Arthritis is not an unknown entity and has been around since prehistoric times. It’s incidence has however certainly seen a dramatic rise in the last few decades. There are various types of arthritis that may not be entirely preventable. Osteo- arthritis is one of the commonest types and occurs entirely due to mechanical reasons. This article provides a short overview of the problems caused and possible solutions.
Due to the structure of our health system, we do not have a mechanism and culture to facilitate referrals to the appropriate specialist doctor. This is largely due to random distribution of speciality practitioners as well as incomplete knowledge about their expertise amongst the people. As people directly approach specialists, they might not always see the exact person suited to their problems. Similarly, it is too easy to get a variety of medicines and splints directly from the stores or even ‘online’ nowadays, that a lot of potentially harmful self- medication is rampant.
Movement is among the very most basic functions, which gets affected in severe arthritis. At present we do not have quantitative statistic measures to evaluate the disability caused in the general population due to arthritis. We accept heart disease as a common killer; heart attack being a sudden unforgettable event. However the total quantity of problems caused with sever arthritis is much higher. It presents gradually and in different forms:
- Immobile & elderly people get more prone to fractures as bones become weaker with decreased mobility.
- Severe arthritis can cause giving way of joints and falls on it’s own accord. Such fractures can get difficult to treat and often work as a beginning towards a slow and painful end.
- Various drugs – both prescribed and self- medicated can cause harmful side effects that lead to kidney failure, etc.
- Decreased mobility brings about decreased self- esteem and confidence, less productivity and mental health issues.
- Untreated osteoarthritis itself is self- propagating: by avoiding mechanical pressure on an affected joint, one strains the neighbouring joints and the other side, overall increasing the risks and making for further complexities in treatment.
Early detection and appropriately instituted treatment can go a long way in preserving quality of life. Similarly, the risks of various treatments need to be evaluated before resorting to operative or non- operative means of treatment in cases of severe end stage arthritis.
There is a lot of knee osteo-arthritis at younger ages in India owing to: (i) widely unrecognised and improperly treated knee injuries and (ii) common activities like squatting, sitting cross legged and praying in our cultures place high demands on the knees. The important preventive measure hence lie in getting appropriate attention if a seemingly simple knee injury does not recover in a couple of weeks. Various non- operative methods exist and are mainly effective in earlier stages of osteo- arthritis: medications, exercises, injections and the like. Treatment needs to be customised to the individual needs of the patient. Medications need to be titrated and monitored to avoid dangerous long- term side effects.
Surgery – What needs to be understood about surgery is that early and rightly directed Arthroscopic surgery can actually prevent arthritis from developing, after one has sustained certain cartilage or ligament injuries. This type of surgery can mostly be performed as a day procedure without admission and often doesn’t even entail stitches. People return to their work within days. This should hence not be viewed as a major event as compared to a fracture or general hospital admission for most other reasons.
Joint Replacement is proving to dramatically change the quality of life for patients riddled with severe end- stage arthritis. It is high time that myths regarding risks associated with such surgery are dispelled, as modern techniques have consistently enabled return to walking right from the day of surgery. This is planned surgery and hence the potential for proper organisation and enhanced recovery as opposed to fracture or emergency operations. For patients wanting to undergo such surgery, there are good services available in most Indian cities. There are an increasing number of dedicated units doing exclusive work, where the standards are bound to be better. At the same time, I would discourage people from travelling too far (more than 5- 6 hours or any flight) to have these procedures undertaken, as travelling back home soon after such surgeries is not without risk. Similarly, one must be in a position to manage stairs within three to four days of surgery too, unless one has not been doing stairs at all before. Only with a reasonable amount of independence, usually achieved within four to five days of surgery is a patient deemed fit to leave hospital, as we cannot guarantee good rehabilitation with the currently available infrastructure of home care services. The cost of surgery varies a lot with the city and set up. However, it does not mean that increased cost would guarantee important things like theatre standards and materials used. There are various standard prosthetic materials from various manufacturers that have shown to provide good results. Success depends on the technique of surgery than whether the implanted prosthetic is of local or foreign make.
The author Dr. Yogeesh D. Kamat is a Consultant Hip & Knee Specialist Orthopaedic Surgeon. He practises exclusively in Joint Replacement, Arthroscopy and Sports Injury related to the lower limb joints and is available at KMC Hospital, Mangalore.