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What are the risk factors?
Like many unsolved diseases, arthritis is probably due to a combination of many factors. These include:
- Age
- Heredity (faulty genes)
- Overweight
- Injury or overuse
- Faulty alignment of joints
- Occupation and lifestyle
- Infection
Can arthritis be prevented?
Although we still don’t know what causes arthritis, there is much that can be done to prevent it getting worse by:
- Maintaining ideal body weight and
- Avoiding joint damage, by carefully performing strenuous activity.
What are the warning signs?
The three main symptoms of arthritis are
- joint pain,
- stiffness or inability to move the joint normally, and
- swelling of the joint that last more than two weeks.
What can I do to help my arthritis?
There are 10 tips to manage arthritis:
- Exercise regularly - A regular, appropriate exercise program designed with your arthritis in mind can help you effectively manage pain. Your doctor can help plan your program with the physiotherapist. Exercise under guidance, so you don't cause further damage or injury. Do not exercise acutely injured or
inflamed joints.
- Maintain normal body weight - Being overweight increases the risk for osteoarthritis. Losing weight helps reduce the stress on hips and knees. Eat right;
keep fats, sugar, salt and fibre within recommended limits. There is no proof that any particular diet has an effect on arthritis.
- Use your joints wisely - Learn how to perform tasks in ways that reduce stress on your painful joints. Protect joints from undue load.
- Use assistive devices - Devices such as a walking stick, splints and braces can help stabilize joints, provide support and reduce pain by reducing the stress
on hips and knees.
- Use heat or cold treatments - Using heat or cold treatments can reduce the pain and stiffness of arthritis. Your doctor can teach you correct ways to use
heat and cold for pain relief.
- Take medicines wisely - Many types of medicines can help control the pain and swelling of arthritis. Work with your doctor to find the medications that suit
you most.
- Get enough sleep and practice relaxation techniques - Getting a good night's sleep restores your energy so you can better manage pain and rests your
joints to reduce pain and swelling. Relaxation techniques (yoga) can help manage pain better.
- Communicate - Don’t suffer alone; talk to family, friends and other patients. Find a doctor you like and trust with whom you can discuss problems and
solutions.
- Seek medical attention early so that treatment can be started before too much damage is done.
What is likely to happen in the future?
Arthritis does not always get worse. It may reach a peak after a few years and stay there or only get a little worse. In others, it may progress as the years go by becoming very painful and disabling. One cannot predict the outcome in individual cases. However, when arthritis really gets worse then one may need to consider joint replacement surgery.
In cases of Osteoarthritis affecting the knee there is another option, Unicompartmental knee Arthroplasty. This is a minimally invasive operation which offers immediate relief of pain, quick recovery and rapid return to an active and normal lifestyle.
What are the preparations for surgery?
Before surgery, you need to:
- undergo a complete medical check-up and some tests (blood tests, x-rays, ECG, etc)
- stop or start some drugs before surgery
- learn specific exercises to speed your recovery
- lose excess weight
- stop smoking
What type of anesthesia is needed?
Surgery may be carried out under general anesthesia when the patient is made fully unconscious or spinal or epidural anesthesia when only the legs are made numb. The decision depends partly on the medical condition and preference of the patient, and the judgment of the doctor giving the anesthesia.
Will the operation be painful?
With modern techniques of anesthesia and better medication available, pain can be very well controlled during the operation (which lasts 1-2 hours) and afterwards. After the first few days, the need for pain medication reduces considerably and usually there is very little or no pain by the time the patient is ready to go home.
What to expect after surgery?
You will be in bed for the first day after surgery, with a drip providing intravenous fluids and tubes to allow injections to be given. There will be one or two tubes (drains) coming out from the dressing around the operated part. You will be advised to keep your leg on a pillow and start exercises for the leg right away. Over the next few days, most tubes will be removed and more exercises started. Standing and walking will commence in a day or two, initially with a walker, and later with a stick or crutches. Periodically the dressing will be changed to check the progress of wound healing. Stitches (or staples) will be removed usually at the end of two weeks.
How long do I need to stay in hospital?
Most patients can go home within one week and return for removal of sutures two weeks after the operation.
How soon will I recover?
After a hip or knee replacement you will be made to stand and begin walking in a day or two after the operation. Initially, you will be given a walker, crutches or stick. By 4-6 weeks, most patients can walk unaided, climb stairs and can do most daily activities independently. This depends to some extent on the condition of the other leg, muscle strength and one's motivation to perform exercises, which play a vital role in the recovery process.
Will I need physiotherapy afterwards?
The exercises are quite simple and not as painful as some people believe. Only in some severe cases is extensive physiotherapy needed. Most patients are taught the exercises while in hospital and can do them easily at home on their own. Rarely is physiotherapy needed after a month.
How successful is Joint Replacement?
As the new surfaces are artificial, there is no pain on movement. Results are very good in 9 out of 10 people and last for 10-15 years. Indeed, joint replacement is the most successful operation for severe arthritis provided the following three requirements are satisfied:
1 It is performed properly by surgeons specifically trained and experienced to perform replacement surgery
2 It is carried out in a well-equipped centre with appropriate facilities
3 It is done in a person who is well motivated, understands the limitations, and follows instructions.
In what way will my new joint be different?
