Osteoarthritis


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Spinal Arthritis

What is arthritis?

“Arthritis” is a general term that describes many different diseases causing tenderness, pain, swelling, and stiffness of joints as well as abnormalities of various soft tissues of the body. Of the combined term, “arthros” means a joint and its attachments, and “–itis” means inflammation. Various forms of arthritis affect nearly 50 million Americans and contribute to the majority of all physical disabilities.

Of the several varieties of arthritis, the most common, the most frequently disabling, and often the most painful is osteo- (meaning bone) arthritis, mostly affecting the weight bearing joints (hips and knees) plus the hands, feet and spine. Osteoarthritis is also known as degenerative joint disease and affects up to 30 million Americans, mostly women and usually those over 45 or 50 years of age.

Osteoarthritis of the spine
Spinal arthritis is one of the common causes of back pain. Spinal arthritis is the mechanical breakdown of the cartilage between the aligning facet joints in the back portion (posterior) of the spine that quite often leads to mechanically induced pain. The facet joints (also called vertebral joints or zygophyseal joints) become inflamed and progressive joint degeneration creates more frictional pain. Back motion and flexibility decrease in proportion to the progression of back pain induced while standing, sitting and even walking. Over time, bone spurs (small irregular growths on the bone also called osteophytes) typically form on the facet joints and even around the spinal vertebrae. Bone spurs are also seen as a normal part of aging and do not directly cause pain, but may become so large as to cause irritation or entrapment of nerves passing through spinal structures, and may result in diminished room for the nerves to pass (spinal stenosis). Osteoarthritis in the spine is anatomically divided into:

  • Lower back (lumbar spine) osteoarthritis, sometimes called lumbosacral arthritis, which produces stiffness and pain in the lower spine and sacroiliac joint (between the spine and pelvis).
  • Neck (cervical spine) osteoarthritis, sometimes called cervical spondylosis (spondy- implies the spine, and –osis is an abnormal condition), which can cause stiffness and pain in the upper spine, neck, shoulders, arms and head.

Causes of osteoarthritis and spinal arthritis
Repetitive trauma to the spine from repetitive strains caused by accidents, surgery, sports injuries, poor posture, or work-related activities are common causes of spinal arthritis. Other known risk factors for developing spinal arthritis include:

  • Aging: steady and advanced aging of spinal structures, beginning in the 30’s, often work-related
  • Gender: osteoarthritis being more common in post-menopausal women (although below age 45, it is more common in males)
  • Excess weight: causing more stress on weight-bearing joints and the spine, particularly during the middle age years
  • Genetics: having a family history of osteoarthritis or congenital defects of joints, spine, or leg abnormalities
  • Associated diseases: the presence of other associated diseases, infections, diabetes, and various other forms of circulating arthritis, such as rheumatoid arthritis or gout

Surgery for spinal arthritis
For spinal arthritis, the only effective surgical treatment is spine fusion surgery to stop the motion at the painful joint. Spinal fusion may also be referred to as “arthrodesis”. Fusion is a surgical technique in which one or more of the vertebrae of the spine are united together (“fused”) so that motion no longer occurs between them. During spinal fusion surgery bone grafts are placed around the spine during surgery. The body then heals the grafts over several months – similar to healing a fracture – which joins, or “welds,” the vertebrae together.

When Is Fusion Needed?
There are many potential reasons for a surgeon to consider fusing the vertebrae. These include: treatment of a fractured (broken) vertebra; correction of deformity (spinal curves or slippages); elimination of pain from painful motion; treatment of instability; and treatment of some cervical disc herniations.

How Long Will It Take To Recover?
The immediate discomfort following spinal fusion is generally greater than with other types of spinal surgeries. Fortunately, there are excellent methods of postoperative pain control available, including oral pain medications and intravenous injections. Another option is a patient-controlled postoperative pain control pump. With this technique, the patient presses a button that delivers a predetermined amount of narcotic pain medication through an intravenous line. This device is frequently used for the first few days following surgery.

Recovery following fusion surgery is generally longer than for other types of spinal surgery. Patients generally stay in the hospital for three or four days, but a longer stay after more extensive surgery is not uncommon. A short stay in a rehabilitation unit after release from the hospital is often recommended for patients who had extensive surgery, or for elderly or debilitated patients.

The decision whether or not to undergo spinal fusion is complex and involves many factors related to the condition being treated, the age and health of the patient, and the patient’s anticipated level of function following surgery. This decision must therefore be made carefully and should be discussed thoroughly with your surgeon.

