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Archive for January, 2013

OA and Housework

January 31, 2013

Some housework involves heavy lifting, and can cause osteoarthritis over time.

There is a well known connection between osteoarthritis and heavy physical exercise. While intense exercise does negatively effect joints and often causes knee pain, this does not mean that all exercise increases risk of osteoarthritis.  In fact, new evidence suggests that routine stresses lead to osteoarthritis more often than exercise does.  Many studies do connect exercise to osteoarthritis, but this connection is most visible in professional superstars, and is far less common for recreational athletes.

A recent study at the Women’s Hospital of Boston examined the stresses that housework can put on the knee.  They found that housework often involved squatting, kneeling, and stair climbing, and that these activities increased risk of osteoarthritis.  This same study shows that recreational sports and fitness are more helpful than they are harmful.  Most of the stress applied to the knees comes from carrying body-weight, and so weight loss can be helpful in reducing knee pain and slowing the progression of osteoarthritis.

So be aware of the damage that housework and manual labor can do.  Most knee osteoarthritis develops slowly over time and is made worse by obesity.  If you suffer from osteoarthritis of the knee, do not avoid exercise to avoid knee pain.  In the long run, weight loss will help you more than rest will.

Prosthetics like the preservation implant protect more healthy bone.  Not all procedures are equally invasive, and surgeries like the MAKOplasty may improve function and accelerate recovery.

The most severe cases of knee osteoarthritis are treated with a total knee replacement.  This highly invasive surgery involves removing large portions of bone in order to attach metallic prosthetic substitutes.  The surgery is highly traumatic and requires a lengthy recovery.  This makes a total knee replacement a difficult option for older or infirm patients because slow healing may make full recovery difficult or impossible.  Total knee replacements are also problematic for very young and very healthy people because the implants typically last only 5-10 years.  When the original prosthetic implant is replaced, even more bone must be removed to anchor the new, larger implant.  This means that a 50 year old man with severe knee osteoarthritis who has a total knee replacement can expect more highly traumatic surgeries every 5-10 years for the rest of his life.   As he ages and his healing slows down, the recoveries for each surgery will be longer as well.

Fortunately, a total knee replacement is not the only surgical option, even for the most severe patients.  Osteoarthritis affecting only one side of the knee has been effectively treated with partial knee replacements for many years.  Robotic technology has vast surgical applications, and has recently been employed in a new procedure called a MAKOplasty.  The MAKOplasty uses robotic arms to trim away only the damaged bone, and to create and implant a unique prosthetic that complements the healthy tissue.  This means that healthy, well vascularized bone is not removed, and so there is much less trauma and a faster recovery.

This procedure may not be appropriate for everyone but the MAKOplasty and other partial replacements could be a more conservative surgical treatment.  If your doctor recommends joint replacement surgery, ask about your options.  You may not need a total joint replacement to get the best results.

OA and Dysfunction

January 18, 2013

Inactivity can make knee osteoarthritis and pain much worse.

The word “dysfunction” refers to abnormal or impaired function, usually of a physiological system or social group.  With regard to osteoarthritis, generic dysfunction of an individual describes a present state below that individual’s potential; living a life of suffering and hardship when a better life is within your grasp.  Anatomical dysfunction such as severe knee deformities and knee pain can be a tremendous obstacle, but it is not insurmountable.  In the moment that your osteoarthritis prevents you from engaging in an activity, you face a broader and more damaging form of dysfunction.

A recent study at Northwestern university examined over one thousand patients with knee osteoarthritis.  Patients with severe knee dysfunction were roughly half as active as those without anatomical deficits.  While this may not seem extreme for individuals with severe deformities, what is frightening is that overweight individuals had the same levels of inactivity.  Obese patients showed even greater inactivity, at about a quarter of the activity level of lighter individuals still suffering from knee osteoarthritis.  Unfortunately, inactivity makes weight issues worse, and can propagate a cycle of inactivity and obesity that gets worse and worse.

But there is a silver lining:

Adjusting your activity level dramatically improves function.  An inactive (“dysfunctional”) individual can regain function and health by increasing their activity level.  If you are categorized as overweight or obese, you need not remain there.  Your ability to overcome obesity is limited only by your control over diet and exercise, because your knee pain and anatomical dysfunction will decrease with your weight.

So add some fiber to your diet.  Add a walk to your daily schedule.  And remember that slow, incremental change will keep you on the path to your goals.

OA and Vitamin D

January 10, 2013

Calciferol (vitamin D) is a commonly recommended dietary supplement. This does not mean that it can help all medical problems.

It is well documented that sunlight increases happiness.  It does so by helping in Vitamin D synthesis which increases the release of seretonin.  Vitamin D has also been shown to effectively treat rickets and other types of bone diseases like osteoporosis.  Vitamin D manufacturers often prey on the american public through advertisement campaigns that describe supposed benefits of Vitamin D that are not supported by scientific literature.  For example, some advertisers claim that Vitamin D reduces your risk of catching the common cold.  Most recently pharmaceutical manufacturers have claimed that Vitamin D can help treat osteoarthritis.  This is not true.

Recent research at Tufts Medical Center examined 145 people with moderate knee pain and gave half of them Vitamin D supplements and the other half a placebo.  They found that Vitamin D “did not make any difference over the two-year period to how much pain they experienced or the amount of structural damage that occurred to cartilage or to the surrounding bone”.

This does not mean that Vitamin D is bad for you.  Vitamin D has numerous health benefits and has no side-effects.  But this does not mean that Vitamin D will help your knee pain, and this research shows that it has no effect on progression of osteoarthritis.  So, while it is recommended to increase levels of Vitamin D, do not generalize its benefits accross all that ails you.  Consult your physician and seek proven treatment for all diseases or pathologies as necessary.

OA and pain

January 4, 2013

Knee pain is a common symptom of osteoarthritis, and can be debilitating.

Recent research by Dr. Malfait at Rush University has identified a key component of the mechanism of ostoearthritis pain.  Knee pain is felt in the lower extremity and then relayed through the spine up into the brain.  In the brain, pain from osteoarthritis is primarily interpreted by proteins and receptors called MCP-1/CCR2.

Several mice that were genetically altered to have deficiencies of MCP-1 and CCR2 experienced less pain when given osteoarthritis.  This observation is important because it looks into an unexplored area of potential treatment.  Instead of simply addressing the mechanical causes of pain (including inflammation and deterioration), this research offers the potential to directly reduce pain in osteoarthritis.

Any discussion of pain should include the healthy role of pain in the body.   Pain serves to relay information about injury, and so elimination of pain receptors could allow progression of ostoearthritis in joints, further worsening the joints.  The identification of MCP-1 and CCR2 offers the potential for the isolated treatment of osteoarthritis pain without compromising the healthy pain systems of the body.