Old age enemy 'degenerative arthritis', what is the most important criterion for surgery decision?
Jul 21, 2024
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Professor Park Shin-hyung of Orthopedic Surgery at Soonchunhyang University Bucheon Hospital said "According to the recent National Statistical Office, the number of people aged 65 or older in Korea is expected to enter a super-aged society with 20.3% in 2025. As a result, the number of degenerative arthritis patients will also increase.'
Degenerative arthritis is a disease that causes inflammation and pain due to gradual wear and tear of articular cartilage. When arthritis progresses, sclerosis and cyst formation of subchondral bones, overformation of bones around and within joints, and deformation of joints occur. Recently, the term osteoarthritis is used more often because not only the joints but also the surrounding bones change.
Major risk factors include age, women, overweight, stress, innate form abnormalities and inflammatory joint diseases. Repetitive joint load, genetic predisposition, joint deformity, and joint damage also affect. It occurs most often in knees with heavy weight, but it can also invade other joints such as the lumbar spine and hip joints.
In the early stages, local joint pain appears during mild activity and then gradually occurs continuously, and improvement and deterioration are repeated. It shows joint movement disorders or mild swelling and tenderness around the joint, and if the joint surface becomes irregular due to wear and denaturation of the joint cartilage, friction can be felt during exercise.
Degenerative arthritis is diagnosed by analyzing the patient's medical history and synthesizing various changes in the joint seen in physical examination and radiographic findings. If there is no significant change in the X-ray, it may be diagnosed by taking an MRI, etc., or it may be diagnosed by excluding other diseases that may cause pain.
Professor Park Shin-hyung can classify stages from 0 to 4 with radiographs. The deeper the stage, the more severe cartilage wear is, and the fourth stage significantly narrows the joint gap, resulting in severe pain, joint movement restrictions, and internal varnish deformation, he said.
Since there is no clear way to completely stop the progression of degenerative arthritis, the purpose of treatment is to relieve pain, maintain joint function, and prevent deformation. In the early stages, conservative treatments such as drug treatment, exercise, and patient education are effective. If the deformation has already occurred, surgery and rehabilitation treatment can be performed to slow the progress of joint damage and increase the range of exercise in which the patient does not feel pain, which can help in daily life.
If the patient complains of severe pain, intra-articular steroid injection treatment may be considered. Within hours and days, pain and swelling are lost, range of motion is improved, and effects last for several months in weeks. However, if used frequently, it is easy to become habitual and steroids can promote degeneration of articular cartilage, so repeated injections of less than 3 months or more than 3 to 4 times a year should be avoided.
Cartilage injection is mainly composed of synovial fluid filling the joint and hyaluronic acid, one of the components that make up the cartilage surface. Hyaluronic acid has a viscous supplementation effect and inhibitory action of cartilage catabolic enzymes, so it itself acts as a lubricant protection for the joint by forming an intra-articular membrane. There is no separate limit on the number of times.
The method of surgery depends on the age. High tibia osteotomy or one compartment of artificial joint replacement can be performed at a young age, and artificial joint replacement can be performed at an older age.
Professor Park Shin-hyung said "The most important criterion for determining surgery is pain. Even if X-rays show more than four stages of arthritis, if the pain is not severe or responds well to preservation treatment, surgery is not necessary. Even in non-surgical treatment methods, there is no improvement in symptoms, and if changes in joints progress and interfere with daily life, surgical treatment can be performed."
Reducing weight load is important to prevent or slow progression of degenerative arthritis. It is recommended to avoid repetitive joint bends, double-legged legs, squatting positions, and sitting or standing for too long. It also helps to avoid joint damage and improve lifestyle habits such as proper muscle exercise and smoking cessation.
If you have been diagnosed with degenerative arthritis, a strengthening exercise of 'the quadriceps' above the knee can help. It is good to do exercise that lasts for 20 seconds while sitting on a chair and pinning your knees. Walking for about 30 minutes to an hour, and swimming or indoor cycling are also helpful to sweat on the flatland.
Professor Park Shin-hyung said, `As we are very concerned about the burden of medical expenses and the deterioration of quality of life due to degenerative arthritis ahead of entering a super-aged society, we should prepare for a healthy old age through early diagnosis and active treatment and prevention," he said.
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