There are a number of conditions that affect the hip and knee joints resulting in disabling conditions that warrant resurfacing procedures.  Arthritis is the number one cause of chronic disability in the United States, affecting more than 40 million Americans.  The CDC projects that over 18% of the U.S. population will suffer from arthritis by 2020.

There are more than 100 different disease processes that affect joints, causing pain, swelling and stiffness.  The four most common conditions are osteoarthritis, rheumatoid arthritis, inflammatory arthritis and post-traumatic arthritis.

What is Osteoarthritis?

Osteoarthritis is the most common form of arthritis and affects approximately 16 million Americans.  It is usually a slowly progressive, non-inflammatory degenerative disease in which the cartilage lining the joint gradually wears away.  This eventually results in the bones rubbing together, causing stiffness and pain. It most often affects middle-aged and older people. The exact cause of osteoarthritis is unknown.

What is Rheumatoid Arthritis?

Rheumatoid Arthritis is another frequent cause of hip and knee degeneration.  The inflammation of rheumatoid arthritis (RA) is more generalized and affects most of the synovial joints.  The lining tissue of the joint, the synovium, becomes inflamed resulting in the release of chemicals that damage the lining cartilage and bone of the joint. The release of these chemicals can cause pain and swelling.

Rheumatoid arthritis can occur at any age and will generally affect both hips and both knees.

The severity of rheumatoid arthritis is variable.  RA patients are usually under the care of a Rheumatologist, that is an internal medicine doctor who specializes in treating joint problems non-surgically.  In addition to the typical ‘arthritis medicines’, powerful drugs such as Methotrexate, Gold, Penicillamine, and Prednisone are used to help control the inflammation and decrease the destruction of the joint surfaces and bone.  When these fail, the Rheumatologist looks to the orthopedic surgeon to resurface or replace these joints.   

What is Inflammatory Arthritis

Inflammatory Arthritis is a chronic disease process in which the body’s immune system starts attacking its own tissues.  In the case of the large joints, the synovium becomes inflamed and with the release of chemicals, destroys the lining cartilage of the joints. As the cartilage is destroyed, the joint becomes stiff, swollen and painful. 

There are many different types of inflammatory arthritis, including rheumatoid arthritis, lupus, gout and many others.

What is Post-Traumatic Arthritis?

Here the cause of the arthritis is a serious hip or knee injury.  In the hip, a serious injury such as a dislocation can affect the blood supply to the femoral head or ball of the ball and socket joint, resulting in a condition called avascular necrosis. Without a blood supply and proper nutrition, the cartilage cells lining the joint die, resulting in loss of the joint cushion.  This then produces pain and disability.  In the knee joint, the arthritis is similar to osteoarthritis and may develop years after a fracture in the knee, a ligament injury or meniscus tear.

What are some of the symptoms of arthritis?

Generally, the pain from arthritis develops gradually, beginning with a little stiffness and progressing to an aching pain.  Sudden onset of arthritis is also possible. The joint may become stiff and swollen, resulting in a decrease in motion and apparent weakness. Pain and swelling are usually worse in the morning or after a period of inactivity.  It may take a few steps to ‘get going’ after a prolonged drive or watching a movie. The pain may be concentrated in one spot, or may be felt all over the body.  Stiff and or swollen joints may make daily chores difficult.  Climbing stairs or getting up from a chair can become a challenge. Some people report that changes in the weather can cause an increase in joint pain.

How do I know if I have arthritis?

Early diagnosis and treatment tailored to an individual’s needs are crucial to slowing down and preventing damage to joints, particularly in cases of inflammatory arthritis. Your doctor will obtain a careful history noting in particular, any prior significant injuries and any family history of arthritis. This will be followed by a physical examination that focuses on your walk, the range of motion to your joints, and the tenderness and swelling to your joints. X-rays of patients with arthritis typically show a loss of the space between the bones and spurs around the joint. Blood tests or other special imaging studies may be needed to diagnose inflammatory arthritis such as rheumatoid arthritis.

What are treatment options for arthritis?

Because there are so many different types of arthritis, each type of arthritis has different symptoms and different treatments.  The good news is that there are things one can do to decrease the pain and disability from arthritic joints. Care of arthritis frequently involves more than one type of treatment. Consult your doctor to discuss the best treatment options for you.  The following are different options available:

Medication: There are many different medications, both prescription and over the counter that are used to treat arthritis. Some of the newer medications, Vioxx and Bextra have been taken off the market due to concerns about serious cardiac effects. Common medications are aspirin-free pain relievers, non-steroidal anti-inflammatory drugs, corticosteroids, disease modifiers, and mild sleep medications. Patients with sleep-disturbing hip or knee pain may benefit from low doses of mild narcotic medication.

Exercise: Patients with hip or knee disease, like anyone else, need to exercise on a regular basis for optimal cardiovascular health.  Regular exercise is also important to keep your body moving and flexible. It helps to lessen the pain, maintain or increase motion, reduces fatigue and helps you look and feel better.  Jogging and other exercise that results in impact loading of the joints will probably increase pain to arthritis hips and knees and should probably be avoided. 

The best exercise for maintaining cardiovascular health in someone suffering from hip or knee arthritis is swimming.  Bicycling and the use of a stair stepping machine are better tolerated than running. Walking on the flats or on a treadmill causes intermediate stress to hip and knee joints.  An exercise bicycle with lower resistance settings would probably give more cardiovascular exercise with less hip or knee pain.  It is important to remain active to properly maintain your muscles, bone strength and cardiovascular system. 

The above mentioned activities are unlikely to cause damage to your joints that can not later be fixed with joint resurfacing or replacement. Prolonged inactivity and progressive weakness can make recovery from a joint resurfacing or replacement take significantly longer, so it's not good to simply avoid activity.