Cartilage degeneration (osteoarthritis)
Degeneration of the articular cartilage is the end result of a long, gradual process throughout the whole life usually called osteoarthritis and is the most frequent reason for major joint arthroplasty to date.
We know only little about the exact mechanism behind the cartilage degeneration but the primary reason would be the decreased potential of regeneration of the cartilage cells. In some cases other, associated diseases are present (e.g. injury, inflammation, infection, congenital abnormality) but in most cases no provoking factor is found. Small focal defect of the cartilage, osteochondritis, or meniscal tears in the long run induce degrading and wear of the cartilage originally providing the smooth, painless gliding of the joint surfaces. Many joints are affected, however the most common and best known are the hip, knee, shoulder, ankle and elbow osteoarthritis.
Prevalence
Mostly in elderly people
Complaints
The range of motion gradually becomes very restricted and almost all motions in the joint are painful. Joints are often stiff in the morning. Following a short “warm-up” period in the morning joints become less painful, and by the afternoon pain returns. Joints are often swollen and axial deformity develop (e.g. bowleg), limping becomes more and more obvious.Usual protocol for examination:
· Assessment of the axis of the extremities
· Checking stability, range of motion, painful movements
· Measuring muscle strength of the limb
· Neurological tests and assessing vascular status
· Checking for any hypersensitivity
· X-ray usually offers sufficient diagnostic value
Treatment options
First choice would be painkillers and anti inflammatory drugs. Always consult with your doctor before start taking any medications. Dietary supplements like glucosamine or chondroitin sulfate may have additional effect. Intraarticular injections of hyaluronic acid derivates and/or steroid offer short but intensive pain relief. All the abovementioned treatment options, however, only postpone the date for the ultimate solution, which is arthroplasty in most cases.
Surgery is inevitable in severe cases, as cartilage is completely demolished and affects large areas, thus the methods used for small focal defects are inappropriate for advanced disease. Surgery may be small intervention, like arthroscopic lavage and debridement of the joint. Preventive surgery in axis deviation (e.g. high tibial osteotomy) may also give many years for the patients before the arthroplasty. Ultimate solution is the arthroplasty - implantation of specially developed prostheses.
Rehabilitation, physiotherapy
Physiotherapy and rehabilitation has primary role in the treatment of osteoarthritis; hydro and balneotherapy along with well conducted physiotherapy for maintaining the range of movement in the joint is invaluable. Most patients will need some kind of walking aid (cane, crutches, frame). Postoperative rehabilitation may be performed only under the supervision of expert physiotherapist.
