There are many types of arthritis but the most common is osteoarthritis. This is a degenerative disease caused by wear and tear of the joints. It can affect different joints in the body including the hip and knee. Older people are most susceptible although osteoarthritis can develop at any age. Degenerative means the condition gradually worsens as time goes on, unless it is treated.
Osteoarthritis is due to a breakdown of cartilage in the joint as a result of injury or inflammation. Cartilage is the firm, slippery coating on the ends of bones which helps to reduce friction in the joints and act as a shock absorber. When it becomes worn or damaged, the body is unable to grow new cartilage and the bones can start to rub against each other, causing pain and stiffness in the joint.
The risk of developing hip and knee osteoarthritis increases with age. It is more common in people who are overweight as this places strain on the weight-bearing joints and also fat tissue produces proteins that can cause inflammation. Placing repeated stress on the joint – as the result of playing sport, for example – can lead to degenerative arthritis and so, too, can joint injuries. If you are born with deformed joints or defective cartilage you may also be more at risk.
The symptoms of osteoarthritis, which may develop slowly over months and years, include:
- Pain in the joint during or after movement.
- Stiffness particularly in the morning or after sitting still.
- Loss of flexibility in the joint.
- Bony spurs which can form around the affected joint.
- Tenderness and/or swelling in the joint.
- A grating sensation in the joint.
Alongside the pain and loss of mobility, osteoarthritis can lead to sleep disturbance and depression in many cases, as symptoms can hinder usual activities.
The consultant will carry out a physical examination to check your affected joint for pain, swelling and loss of flexibility. If osteoarthritis is suspected you may be referred for imaging tests to get a more detailed picture of the affected joint. These may include:
- X-ray, which can show up bony spurs and a narrowing of the space between the bones due to cartilage loss.
- MRI scan, which can produce detailed images of the bone and soft tissue and show up damaged cartilage.
- Blood tests may be used to rule out rheumatoid arthritis, which is an autoimmune condition.
- Joint fluid analysis is sometimes used to rule out infection in the joint.
Minimally invasive treatments will normally be recommended in the early stage of osteoarthritis.
This might include:
- Pain-relieving medication
- Certain types of antidepressants which have been shown to reduce chronic pain.
- Physiotherapy exercises can help to strengthen the muscles around the joint, as well as reducing pain and increasing movement and flexibility. Low impact exercises like walking or swimming may also help.
For more advanced osteoarthritis, there are a number of non-surgical and surgical procedures such as:
- Injections of corticosteroids directly into the joint to relieve pain.
- Injections of hyaluronic acid to help lubricate and cushion the knee joint.
- Knee osteotomy surgery to shift your body weight away from the damaged part of your knee. This involves cutting a wedge-shaped section of bone either above or below the knee.
- Joint replacement surgery – for the most severe cases of osteoarthritis, the best form of treatment may be to replace the damaged joint with a prosthetic implant. You may have partial or total joint replacement surgery, depending on the extent of the damage. Eventually, prosthetic implants wear out, after which you may need revision joint replacement surgery.