We have provided a
page of information on osteoarthritis because of its prevalence and relative lack of knowledge regarding potential for treatment in
the general population.
is the most common of many forms of arthritis which can affect people. It is estimated that 50% of people over 50 years of
age have osteoarthritis. Although common and a potential source of reduced function there is a lot one can do about arthritis
to relieve its symptoms and maintain or increase function.
progresses over time and is responsible for a significant cause of treatable disability as a person ages. Decreasing function
promotes further loss of function in the joint(s) involved which in turn promotes further disability. The osteoarhtritis cycle
spirals downward unless proper intervention to support the affected joint(s) is instituted.
Although we do not know
the exact mechanism of how osteoarthritis is initiated, the process involves the breakdown of the molecular scaffold which
makes up the cartilage lining of the joint structures. This allows the water normally trapped within the scaffold
to be released changing the properties of the cartilage and resulting in significantly increased friction during normal
joint movement and decreased resilience to compression. This in turn leads to further breakdown of the cartilage and
a vicious cycle of degradation in osteoarthritis. Once the cartilage is degraded, excessive pressure is transmitted to the
bone surfaces which are usually protected by the cartilage. This leads to characteristic changes in the bone which lead to
joint deformation and dysfunction including pain, swelling and restricted range of motion. This is the classic definition
of osteoarthritis. The pain and stiffness leads to decreased use of the joint resulting in a weakening of the surrounding
muscles. Muscles which act on a joint not only move the joint but provide it with appropriate support and shock absorption.
With decreased use of the joint the affected, muscles lose this ability resulting in a loss of joint protection and further
Causes of osteoarthritis
include congenital or developmental defects in a joint, previous acute or repetitive trauma or infection of the joint, heredity
and other unknown factors.
Osteoarthritis is diagnosed on clinical grounds through a medical history and physical examination. The diagnosis
is supported or confirmed by investigations including x-rays, bone scans, CT and MRI. The most common joints of the peripheral
skeleton include the knees and hips and hands. Most of these cases will not require surgery. Osteoarthritis of the neck and
back are extremely common. Osteoarthritis of the spine rarely requires surgery and is very amenable to rehabilitation and
other conservative measures.
Currently there is
no known way of reversing osteoarthritis once it starts. The treatment of osteoarthritis involves providing biomechanical
and chemical support to the joints involved and treating the pain stiffness and swelling as necessary. The goal
is to maintain function and slow down the further breakdown of the ostearthritic joint. This may delay or completely eliminate
the need for surgery including joint replacement.
The most important factor in treating osteoarthritis is trying
to maintain adequate biomechanical support and stability for the joint while providing relative rest of the joint.
This is achieved through a comprehensive program of flexibility and strengtheningprogram provided through physical rehabilitation.
Specialized rehabilitation techniques such as aquatic therapy, available at The Toronto Centre for Sports Medicine provide a unique and unmatched method of rehabilitation of osteoarthritic
Chemical support of the joint can be achieved through the oral intake of glucosamine
and chondroitin(two of the molecular building blocks of the cartilage scaffold) which are available
as over the counter supplements in pharmacies and health food stores. While there is a lot of controversy as to whether they
are effective, many studies backed by clinical experience seems to indicate that they can help relieve inflammation and pain
and may help to slow the progression of osteoarthritis. It is too early to say whether these products can reverse the osteoarthritic
process to any degree. The good news is that they have very few side effects and are fairly inexpensive. There is not much
to lose in trying them. These supplements are generally contraindicated in diabetics or people on blood thinners.
is the injection of hyaluronic acid (another molecular building block of the cartilage scaffold)
into a joint. It functions similar to glucosamine and chondroitin and has been found to relieve inflammation and pain
and preserve joint function. There are many products available on the market, often covered by extended
health plans. These products are injected during a short office procedure which is no more painful than receiving an immunization.
The effect of these injections may last up to six months at which time they can be repeated. Patients with moderate osteoarthritis
have obtained significant relief and attained increased function of the injected joints. The most common joint injected is
of the products we have injected extensively at our centre is Durolane. We are very excited about such products because the ease of administration, the low rate of side effects (virtually
none) and the excellent functional results patients have obtained. You can read up on its qualities and potential side effects
by clicking on the link. Viscosupplementation should be considered in anyone
with mild to moderate osteoarthritis especially of the knee.
of osteoarthritis involves further support of the joint through biomechanical interventions beyond physiotherapy. This may
include soft over the counter braces, splints, orthotics, osteoarthritis unloader braces etc. These braces
provide further support of the joints over and above optimal muscle functioning. The effects can be dramatic. The information
for these products is available by clicking on the following links and selecting osteoarthritis unloader bracing if not readily
visible: Ossur, Donjoy. You may also visit our web page on custom osteoarthritis knee braces.
With regards to all the interventions
listed above, the earlier the interventions are instituted in osteoarthritis the more effective they will be in providing
joint preservation and joint function.
In summary osteoarthritis
is very common in our population. Effective treatment of osteoarthritis is available. This is achieved through a comprehensive
assessment of the joint and prescription of appropriately timed supportive exercises, chemical and biomechanical supports
as necessary. We are always excited to see our patients increase their function and reduce their pain and disability as a
result of our assessment and treatment suggestions.
If you think you have osteoarthritis it is important to be assessed as soon as
possible so that the appropriate interventions can be instituted as early as possible. This will maximize joint preservation