Osteoarthritis

According to information presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), there are more than 4.5 million Americans living with a total knee replacement. Over the past decade, the number has more than doubled. The greatest increase was attributed to younger people and baby boomers needing the surgery, but the primary reason for needing a total knee replacement still is knee osteoarthritis.

Researchers used several studies and data banks to determine the number of people living with a knee replacement. The 4.5 million statistic, which is 4.7% of the population age 50 or over, is greater than the rate of congestive heart failure or rheumatoid arthritis. It was also determined that among those 60 to 69 years old, 4.1% of men and 4.8% of women, have a knee replacement. Among persons 70 to 79 years of age, 7.1% of men and 8.2% of women have a knee replacement. Of people age 80 or older, 10% have had a knee replacement. The numbers reflect the significant and growing need for total knee replacement surgery -- and also reflect that revisions will become more prevalent as the prostheses wear out in younger patients.

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Biomarkers are biologic molecules that are useful for detecting the presence or progression of a disease or the effects of a particular treatment. When we hear about biomarkers, it's usually related to rheumatoid arthritis. Biomarkers have been more difficult to identify for osteoarthritis.

Researchers at Detroit's Henry Ford Hospital, in collaboration with University of Guelph in Ontario and University of Toronto, have identified two molecules that appear to be promising as biomarkers for measuring cartilage damage associated with osteoarthritis. The molecules, called non-coding RNAs, were identified in 30 patients who were one year post-op from reconstructive surgery to repair an anterior cruciate ligament (ACL) injury. Researchers, excited about the discovery, say the next step is to study more patients and determine if the concentration of non-coding RNAs in blood can be used to predict whether cartilage damage will worsen.

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According to study results presented at the 2012 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), elderly osteoarthritis patients who had total knee replacement surgery had half the risk of mortality when compared to osteoarthritis patients who did not have the procedure. At 3, 5, and 7 years after surgery, the rate of congestive heart failure was also lower. Diabetes rates were the same between patients with and without total knee replacement. Depression rates were a bit higher for total knee replacement patients at 3 years postop but the same at 5 and 7 years postop.

The study was based on a review of Medicare records that separated osteoarthritis patients into two groups: those who had total knee replacement surgery and those who did not. Researchers concluded that total knee replacement surgery is both beneficial and cost effective.

Related Resources:

• Total Knee Replacement - What You Need to Know
• Total Knee Replacement vs. Partial Knee Replacement
• Why Patients Delay or Decline Knee Replacement Surgery
• What Is Joint Replacement Surgery?

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Researchers evaluated the impact of daily cane use on pain, function, general health and energy expenditure among people with knee osteoarthritis. The study participants were randomly assigned to serve as part of the experimental group or the control group. The experimental group used a cane every day for 2 months. The control group did not use a cane during that time frame.

Results published in the Annals of the Rheumatic Diseases revealed that people who used a cane had significant improvement in pain level compared to those who did not use a cane. Also, by the end of the 2-month period, cane users covered more distance during a 6-minute walk and had less energy expenditure. Since the improvements were observed over time and not necessarily after just one month, it was concluded that patients had to adapt to using a cane. By adapting to the cane and reducing joint load on the affected knee, pain, function and certain aspects of quality of life did improve.

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Osteoarthritis can affect a single joint, especially when symptoms first appear. There are several treatment options for osteoarthritis. Most likely, you are familiar with some of the oral medications your doctor may prescribe for you. Your doctor also may advise you to exercise and watch your diet. An intra-articular injection is yet another treatment option your doctor may offer.

Intra-articular corticosteroid injections have been used for decades to treat localized joint symptoms related to arthritis. More recently, intra-articular hyaluronan injections have been used to treat knee osteoarthritis. Learn more about joint injections in What Is an Intra-articular Injection?

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• Is a Second Course of Hyaluronic Acid Safe and Effective?
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We've all heard it, read about it, or seen it on TV. Exercise and regular physical activity are beneficial for osteoarthritis. Exercise helps improve muscle strength, balance, and coordination. It helps us maintain our ideal weight. It helps to maintain joint mobility, joint function, and actually decreases joint pain. But somehow, we think they are talking to everyone else besides ourselves.

