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Osteoarthritis

Although Osteoarthritis occurs in people of all ages, most common in elderly.

Although Osteoarthritis (OA) occurs in people of all ages, osteoarthritis is most common in people older than 65. Common risk factors include increasing age, obesity, previous joint injury, overuse of the joint, weak thigh muscles, and genes. One in two adults will develop symptoms of knee OA during their lives. One in four adults will develop symptoms of hip OA by age 85. One in 12 people 60 years or older have hand osteoarthritis.

Some management principles are “OLD BUT GOLD”. According to Obesity and increased burden of hip and knee joint disease in Australia: Results from a national survey, odds of OA was up to 7 times higher for obese individuals, compared with those classified as underweight/normal weight. Concurrent obesity and joint disease had a marked impact on several key aspects of wellbeing. Every pound of weight lost resulted in a fourfold reduction in the load exerted on the knee per step during daily activities.

Exercise and thigh and hamstring muscle strengthening has shown to have 25-47% reduction in OA progression according to the American Orthopedic Association. And a recent double-blind controlled study in Europe showed that exercise bike 5mins twice a day has 10 times more pain relief at one year than glucosamine.

Then there are some “MYTHS”. Glucosamine and chondroitin sulfate, substances found naturally in joint cartilage, can be taken as dietary supplements. Although patient reports indicate that these supplements may relieve pain, according to the American Orthopedic Association (AOA) there is no evidence to support the use of glucosamine and chondroitin sulfate to decrease or reverse the progression of arthritis. In addition, the U.S. Food and Drug Administration does not test dietary supplements before they are sold to consumers. These compounds may cause side effects, as well as negative interactions with other medications. AOA also recommends consulting your doctor before taking dietary supplements.

Platelet rich plasma (PRP) – “FACT OR FICTION” In the author’s own study in a group of 160 knees studied over a 6 month to 1-year period. Significant pain reduction in all form Osteoarthritis 78.6% at 6 months. Early OA (Gr I- IIOA) – 90.9 %, Moderate OA (Gr II- III OA) – 70.3%, and late OA (Gr III +) - 46.6 % one year pain reduction. Many other international studies have shown similar results. Hence PRP has good results for early OA, while in late OA the benefit is not that pronounced.

Osteochondral grafting, mosaic plasty, alone or together with selected osteotomies, are other newer methods used to treat localized cartilage loss. While partial knee replacement is a good option where just the affected area (inner or outer knee) can be resurfaced leaving the other less damaged native knee. However, the ultimate solution for late stage OA is a total knee replacement. With modern techniques of using a computer aided navigation system, the PRECISION of the knee replacement is accurate to 1 degree and is now the gold standard.

So where can all this be done? Right here in Sri Lanka! Now Durdans Hospital has been equipped to be able to perform surgeries of the knee, hip and shoulder to first world standards; having been modeled after the Melbourne Orthopedic Group and the Avenue hospital where the author specialized in these fields.

 

- Dr. Ashan Abeyewardene

Consultant Orthopaedic Surgeon at Healthy Life Clinic

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