Early Arthritis Services
Not all patients with arthritis need a joint replacement. Most of the patient with arthritis can fall in this category and may not need a replacement until absolutely necessary. Other modalities of treatment may benefit, either non-operative or operative.
- Regular analgesics and anti-inflammatories is the first thing to consider for relieving arthritis pain.
- Physiotherapy: Regular exercises and keeping the muscles strong and fit with specific physiotherapy regimes help control the pain and avoid the joints getting stiff.
- Joint Injections: The next step in managing joint pain in arthritis would be joint injections. These can be either a combination of Local anesthetic and steroids or can be Hyaluronic Acid. Steroids act by reducing the inflammation in the joint and thus reducing pain. The effect can last from a few days to few months. Thus it’s a temporary measure for controlling pain and multiple injections are not advisable. In arthritis, because of loss of cartilage and smoothness, the body generates more synovial fluid (natural lubricant) for better joint function. This excess synovial fluid causes joint swelling and effusion and adds to the pain. Similar to natural lubricant, Hyaluronic acid injections contain synthetic lubricant, which helps with joint function and avoids the swelling and effusion.
- Arthroscopy (Keyhole Operation): It is a procedure where through a small incision, a camera and instruments are passes in the joint and procedure carried out. Although there is a limited role for arthroscopy in arthritis, it may be beneficial for pain due to degenerative meniscal tears, inflammation, loose bodies, etc. As it’s a low risk and a day case procedure, it’s worth trying depending on your symptoms. I will guide you further on this on your visit.
- Realignment Osteotomies: One of the reasons of progression of arthritis is the malalignment in the lower extremity weight-bearing axis, which puts unequal load distribution across a joint. In realignment osteotomies, a bone is surgically broken and realigned and fixed in a proper alignment in view to stop the progression of arthritis and treat the pain and deformity.
Realignment osteotomies for Knee Arthritis
High Tibial Osteotomy (HTO): HTO is a surgical procedure to realign the leg and reduce the pain you have from your knee by transferring the body weight to the preserved normal outer side of the knee.
HTO does not return the knee to normal. Instead it prolongs the life of a damaged knee, helps relieve pain in the knee and delays the need for a total knee replacement.
When standing, your weight should be evenly distributed from your hip, through your knee to the centre of your ankle, to result in even contact with the ground. In arthritis, you may notice that your leg are getting bowed, and hence the weight is getting transferred through the inside part of your knee and accelerating arthritis. In HTO, the leg bone (Tibia) is surgically broken, realigned and fixed so that the weight passes through the non-arthritic area in the knee.
Realignment osteotomies for Hip Arthritis
Periacetabular Osteotomy: Realignment osteotomies for hip arthritis are usually reserved for early cases with dysplastic hip (where the socket is underdeveloped or shallow causing uneven stresses across the hip joint resulting in arthritis). In these cases the pelvis is surgically broken at three places so that the socket becomes free. The socket is then reoriented and fixed in a way that femoral head coverage is increased. This is called as Periacetabular O steotomy or Ganz Osteotomy.
Joint Replacements in Early Arthritis and Young Patients
Most of the above mentioned treatment modalities are often tried before making a decision to proceed with joint replacement.
Historically, joint replacements were avoided in young patients because of their longevity and need for further revisions down the line.
But with modern prosthetic materials, better understanding of the biomechanics, improved instrumentation and innovative technologies; joint replacement surgeries can be done even at young age.
Things to consider while opting for joint replacement in young patients:
- Uncemented vs Cemented Implant fixation
- Bearing Surfaces
- Approach
- Approach
- Patient physical demands
Visit me for a more detailed discussion of your condition.
My Experience with Young Patient Arthritis Services:
In my training years in Ireland and UK, I got the opportunity to be a part of “Young Adult Arthritis Clinic”. These were specialized clinics led by 2-3 consultants each expert in either Arthroplasty or Paediatric orthopaedics. The patient were mostly having secondary arthritis due to paediatric conditions like Slipped Capital Femoral Epiphyses, Developmental Dysplasia of the Hip, Perthe’s Disease, post traumatic Etc.
The youngest patient that I have been a part of is 15 yrs old needing Hip replacement for failed SUFE.
I am well aware of the difficulties involved and the decision-making factors in these tricky cases.
