Dealing with arthritis and how that can lead to joint replacements was the topic of the Talking Health radio interview on News Radio 1240 KQEN last week.
Talk show host Lisa Platt interviewed Candice Spence, a registered nurse at New Strides Joint Center, Dr. Cary Sanders, an orthopedic surgeon at Centennial Orthopedics, and Melissa Russell, a physical therapist at Mercy Medical Center.
The following is an edited version of the interview.
Lisa: Candice, what is arthritis?
Candice: Arthritis is not really a single disease or a single diagnosis. It’s rather a symptom of a joint disease causing pain, stiffness, swelling and often times decreased range and mobility.
Lisa: What are the most common types of arthritis?
Candice: There are over a hundred types, and the most common being osteoarthritis, which is a degenerative disease causing the cartilage between the joints to wear away.
Lisa: How does someone know if they have arthritis? Are there some symptoms?
Candice: There’s pain, stiffness, swelling and decreased mobility, but you really need to have it diagnosed by a physician. You might possibly need some lab work, blood draw or imaging studies.
It is more prevalent in women than men, middle-aged with progression of the aches and pains with age.
Lisa: What are some of the options to treat arthritis?
Candice: Some of the options are anti-inflamatories, lots of low-impact exercising like walking, cycling, waterobics, and just keep that joint moving and strengthen the muscles surrounding the joint, injections provided by orthopedic surgeons, and hot and cold compresses. When all else fails there are assisted devices such as walkers, canes, crutches.
Cary: I think finding a non-operative, non-surgical treatment is a real important part because surgery is always a last resort, and I think there is a lot of value to putting that off as long as you can.
The injections are basically two types. One is a corticosteroid medication. They are powerful anti-inflamatory medications that we inject right into the knee, and they basically just cool everything down and make things feel better. It’s not a permanent solution to the knee, but very often they can last a few months and several months in some cases, but they’re really good at quieting down a bad flare-up.
The second kind of injection is a hyaluronic acid, which is a substrative cartilage, and is part of the surface coating of normal cartilage and it’s purified and injected into the knee and it acts as a lubricating mechanism where it essentially optimizes the cartilage that you have left in your knee.
If you are someone who has a little cartilage left, but not much, it’s going to help you more than someone who is way advanced with bone changes and with cartilage being long gone.
Lisa: Melissa, from a physical therapists standpoint is exercise important in treating arthritis?
Melissa: Exercise does play a big impact. Any time you’re strengthening the muscles around the joint, getting those muscles stretched, pulling the bones apart a little, giving the joint space a little bit more room, and overall strengthening is good.
Low-impact activities, swimming, cycling, walking, are good and I tell folks to do as much as you can, as long as you are within your tolerance, and that really helps delay getting a joint replacement.
Lisa: Can you talk about some of the surgeries and the physicians available to do the surgeries?
Cary: Basically, we’re looking at a scope operation, which we do on occasion, in the setting of arthritis. But more often than not, if it’s just arthritis pain, then we’re talking about joint replacement. The reason total joint replacement is often selected, is that its track record is pretty tough to beat. When you look at it and compare it to other lesser, like the scope, or other non-surgical treatments, it really beats all of them pretty easily.
As a surgeon, I try to let the patient be in the driver’s seat. I feel my job is to inform them of what their options are and talk about the risks and benefits of each, and let them decide what feels right for them.
It’s always important to remember that not everybody is a candidate for total joint replacement. Some people’s health is just too poor for this operation.
Lisa: Let’s talk about the new program at Mercy, for patients who might need a joint replacement.
Candice: We use the Marshal Steele program, but we call it New Strides. It starts in the surgeon’s office where they optimize the patient, and between the two of them they’ve decided to have this elective joint replacement done. Then they do a pre-op class where they get all the education they need as far as what to expect during their stay at the hospital and what we expect for them with recovery, physical therapy, in-patient and out-patient. We do home environment screening so we assess the home and make sure they have proper equipment.
Once they decide, yes this is what they want to do and they go through that class, they’re scheduled for surgery.
Lisa: Melissa, can you tell us how physical therapy plays a big role in this program?
Melissa: Some folks will have outpatient therapy, kind of preparing them for surgery and getting folks stronger. We get them educated on setting up their home for success and preparing their bodies for success. We encourage them to do the pre-op exercises to get the muscles around the joint stronger, and to learn those exercises they’ll be doing after surgery.
So after surgery, we implement the same things that we tell them in the pre-op. We get folks up the day of surgery; it’s not uncommon for folks to be walking in the hall working on getting a nice normal walking pattern again. We’re teaching them exercises and stretches to do with their hips and knees so after they have their surgery, we see them twice a day in group sessions. They also see occupational therapy to work on self-care tasks.
With all the focus on identifying what we can improve and we making those improvements, that really has decreased our length of stay from three to five days; now it’s one to two days. So with this group therapy, it’s an early mobility, rapid recovery program, and putting all these pieces together is beneficial as a recovery process to the patient.