When asked what keeps them from exercising, many osteoarthritis patients say exercise increases rather than decreases joint pain. They aren't really sure if certain forms of exercise would hurt rather than help. Many people don't think they are capable of doing enough to even matter. And, then there's the fact that most doctors don't take time to emphasize the importance of exercise, so how important can it be? While many patients excuse themselves for one reason or another, many just don't know where to start. We've got some suggestions for How You Can Start to Exercise with Osteoarthritis.

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Blood clots (venous thromboembolism) are among the known complications associated with total or partial knee replacement and total or partial hip replacement surgery. As you likely know, especially if you've had one of the procedures, in-patients are treated prophylactically while hospitalized to prevent blood clots. Since patients are treated with the intent of lowering the risk of blood clots post-op, how significant is the risk?

According to a report in the January 18, 2012 issue of the Journal of the American Medical Association (JAMA), researchers have estimated the risk based on a meta-analysis of 47 studies that documented blood clots in nearly 45,000 patients who received recommended prophylactic treatment while in the hospital. Researchers concluded that 1 in 100 patients who have knee replacement surgery and 1 in 200 who have hip replacement will develop blood clots (symptomatic venous thromboembolism) prior to discharge.

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• Hip and Knee Replacement Patients Face Potentially Fatal Blood Clots
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More than 27 million Americans have osteoarthritis, with knee osteoarthritis accounting for about 10 million. The disease is among the leading causes of disability. In advanced stages of osteoarthritis, when conservative treatments no longer yield a satisfactory response, joint replacement may be necessary to relieve pain and stiffness and improve quality of life. Knee replacement is the most common type of joint replacement surgery. According to the Agency for Healthcare Research and Quality (AHRQ), there were more than 600,000 knee replacement procedures performed in the U.S. in 2009.

Researchers in Finland analyzed the incidence of knee replacement surgery (partial and total) in their country between 1980 and 2006. According to the study results published online January 17, 2012 in Arthritis & Rheumatism, there was a 130-fold increase in the incidence of knee replacement surgery during that time for people between the age of 30 and 59 years old. The most rapid increase in incidence of knee replacement surgery occurred from 2001 to 2006. The greatest increase in incidence occurred in people 50-59 years old. Researchers also found that in the last 10 years of the study, incidence of knee replacement was higher among women than men.

Related Articles:

• Knee Replacement - What You Need to Know
• Total Knee Replacement vs. Partial Knee Replacement
• Why Patients Delay or Decline Knee Replacement Surgery
• What Is Joint Replacement Surgery?

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According to study results published in Arthritis Research & Therapy, cells from osteoarthritic knees have abnormally shortened telomeres and the percentage of cells with ultra short telomeres increases closer to the damaged area of the joint. Telomeres are repetitive sequences of DNA found at the ends of a chromosome. It is known that as we age, telomeres become shorter. Telomeres also shorten when there is cell damage, such as oxidative damage.

Researchers have concluded that there are two processes occurring with regard to telomere shortening in osteoarthritis. First, there is age-related telomere shortening which leads to cells being unable to continue dividing. Secondly, there are ultra short telomeres, likely due to compression stress when the joint is used and ultimately leading to the joint's failure to repair itself.

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• Does Aging Cause Osteoarthritis?
• Does Everyone Develop Osteoarthritis?
• Shorter Telomeres and Hand Osteoarthritis
• Telomeres and Aging - Understanding Cellular Aging

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Many osteoarthritis patients are drawn to herbal treatments. They hope a natural approach to treating their disease will present a cure, as opposed to temporary symptom relief provided by traditional medications. But, according to a review in the January 2012 issue of Drug and Therapeutics Bulletin, few studies have evaluated the use of herbal medicines for osteoarthritis -- and the few that did were not high quality. For example, some included too few study participants.

While some patients claim they have been helped by taking herbal medicines, there is less than convincing evidence to generally support the use of herbal medicines for osteoarthritis. Existing clinical studies have suggested vegetable extracts, frankincense, and rose hips may be effective while having few undesirable side effects. Also, since herbal medicines can interfere with prescription drugs, you should discuss everything you are taking with your doctor.

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• Herbal Treatments for Osteoarthritis
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• Alternative Medicine for Osteoarthritis Is Mostly Ineffective

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