(light upbeat guitar music)
- Arthritis is the degeneration
of a joint over time.
Hi I'm Paul Toogood I'm one of
the orthopedic surgeons here
at San Francisco General Hospital.
I am a trauma surgeon which means
I take care of injured patients
but I'm also a joint replacement surgeon
which means I help people with arthritis
specifically of their hips and their knees.
A joint is any place where two bones come together
and the caps, or the ends of those bones,
is covered with cartilage.
And cartilage is a special tissue for two reasons.
Number one it's a very smooth tissue
and it moves past each other with very little friction
and number two it's a tissue that doesn't have
any nerve endings in it and so
when those two pieces of cartilage at a joint
move past each other, there's generally no feeling
at all experienced by a person.
Arthritis is the loss of that cartilage
at the ends of bones and so when you lose cartilage
what remains is the two bones themselves rubbing together
and unfortunately bone has neither
of the two qualities that cartilage does.
It is not a smooth surface, it's a rough surface
and also it is a surface
that has many nerve endings in it
and unfortunately when rough surfaces in the body
rub past each other people sense that as pain.
So there are multiple causes of arthritis.
So again, arthritis is just a generic term
which means destruction of the joint
but there are multiple things that can cause
destruction of the joint.
So the most common cause of arthritis
is osteoarthritis and what that term means
is that all of us over time experience
a slow degeneration of the joint
simply from the use of those joints.
And the more we use those joints,
and the longer we use those joints
the tread on our joints, just like the tread on a tire
can go away and that's what
osteoarthritis essentially is.
It's a mechanical process that occurs over time
for all of us.
So another common cause of arthritis
is inflammatory arthritis.
So whereas we think of osteoarthritis
as mostly a mechanical phenomenon,
inflammatory arthritis or as an individual
has more inflammation in their body then normal
when there's a lot of inflammation in a joint
it can lead to the destruction of that joint
over time more rapidly then we would normally expect.
Common examples of inflammatory arthritis
would be rheumatoid arthritis, psoriatic arthritis
associated with psoriasis,
and also ankylosing spondylitis
which is a form of again, systemic inflammation
that tends to affect young men.
Rheumatoid arthritis most commonly affects young women.
So whereas osteoarthritis typically affects
anyone over a certain age, rheumatoid arthritis
typically is first noticed in women
in their 20s, 30s, 40s, and if left untreated
can affect multiple joints in their body quite rapidly.
The primary symptom of arthritis, of any type, is pain.
So patients who come to our clinic with arthritis
almost always the number one complaint
is pain in the knee or pain in the hip,
and again, that is shared by arthritis
regardless of the cause.
Other symptoms that people might notice
is they may notice a subtle deformity of the limb
so people with arthritis, of the knee in particular,
can notice that they may be becoming
more bowlegged or more knock-kneed slowly over time.
Patient's will also complain of stiffness,
so a lack of motion at the joint
as compared to what it was prior
to the development of their arthritis.
Patient's will also sometimes notice
with hip arthritis a leg-length discrepancy
which means they'll actually notice
that the leg that is affected by their arthritis
can be slightly short compared to the other side
that does not have that problem.
Arthritis in all of its forms is not a disease
that we can stop and it's not a disease
that we can completely halt the progression.
It is fortunately a disease that despite its progression
we can symptomatically control, usually for
a long period of time, before major interventions
have to be undertaken.
Most pain is self-limiting.
So if you stub your toe on the way out the door
that pain resolves.
The pain with arthritis unfortunately is not like that.
It does not spontaneously go away
and that's because the disease itself
does not spontaneously go away.
So arthritis unfortunately slowly
gets worse and worse over time
and people's symptoms in general
get worse and worse over time.
So the treatment of arthritis is basically into two buckets.
There is nonoperative management
and then there is surgery.
The reason we usually start with nonoperative treatment
is because it is very low risk.
Common nonoperative treatments for arthritis
include activity modification, which is a fancy way
of saying, just avoiding activities that bother it.
So if going up and down stairs
is particularly troublesome patient's can do
simple things like finding an escalator
or finding an elevator if that's a possibility.
Besides activity modification there are also
common medications that are used
for the treatment of arthritis.
These are things that are available over-the-counter
without a prescription from a physician
and these include antiinflammatory medications
like Advil, naproxen, ibuprofen, and then also TYLENOL.
In addition to medications other things
that patient's will frequently try
are braces, particularity around the knee,
to help stabilize that joint.
That can provide some people with some relief
and also physical therapy.
Physical therapy doesn't reverse the process
of arthritis but it can strengthen the muscles
and the tendons around the joint
and that can provide people with some symptomatic relief.
The final nonoperative treatment
that we have in our arsenal are steroid injections.
Steroid injections basically take a large dose
of antiinflammatory medication
and put it right to where it's needed in the joint
and that can provide people with several weeks
to several months of quite effective pain relief.
So the decision to have surgery is one
that is really made by the patient,
although the physicians certainly will guide them
to an appropriate choice.
The primary driver of when to have surgery
is not how good or bad an x-ray looks,
it's how severe the patient's symptoms are,
again specifically pain, and how well
that's being managed with nonoperative treatment.
So if someone still feels like
they're able to do most of their activities
and function at a high level with nonoperative management,
then we continue on with nonoperative management.
However most people will get to a point over time
where they find their symptoms intolerable,
whatever that means to them.
They are unable to do the things
that they wanna do, function at the level
that they wanna function
despite attempting nonoperative management.
And that's the point where we start
to talk to them about the risks and benefits
of surgery and whether or not a surgery
would be the correct option for them.