Treating Arthritis

All of us are born with healthy cartilage. In some, however, the mixture of injury, aging, and genetics can lead to cartilage breakdown over time. Arthritis is essentially damaged cartilage. Cartilage is the smooth, glistening cushion between bones. For most, arthritis is a wear and tear process of degeneration, and follows a gradual pattern of worsening pain. The pain is caused by erosion of the bony cushions. As this smooth surface of cushion deteriorates, the ends of the bone become roughened and irregular. The joint becomes stiff, grinding, and inflammed. Bone rubs on bone, and that causes severe pain.

The spectrum of arthritis ranges from the occasional aches and pains to its most severe forms with unremitting pain and compromised mobility. In the beginning, patients have more good than bad days. As the disease progresses, the bad days begin to outnumber the good. Unfortunately, once damaged, cartilage cannot repair itself. The diagnosis of arthritis is made most accurately with x-rays. As only bone shows on x-rays, the doctor can determine the health of the cartilage by examining the space between the bones. End stage arthritis is typically bone-on-bone.

The discomfort of the degenerative process commonly begins to creep into a person’s life in their latter years and may thereafter reduce the quality of life. Fortunately, modern medicine now offers several regimens for the relief of joint pain. The majority of patients with mild symptoms are effectively treated with a conservative regimen of lifestyle changes, physical therapy, injections and anti-inflammatories.

The management of advanced arthritis, however, requires a more aggressive approach. Over time, a subset of patients will continue to suffer from pain and worsening of disease despite even the most effective medical management. These patients may instead achieve a dramatic improvement in symptoms through surgical means. The task of the health care team is to match the optimal procedure to the patient. Just as each patient is unique, so is their disease process, and it is therefore essential to tailor surgical treatment to the individual.

Joint replacement is perhaps among the most significant medical advances in the past 50 years. In the end stages of extensive arthritis, surgery offers the hope of dramatic pain relief and restored function. Mobility and independence are regained. After successful surgery, we expect patients to resume an active life of walking, recreation, work and travel.

We have embraced new technology to speed recovery and improve precision. Surgical navigation and modern tools allow us to work around muscles and tendons, rather than cutting through them. We have identified and use optimal mechanical designs, bearing materials, and fixation strategies. As our patients are living longer and longer, we expect our joint replacements to last longer. Improved material technology allows us to use gender-appropriate sizing when needed.

Pain management with new medicines is excellent. Surgery these days is less painful and less frightening. Routine patients no longer require general anesthesia or ventilator assistance. Strict attention to postoperative pain management protocols have been a major success. With oral premedication, pain fibers are blocked before they can be activated. Regional nerve blocks provide safe and thorough analgesia both intraoperatively and postoperatively. Preoperative education classes not only prepare the patient and family for surgery and recovery, but also demystify the complexities of knee replacement.

Perioperative Care
Perhaps the greatest concerns among patients surrounding surgery are fears related to anesthesia and recovery. In our hands, surgery is a very safe procedure. Preoperatively, our team of Internists and Critical Care Physicians will perform a thorough evaluation of your health to optimize your medical condition. Our Anesthesia Physicians have pioneered safe and predictable methods used nationally to minimize blood loss and postoperative discomfort.

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