on both sides of the body at the same time; if you have RA in one knee, you are likely to have it in the other.
Our joints contain small, slippery sacs called bursae that help muscles and tendons slide smoothly over our bones. Bursitis is the inflammation (swelling) of one of these sacs. Overuse or constant pressure on the knee causes the bursa to fill with fluid. It then becomes irritated, gritty and rough, and can create friction in other parts of the joint as it swells.
Two common sites for bursitis in the knee are the kneecap (prepatellar bursitis) and the pes anserine ("goosefoot") bursa, located about two inches below the knee where the shinbone meets three tendons from the hamstrings. Pes anserine bursitis often afflicts runners and other athletes as well as people with osteoarthritis ("wear and tear" arthritis), tight hamstrings, obesity, or turned-out knees or lower legs. Symptoms include pain on the inside of the knee or at the top of the shinbone that gets worse with exercise or stair-climbing. Prepatellar bursitis tends to occur in people whose jobs involve long periods of kneeling, who play sports that frequently involve falling or being struck on the knee, who have been in a car accident, or who have rheumatoid arthritis or gout. Symptoms include pain after activity and swelling and tenderness on the kneecap.
A hip fracture involves a break in the top of the femur when the bone angles toward the hip joint. Hip fractures are especially common in older patients and those with osteoporosis. They are usually extremely painful and require surgical repair to relieve pain and restore proper functioning.
During hip fracture surgery, an incision is made over the affected area and the bones are aligned back in place. The bones are often held in place with metal pins, screws, rods or plates while they heal, which may or may not be removed later on. The incision is then closed with sutures or staples. This procedure usually takes two to four hours to perform.
Hip arthroscopy is a minimally invasive procedure used to diagnose and treat a wide range of conditions affecting the hip joint. This procedure can be used to confirm the diagnosis of various imaging procedures, such as X-rays and MRIs, as it provides your doctor with a three-dimensional, real time imaging of the affected area, allowing for the most accurate diagnostic results. If damage or abnormalities are detected during the diagnostic procedure, repairs can often be made during the same procedure, offering patients many advantages over traditional surgery.
Arthroscopic techniques can often be used to treat conditions such as:
During the hip arthroscopy procedure, your surgeon will make a small incision near the affected area of the hip and insert an arthroscope, a long flexible tube with a camera on the end that displays images of the inside of the hip joint to detect any damage. If damage is detected, it can be repaired during the same procedure by inserting surgical instruments through a few other incisions. Your surgeon can replace damaged cartilage, join together torn ends, remove loose bodies or realign the joint to minimize pain and inflammation.
Hip replacement is usually a last resort treatment for patients with severe hip pain whose daily lives are affected by the pain, including those with arthritis, fractures, bone death or other conditions. In this procedure, the diseased bone and cartilage are replaced with a metal ball and plastic cup.
The artificial joint, called a prosthesis, may be cemented in place, may be cementless, or may be a hybrid of both. The prosthetic devices provide pain relief and restored function for 25 years or longer in most cases.
Most patients who undergo hip surgery achieve successful relief from their condition, including pain relief, restored function and an improvement to their overall quality of life. There are certain risks associated with hip procedures, including infection, nerve damage, blood clots and reactions to anesthesia, but these risks are considered rare and can be further reduced by choosing an experienced and skilled surgeon.
Your doctor will decide which procedure is best for you based on a thorough evaluation of your condition and medical history. It is important to discuss the details of your procedure with your doctor in order to achieve the best results.