As an experienced orthopaedic surgeon Dr. Alf Neuhaus can confirm that osteoarthritis of the joints is, next to lower back pain, the most frequent health problem an orthopaedic consultant has to treat. Osteoarthritis is usually a slow on-going process and due to the missing nerve connection inside the joint, the initial phase of this disease cannot be felt.
Arthritis within a joint starts slowly with the loss of the elasticity of the cartilage, like a rubber cushion getting brittle over the years, and therefor losing the capacity to resist pressure. In addition the normal joint fluid, produced every day by the joint synovial tissue (the membrane around the joint), is losing its nutritious effects, eventually causing the cartilage to dry out. The cartilage gets weaker and thinner until it starts to break up in some areas. This results in part of the articular joint surface not being covered and protected anymore, leaving the bone exposed. Advancing further, these areas of exposed bone inside the joint get that big that the joint practically moves ‘bone on bone’.
The signs of the early stages of this disease are repetitive joint swelling following ‘on your feet’- activities, occasional warmth, aches or pains at night, or pain after sitting for a prolonged period of time. Alarming signs would be swelling of the joint in the morning, sharp pain on motion or decreased range of motion due to pain. Having experienced any of these symptoms one should consult a bone and joint specialist (orthopaedic surgeon) to verify the stage of the disease. Dr. Alf Neuhaus will perform a thorough physical exam as well as taking radiographic images of the joint(s) using the digital X-ray facility available in Clinica SANDALF. Regarding the knee joint in particular these radiographic images will be taken in standing position to show the true joint gap. A MRI scan, or other scans of the joint are usually not needed.
Should the arthritis be in an advanced stage (grade III or IV), a surgical procedure might be needed. In the early or moderate stage of the arthritis (I – II) conservative treatment would be the treatment of choice. Usually this consists in physiotherapy, specific exercise programs, non-steroidal (no cortisone) anti-inflammatory tablets, acupuncture, diet and similar. It might sometimes be necessary to support the conservative treatment by injecting Cortisone into the joint to reduce the inflammation.
Hyaluronic acid, comparable with a WD40 liquid, injected straight into the effected joint, has proven to be a very helpful ‘tool’ to treat the symptoms of early arthritis. It has first been used in 1942 as a bakery product. It is found in joint fluid, cartilage, tendons, hair, skin, lips and eyes. Hyaluronic Acid is a carbohydrate – sugar – which changes into a thick ‘jello’ by attaching itself to water. This gel covers the joint surface like a cushion and acts like a suspension. It also reduces the inflammatory reaction as the joint can move with less resistance (being ‘oiled’). This effect of one injection could last between 6 and 24 months, very much depending on how badly the joint is worn out. As a synthetic ‘oil’ without any chemical additives it has no side effects at all and can be repeated as desired.
The knee joint is the most often injected one, but Dr. Alf Neuhaus also frequently injects ankle, hip and shoulder joints. Even smaller joints like wrist and elbow can be injected, usually applying only half of the medication is used.
Unfortunately there is no healing potential inside a joint, destroyed or degenerative cartilage cannot re-grow. Hyaluronic Acid joint injections can’t change this fact either, but they have shown to reduce pain and increase joint mobility at least temporarily, allowing to return to some sport activities and restore some life quality. Ring our office Clinica SANDALF and make an appointment to find out if this injection would be of any benefits for you.