Achy Breaky Joint Issues

Have you been ignoring the discomfort in your knees when you walk down the stairs or go for your evening jog?

Our joints well-oiled mechanisms that keep our limbs moving and functioning as they should. Like all mechanisms, they can experience wear and tear over time, resulting in intense pain.

Sore and swollen joints are the hallmark condition of Osteoarthritis or OA – the most common form of arthritis that primarily affects our knees, and other weight-bearing joints such as the hips and spine.

A degenerative joint disease, OA is characterised by the progressive loss of cartilage, which eventually leads to the smooth surface of the cartilage becoming rough and causing irritation to the joint. In advanced stages of the disease, the cartilage wears out completely, exposing the underlying bones, causing them to rub against each other.

According to the National Center for Biotechnology Information (NCBI), more than 10% of the U.S. adult population had clinical OA in 2005, and in 2009, OA was the fourth most common cause of hospitalization. About 90% of the American population is said to have some features of OA in their weight-bearing joints by the age of 40.

OA is common in Asia, though early awareness is still lacking. In Malaysia, it is estimated that about 20% of the population will have OA by the age of 60. Derived from Greek words osteo, arthro and it is which mean bone, joint and inflammation respectively Osteoarthritis can also affect the non-weight bearing joints like the shoulder, elbow, wrist and fingers. The early features of OA are pain, swelling and stiffness of the joint that can last for days or up to weeks. Over time, these episodes will become more frequent, last longer and the symptoms become more intense.

These are two types of OA – primary, without any predisposing cause; or secondary, caused by underlying conditions such as previous joint injuries or trauma. Regardless of type, if left unattended, OA can result in continuous pain even while resting, as well as loss of mobility and deformity of the joint.

Not just the old folks

While arthritis and joint ailments are typically linked to older people, trends indicate that there has been a spike in incidents of OA among the younger population (in their 40s or below) around the world.
High-impact physical activities, such as running, hiking and playing traditional field sports on hard-court surfaces such as futsal, can increase the risk of developing OA. However, you may not need to hang up your boots just yet.

“Ironically, the majority of knee replacements I do for end-stage arthritis are for those who have never exercised a single day in their lives; while there are septuagenarians running marathons without a hint of arthritis in their knees,” says Dr. Siva Kumar Ariaretnam, Consultant Orthopaedic Surgeon at Sime Darby Medical Centre Ara Damansara and Sime Darby Medical Centre ParkCity, the two new hospitals under the SIme Darby Healthcare Group.

“Weight-bearing exercise is a necessary component of any exercise regime. Doing low impact exercises like swimming and cycling alone are great for cardiovascular well-being, but can hinder adequate bone mineralization leading to brittle bones. So, often a balanced exercise regime with a good mix of low and high impact exercises is advised,” he adds.

According to Dr. Siva,obesity and heavy manual labour are also known aggravating factors for knee OA. However, primary OA is often congenital (predisposed based on family history). This is where early detection plays a role in delaying or preventing the need for surgery altogether.

“Often there are foot abnormalities that contribute to OA of the knee and even the spine. These, if recognised and corrected early with the use of simple and inexpensive foot orthotics, can go a long way in protection your joints. Muscle imbalances in the knee can also be corrected with simple everyday exercises that can be done while sitting at your desk or standing.”

Even for those beyond the early to moderate stages of OA, all is not lost, assures Dr. Siva.

Besides proper footwear and insoles, the correct use of supplements can help a great deal in protection your joints. Knee braces have also been used successfully for years for sports and manual labour, in an attempt to avoid or delay surgery.

He also cautions against the vast majority of untested, and in some cases harmful, herbal remedies in the market, instead recommends clinically-proven traditional anti-inflammatory remedies that are derived from staple Asian Kitchen condiments, which actually work.

There are also various “biologic therapies” that can be administered as injections into the knee in the advanced stage, which help alleviate the pain and in some instances heal the damaged tissues in the knee.
However, once OA has reached an advanced stage surgery becomes a necessity.

Minimally Invasive surgery

The good news is – unlike 20 years ago, today’s technological and medical advances have opened up various minimally-invasive surgical options that do not impede one’s ability to continue working or maintaining a robust and active lifestyles afterward, making it a viable option for patients of any age.

An emerging technology that has taken the world by storm is Patient Specific Instruments (PSI). Using a CT or MRI scan of the joint, a cutting jig that is custom-made to the patient is fabricated, which fits the exposed knee like a piece of a puzzle.

“PSI reduces about 9 steps and an average of 19 minutes of surgery, without compromising the outcome. It can be performed significantly faster and more accurately than conventional surgery, providing greater overall benefits to the patients,” explains Dr. Siva, who successfully performed the first case of United States Food and Drug Administration (US-FDA) approved PSI surgery in Southeast Asia, right here in Malaysia, more than two years ago.

Its benefits are seemingly endless. PSI technology addresses many of the issues of conventional surgery and of CAS (Computer Assisted Surgery), and avoids the added risk of infection, fractures and vascular injuries.

“In addition, PSI allows minimally invasive surgery to be performed, reducing the cuts in the muscles and tendons that move the knee. This enables a majority of patients to bend their knee even as they are being wheeled out of the operating room, and walk within 6 hours of surgery with little or no pain!

This in turn reduces the risk of deep-vein thrombosis and its associated pulmonary embolism, which are rare but potentially fatal complications of surgery associated with delayed mobilization,” he adds

Better than cure

Before we resign ourselves to the fact that our joints will one day wear out, let us first look at some precautionary measures to keep Osteorthritis at arm’s length.

For Example, maintaining an ideal body mass index (BMI) and ensuring that you are not overweight or obese, is important in preventing stress on your joints.

A healthy lifestyle is also important, but exercises should be tailored according to age and physical fitness. Ensuring you do the appropriate exercises, including weight-bearing exercises, is as important as ensuring that you exercise regularly.

Dr. Siva adds that those who do experience aches and pains in their joints more than once, or for a prolonged period, should not delay in seeking their doctors’s opinion at once.

Identifying the early signs or symptoms of OA is important to ensure that we obtain necessary and immediate attention. Some common symptoms may include:

- Pain in a joint during or after use, or after a period of inactivity.
- Tenderness in the joint, especially when waking up in the morning or after a period of inactivity
- Loss of flexibility and difficulty using the joint
- Grating sensation when using the joint
- Bone spurs, which appears as hard lumps, that have formed around the affected joint
- Welling (effusion) in the affected joints, in some cases.

This article was contributed to Tab A Doctor by,
Dr Siva Kumar, Orthopaedic Surgeon, Sime Darby Medical Centre