As a physiotherapist, one question I find that is commonly asked by patients to me is – I’ve been diagnosed with arthritis, when do I know I need a total hip or a total knee replacement?
Firstly let’s define arthritis. It involves the degeneration of cartilage within the joint itself – cartilage is the connective tissue that lines the end of each bone and stops them from rubbing directly over each other when we move. In arthritis, this cartilage layer has degenerated, thus getting “bone on bone” and hence, the production of pain. There are two main types of arthritis – rheumatoid arthritis (RA) and osteoarthritis (OA). They differ based on the way the cartilage degenerates. In RA, the immune system of the body attacks the cartilage for some yet to be determined reason. This is often managed with medication and carefully managed exercise. Osteoarthritis on the hand, is caused by “wear and tear” in which constant grinding of the cartilage over life has caused the cartilage to wear away – this is the more common form of arthritis seen in people.
Unfortunately cartilage do not grow back. So you may be asking how is this pain managed?
Physiotherapy management is usually always the first case management. Your physiotherapist will assess you for any dysfunction of the muscles in your lower limbs – often muscular weakness will cause a greater impact in your joints. Your physio will also assess your range of movement, balance and walking pattern. A targeted exercise program may be given depending on your deficiencies, and exercise modalities such as clinical pilates and hydrotherapy may also be advised. Your physiotherapist will also look for other issues that may be contributing to accelerating the arthritis. These issues can involve referring patients to the right practitioners in regards to weight loss management, foot wear and mental health and wellbeing. In many cases of osteoarthritis, physiotherapy is enough to control and manage their pain and no surgical management is required.
However there are people in which further action is needed. Surgical joint replacements are turned to when pain is so significant that it prevents them from doing their activities of daily living (i.e. walking) thereby impacting their quality of life (note that age and current health is heavily considered when determining whether to proceed with surgery). Even if surgical intervention occurs, studies have shown that having done an exercise program targeting weakened muscles prior to surgery offers a more positive prognosis with better outcomes than those with weakened muscles.
So if you have been diagnosed with arthritis, book in with one of our Stay Tuned practitioners to get a detailed assessment of your strength and function! It may just be doing your joints some good!