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Note: All information presented here has been obtained from publicly available medical resources and is here for reference purposes only. Healthbase does not claim to be a medical professional and does not provide any advice on any issues relating to medical treatment.

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 Hip Replacement

More than 270,000 hip fractures occur in the United States each year, with about 90% of them occurring in people older than 60. Hip fractures are more common in older people because of osteoporosis and because older people are more likely to fall. Use of some drugs increases the risk of hip fractures in older people (see Aging and Drugs). One in three women and one in six men who reach age 90 will fracture a hip during his or her lifetime.

The upper end of the femur (thighbone) has large bony bumps (trochanters) where powerful muscles attach, then a short neck, and finally a spherical head that forms the outer half of the hip joint. Most hip fractures occur just below the spherical head (femoral neck or subcapital hip fractures) or through the trochanters (intertrochanteric hip fractures).

Femoral neck hip fractures are particularly problematic because the fracture often disrupts the blood supply to the femoral head, which forms the hip joint. Without a good blood supply, the bone cannot heal and eventually collapses and dies. Intertrochanteric hip fractures tend to create large broken bone surfaces that cause internal bleeding.

Symptoms and Diagnosis

Most older people fracture their hips by falling while walking on level ground, often when indoors. They usually cannot move their leg, much less stand or walk. When a doctor examines the person, the leg appears shortened and turned outward because of the unbalanced pull of muscles and gravity. Swelling and a purplish bruise develop because of blood leaking from the fracture.

An x-ray usually shows an obvious fracture and can help a doctor confirm the diagnosis. However, faint fracture lines may not be seen initially on x-ray. Thus, when a person continues to have pain and is unable to stand a day or more after a fall, the x-ray may have to be repeated or a magnetic resonance imaging (MRI) or bone scan obtained.

Treatment

Most people with a hip fracture are treated with surgery. The type of surgery depends on the type of fracture.

 

Repairing a Fractured Hip

Repairing a Fractured Hip

There are two common types of hip fractures. Femoral neck or subcapital hip fractures occur in the neck of the femur. Intertrochanteric fractures occur in the large bony bumps (trochanters) where the powerful muscles of the buttocks and legs attach. When the fracture is not too severe, metal pins can be inserted surgically to support the femoral head. This surgical procedure preserves the person’s own hip joint.

Treatment of severe femoral neck hip fractures involves removing the broken pieces surgically because the blood supply to the femoral head has been damaged. If damage to the femoral neck is incomplete (the break does not go all the way through), metal pins can be inserted surgically to support the femoral head (internal fixation). This is a smaller surgical procedure and the person’s own hip joint is preserved.

Intertrochanteric hip fractures are treated with an implant, such as a sliding compression screw and side plate. This implant securely holds the bone fragments in their proper position while the fracture heals. The fixation is usually strong enough to permit the person to bear weight as tolerated. While the bone fragments generally heal in a couple of months, most people continue to improve in terms of comfort, strength, and walking ability for at least 6 months.

If partial hip replacement is needed, special metallic implants are used that have a polished spherical surface to match with the joint socket and a strong stem to fit within the central marrow canal of the thighbone. Some prosthetic implants are secured to the bone with a rapid-setting plastic cement. Others have special porous or ceramic coatings into which the surrounding living bone can grow and bond directly.

 

Replacing a Hip

Replacing a Hip

When the topmost part (head) of the thighbone (femur) is badly damaged, it may be replaced with an artificial part (prosthesis), made of metal. This procedure is called partial hip replacement. Very rarely, the socket into which the femoral head fits (forming the hip joint) must also be replaced. The part used is a metal shell lined with durable plastic. This procedure is called total hip replacement.

After joint replacement surgery, the person usually begins walking with crutches or a walker immediately and switches to a cane in 6 weeks. However, artificial joints do not last forever. The person, especially someone who is active or heavy, may need to undergo another operation 10 to 20 years later. Joint replacement is often advantageous for older people, because the likelihood that additional surgery will be needed is very low. In addition, older people benefit greatly from being able to walk almost immediately after surgery.

Sometimes the whole joint needs to be replaced. This procedure is performed rarely for fractures, but most commonly for osteoarthritis (see Osteoarthritis (OA)).

If people with hip fractures are forced by their illness to stay in bed, they are at increased risk for serious complications, such as bedsores, blood clots leading to pulmonary embolism, mental confusion, and pneumonia. A great benefit of surgical fixation is that it allows the person to get out of bed and begin walking as soon as possible. Usually, the person can take a few steps with a walker 1 to 2 days after the operation. Physical rehabilitation is started as soon as possible

Sources:

http://www.merck.com/mmhe/sec05/ch062/ch062d.html

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