Arthritis has existed for thousands of years. Over 50 per cent of the population have arthritis in one or more of their joints. By the time you are 75 years old, there is an 80 per cent chance that you will have developed arthritis somewhere, particularly in the larger joints such as the hip or the knee. Over 180 million people in Inda are affected by arthritis.
Arthritis can take various forms, most common being osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs due to wear and tear of the joint as people grow older. This is called natural degeneration. Rheumatoid arthritis is very different to osteoarthritis, affecting young people. The exact cause is unknown. It starts as an inflammation of the lining of the joint, which slowly becomes uncontrollable, resulting in joint destruction. There are several other conditions which can cause arthritis, but are fortunately rare.
The common feature of all forms of arthritis is a loss of smoothness of joint surfaces so that low-friction movement is replaced by irregular, gritty, high-friction agony. The joint changes, in turn, can cause changes to the muscles and ligaments surrounding the joint. Therefore, patients can also feel pain in other areas such as the back or even the ankle.
Effects of arthritis on the population
Arthritis is a major cause for concern for the whole population. It affects people when they are in the best their ability to contribute to the family, society and the nation. It not only affects the individual who has developed the disease, but also affects the relatives, friends, work colleagues and others, who must provide support for those have it. Quality of life plummets, income can fall and treatment is regularly needed.
Available treatments
For arthritis of any form, surgery is usually undertaken reluctantly. It is better, often safer, to manage the condition without an operation, if at all possible. Arthritis sufferers may try the effects of a range of treatments, including physiotherapy, aromatherapy, osteopathy, chiropractic, reflexology, acupuncture and diet. Despite these best efforts, patients may eventually struggle to keep pace as arthritis advances.
Hospital treatment can be either medical or surgical. Medical treatment involves prescription of drugs and other non-invasive therapies. Surgical solution can take many forms, starting from less invasive joint injection to a more invasive, total joint replacement. Some are widely performed, while others are to be found only in specialist centres. Despite the frequency of surgery, there are a few areas a patient may want to learn more about the relative merits and disadvantages of treatment options.
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Surgery
Over many centuries, surgeons have designed a number of operations to deal with the ravages of arthritis. Surgery must be reserved for only those, whose quality of life has deteriorated significantly and, who understand and accept the risks and benefits of the procedure planned. Surgery is not a pleasant prospect for anyone but for people with debilitating arthritis, it could mean a major difference between leading a normal life and putting up with a debilitating condition. However, the results of the operation are varied and depend on the skill of the surgeon. Responsibility also lies with the patient to help make a decision on surgery, as this a "quality of life" issue.
A number of tests, commonly blood tests, urine tests, x-rays and tracing of the heart (ECG) are performed before the operation. A reasonable level of health is required in order to undergo surgery, although in case of doubt, an anaesthetist is often asked to advise beforehand.
Joint replacement is widely performed these days and results are far superior to other surgical options. However, the artificial joint has its own life of approximately 15 years and, a revision surgery is eventually needed. Physiotherapy is a mainstay of early recovery in the immediate post-operative period. Full rehabilitation after surgery requires a concerted effort from the patient.
Finally, it is perfect to have worries and questions about your operation. Discuss your options in detail with your surgeon and ask your surgeon about any queries you have before the operation.
(By Dr Vijay D Shetty, Director, Department of Orthopaedics, Dr LH Hiranandani Hospital, Powai, Mumbai.)
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