Taking Care of the Joints

“I do not want to undergo surgery, Doctor! Please give me medicines and suggest few exercises” said the plump, bow-legged grandmother of two. “That probably could have worked for you a few years ago, Ma'am. It's too late to avoid surgery now”, I said.

This is a scenario I encounter in my practice nearly every day. What couldn't have worked for the grandmother, may work for some other person.

Let's discuss the potential problem joint pains.

Every typical joint in the body has layers located next to each other of something known as the hyaline cartilage. This is a very smooth, glistening layer of whitish cartilage that gives the joints a uniform surface for motion. As long as this surface is intact and well lubricated, a person is fine.

Osteoarthritis is a condition wherein this smooth layer of cartilage starts eroding and isn't efficiently replaced by the body. As a result, the thickness of this layer decreases until one day, the underlying raw bone is denuded. The surface becomes uneven and not conducive for smooth unhindered movements. This causes pain and creaking noise.

The condition typically progresses through stages:

Stage 1 is characterised by minimal or no pain and a near-normal X-ray. There is some softening of the cartilage and this is reversible.

Stage 2 consists of a slight reduction in the cartilage thickness and a mild to moderate pain. Exercises, weight reduction, activity modification would be helpful in this situation.

Stage 3 shows more thinning of the cartilage and definitive degenerative changes in the joints on X-ray. The pain is more pronounced and there might be a slight curvature appreciated in the knee. An injection of Hyaluronic acid in the joint, coupled with exercises and activity modification are warranted.

Stage 4, as in the case of aforesaid grandmother, will mandate a surgery as the cartilage has completely been eroded, at least in patches, causing more pain and progressing deformity in the joint.

Risk factors

So, coming to the matter at hand, how to retard the progression of these stages? How to postpone or avoid surgery altogether? What are the Dos and the Donts? Here are some of the factors to consider.

Identify yourself

Some people tend to bald early, some develop grey hair early. Similarly, there are genetic and hereditary tendencies at developing osteoarthritis early. If your parents or immediate relatives have had early osteoarthritis, chances are that you will, too. So be alert and identify yourself early.

Age

Age takes a toll on your body in multiple ways. Changes occur in practically every organ, ranging from the brain to toenails. Lifestyle modifications are a must in everyone after the age of 45 to delay osteoarthritis.

Weight

With every step that you take, your weight- bearing joints carry the burden of your body weight; mainly the knees and to some extent the hips and ankles bear the brunt of those additional kilos. It is recommended to maintain healthy body weight to protect the joints.

Gender

Research studies have shown that women have a higher tendency to develop early osteoarthritis compared to men, due to mechanisms that are yet unclear. So, if you are a middle-aged woman, it is time to be extra cautious about your joint health.

Inflammatory Arthritis

Certain inflammatory arthritis like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and gout may lead to early degeneration of the joints. If you have unexplained joint pains and stiffness, even at a very young age, please consult the orthopaedic doctor or the rheumatologist at the earliest to get a diagnosis. If you have one of the above-mentioned conditions, targeted therapy is essential to slow down the progression of these potentially  crippling diseases.

Preventing joint problems

With risk factors aplenty, it's not possible to fight all these demons and live through the age of 80 without undergoing this surgery. Or is it? There are various ways to ensure the health of your joints till the very end. Let's take a look at some of these.

Diet

Diet plays a vital role in all bodily functions. A well-balanced diet not only gives you a healthy body, but it also helps in a general feeling of well-being.

Omega-3 fatty acids - Fish and fish oils are a rich source of omega-3 fatty acids. All types of fish have Omega-3 in varying amounts. Noteworthy Indian fish that are rich in Omega-3s are halibut (Bakas), herring (Hilsa), mackerel (Bangda), Indian salmon (Rawas) and so on.

Vegetarians - don't be disheartened. Nuts like almonds, walnuts, flax seeds also have considerable amounts of omega-3 fatty acids. It's a good idea to incorporate some in your diet.

Brassica vegetables - Vegetables of the brassica family including broccoli, cabbage, cauliflower and kale. They are known to reduce the inflammatory markers associated with arthritis. They also provide with the much needed dietary fibre.

Fruits - Certain fruits such as Blueberries are rich in anthocyanin, a powerful flavonoid which reduces inflammation.

Apples are a fibre- rich, anti-inflammatory fruits that have multiple health benefits. Pineapples are rich in bromelain, an anti- inflammatory nutrient which reduces joint pain and swelling. It's recommended to not discard the core of this fruit, as it's richer in bromelain than the rest of it. Tomatoes are rich in lycopene, a powerful antioxidant.

Cooked tomatoes are richer in lycopene concentration than raw ones.

Beans and lentils - Black beans, soybean, chickpeas and lentils are an excellent source of the anti-inflammatory anthocyanin, in addition to being rich in protein and fibre.

Garlic and root vegetables - Root vegetables like garlic, onions, ginger and turmeric have anti-inflammatory properties.

exercise combined with a balanced and healthy diet can help in weight reduction, which in turn reaps dividends in slowing down the process of osteoarthritis.

Certain activities like high impact exercises, however, can cause more harm than benefit to the mildly arthritic knee, furthering the progression of the disease. It is therefore advisable to consult a physiotherapist regarding which exercises to be done and the ones to be avoided.

Obesity is another important factor which hastens the degeneration of the knee. The burden of the extra weight falls squarely on the knees with each step that you take, and hence it is of utmost importance to keep one's weight in check. Cardiovascular exercises and diet may help the cause.

Swimming and cycling are excellent low impact activities that can help burn those extra calories without being harsh on the body.

Lifestyle changes

Activity modification may often be needed to slow down the process of degeneration. Squatting, sitting cross-legged and stair climbing should be avoided as much as possible. Squatting and getting up from a cross-legged seated position puts a lot of stress on the knee cap, vigorously rubbing it against the lower thigh bone. These activities hasten the degeneration of the patellofemoral compartment (the front of the knee between the kneecap and the thighbone) of the knee.

Surgery

These are a few but important measures one can take to prevent the progression of osteoarthritis to the final stage. Despite the best efforts, however, many people find themselves at the wrong end of the disease spectrum. So does life stop there? Do such people never have painless knees?

About fifty years ago, the answers to these questions would have been disheartening. The world has come a long way since then and new technology and technical expertise is now available to relieve knee pain. Today, various surgical methods are available to treat severely arthritic knees with the help of joint replacement implants that are world- class and time-tested.

The implant, once placed, is good to use for about thirty-five years, which for practical purposes is a life-time of durability. The knees look straight, they are pain-free and barring a couple of dispensable activities, the person can perform his or her daily routine with much ease.One of the common concerns about the surgery and the outcome is Diabetes. It is important to check and keep your blood sugar levels within range to gain the best results of the surgery.

To conclude

Osteoarthritis is a condition which needs a proper understanding and appropriate precautions to prevent progression. It is recommended to seek timely medical care to know about your joint health and prevent further complications.

Dr Hrishikesh Patkar is an orthopaedic and a joint replacement surgeon.