Initially the knee may feel a little different. However, soon you will become used to it and will even forget that you have had an artificial joint implanted.
What are the possible risks and complications?
If you are in average health, the risk of dying from the operation is so slight that it is no greater than the normal risk associated with everyday activities. Every care is taken to prevent complications, but sometimes they are unavoidable.
Infection of the new joint is the most severe complication that may occur. The risk of infection is minimum - less than 1% - if the operation is performed in specially-designed operation theatres with laminar airflow, by using special gowns and other advanced techniques. If infection does not respond to antibiotics, a further operation may be needed to remove the new joint. By advanced techniques another joint may be inserted after an interval. Care must also be taken that infection elsewhere in your body is treated so that it does not spread to the joint.
Loosening of the joint may occur but, if it occurs at all, it is usually after many years of good use of the part and may be seen in 5-10% patients after 10-15 years or more. Sometimes it is due to poor technique, and sometimes due to overuse by the patient who has not followed instructions. If it causes pain, revision of the replacement may be required.
Blood clots may occur in the veins of the legs due to many factors. Your doctor will take precautions to reduce the risks and will explain these measures to you.
Dislocation of one of the components may occur. This is commoner after hip than knee replacement and occurs in 1-2% cases. Following instructions carefully in the first few weeks can greatly reduce the chance of this happening.
Wear occurs to some extent in all joint replacements. Wear depends on the design and quality of the materials, the load on them (your weight and activity level) and length of time since they were implanted. Only if excessive wear occurs and causes loosening does it need revision.
How can I increase my chances for success?
Choose a surgeon who is a specialist in joint replacement surgery and does them regularly and frequently, not once in a while.
Make sure that the operation theatre is appropriate for joint replacement surgery.
Ensure that the surgeon is going to use good quality parts.
Meet with and talk to several other patients who have been operated upon by the surgeon performing your operation.
Follow the instructions given by your surgeon.
What are the do’s and don’ts after Joint Replacement?
- Walk as much as you want, play golf, swim and even dance.
- Avoid strenuous sports, such as singles tennis or running.
- Do not squat or sit on the floor.
- Keep your weight under control.
- Watch for and prevent infection of any kind particularly urinary and dental infections.
- Regularly follow-up and visit your surgeon as advised by him to ensure the long-term success of your operation.
- Always check with your surgeon when in doubt.
Will my new joint last forever?
It may last up to 20 years providing you are careful with it - and techniques are getting better and better all the time. Most older persons can expect their total joint replacement to last the rest of their lifetime, giving them years of pain-free living that would otherwise not have been possible. Younger patients may need a second replacement - called revision surgery. The first joint is removed and a new one can be inserted. Materials and techniques are constantly improving and the future is bright for those who choose to have a joint replacement.
How do I proceed further if I think I need Joint Replacement?
If you have severe pain from arthritis and want a better quality of life, make up your mind whether you might need joint replacement after asking yourself six questions:
- Am I suffering from intolerable pain?
- Is it getting worse over the last few weeks or months?
- Is the pain constantly troubling me, even when I am sitting or sleeping?
- Am I unable to carry out my daily activities and do things that I like (such as going out to meet people, taking long walks, etc.)?
- Is no treatment that I have tried really helping me?
- Is this how I want to live the rest of my life?
- If the answer to questions 1-5 is "Yes" and the answer to the last question is "No", then you must consult a specialist doctor who can help you.
How do I choose a specialist in this field?
Find a good specialist you like and one you can talk to comfortably. He should be experienced in arthritis surgery and should be a specialist in Joint Replacement surgery and doing lots of them regularly. Results are better if surgeons do more than 100 replacements a year. Select your specialist carefully even if you have to travel a long distance to see him. Take your time and remember, there is never any rush to get admitted and have surgery urgently. Make sure your doctor has enough time for you, talks in simple language that you understand, explains and listens to you. To get the most out of your doctor, communicate well with him.
Prepare: Write your questions down and have a clear idea why you are visiting him. If possible prepare a summary of your history, symptoms, treatments tried, side-effects, etc. Take with you all your x-rays and previous medical reports.
Ask: questions about your diagnosis, tests, treatment options, future outlook and follow-up visits.
Repeat: anything important the doctor has told you to double-check that there is no misunderstanding.
Take action: Make sure you understand what to do next. If in doubt, do not hesitate to ask for a second opinion. Most good doctors will not feel offended and will even suggest some other names.
Once you have come so far you the last thing left is…
Making up your mind: They conquer who believe they can
We have tried to give you plenty of facts. Read them. Digest them. The possession of facts is knowledge; the use of them is wisdom; the choice of them, education. The choice is yours. Choose wisely.
The power within you and the support that lies behind you are infinitely greater than the problem that lies ahead of you.
Remember, where you are today is the result of choices you made yesterday. But where you will be tomorrow will be the result of decisions you will make today.
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