Ask the Doctors November 2019 Issue

Ask The Doctors: November 2019

Q: I have pain in my hip, and my doctor tells me I have osteoarthritis. Can arthritis be cured?

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A: The short answer to your question is no. But that doesn't mean there's nothing you can do about it. Osteoarthritis is caused by the degeneration of cartilage, and it cannot be reversed. Where two bones meet to form a joint the ends of the bones are covered with cartilage, which is a tough slippery material that allows the bones to glide smoothly over each other. At the most mobile joints (called synovial joints), which are the hips, knees, shoulders, elbows, wrists, fingers, ankles and toes, the cushioning cartilage can wear down. The reasons are not known, but it is partly a function of aging. Close to 50% of Americans ages 65 and over have arthritis.

Cartilage has a limited ability to heal itself, so once it is gone, the damage is permanent. Once cartilage breaks down, bones can rub together, causing pain, swelling and loss of motion in the joint. Researchers are looking for ways to stimulate the body to regrow cartilage. For example, stem cell therapy is an intriguing possibility. Stem cells have the potential to divide and transform into many different cell types, including muscle, blood and cartilage. Even though stem cell therapy is available today, the science behind it is still in the experimental stages.

For now, the best approach to osteoarthritis is to start by seeing a doctor to get an accurate diagnosis. Effective treatments include physical therapy, ongoing exercise, weight loss (if overweight), short courses of non steroidal anti-inflammatory drugs (unless there is a medical reason not to take them) and assistive devices. In some cases, corticosteroid injections may be helpful. If pain and impaired function persist, joint replacement surgery may be an option.

Q: I'm planning to have knee replacement surgery. How long can I expect my knee implant to last?

A: Total hip and knee replacement are two of the most common orthopaedic surgeries performed today. They have a high success rate, allowing most people who have them to be free of chronic pain and able to return to an active life. But they are big surgeries that involve a long rehabilitation. And there are risks with any surgery. So you don't want to go through it more than once if you can avoid it.

There's no guarantee that any operation will be 100% successful. And whether the implant will last your lifetime depends on a number of factors. In a small number of cases, joint replacements fail early on, usually because of an infection. Factors such as uncontrolled diabetes, being obese and poor nutrition can increase chances of an infection.

Over the long term, surgery may be needed to replace the original implant because of loosening of the implant or instability. A second "revision surgery" is technically more difficult, and success rates may be lower than with a first operation.

When joint replacements were first performed, it was thought that the implants would last about 10 years. With newer implant designs and better surgical techniques, we now know that joint replacements last longer than that. Based on several studies, it's thought that about 90% of total knee replacements will still function at least 10 to 15 years later. Two studies published in The Lancet (February 2019) found that about 82% of total knee replacements and about 58% of total hip replacements lasted at least 25 years. To help keep your new joint intact, stay active, but avoid high-impact activities, and maintain a healthy weight.

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