Transcription:
Arthritis and Joint Replacements: What You Need to Know

Scott Webb: Arthritis especially wear and tear arthritis is very common. Though there are things we can do to slow down the progression, we might eventually have to consider joint replacement surgery. And I'm joined today by orthopedic surgeon, Dr. Rishi Dave. He's here today to talk about arthritis and what he can do to help folks who are suffering from it. This is The Health Works here podcast for Emerson Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're gonna talk about arthritis. As I mentioned to you at 54, I'm very familiar with osteoarthritis, but we'll get to all that soon. Before we get rolling here, though, I wanted to have you tell us about yourself a little bit. What do you do? How do you do it? Tell us about your fellowship training, why that's particularly relevant to our conversation today?

Dr. Rishi Dave: orthopedics is the field in medicine where we are basically dealing with bone and joint surgery mainly. I've done that in residency and then I went on to do fellowships, which are elective, extra training. Elective meaning that people, surgeons can choose to do it after they've completed their residencies but are not, obliged to do it. And I've done fellowships in foot and ankle. And then most recently in arthoplasty, which is the term within the orthopedics world we use for hip and knee replacements. That's a very kind of common thing to talk about and yep, it involves arthritis like you were talking about.

Scott Webb: Yeah and, maybe rheumatoid arthritis is a little bit outside the scope today, but certainly with osteoarthritis, the wear and tear arthritis, I think many of us are familiar with that, especially when I wake up in the morning and I try to get out of bed. So just have you a baseline here. What is arthritis exactly, and is it just age or is it behavior, lifestyle, family history? Is it the whole sort of kit and caboodle?

Dr. Rishi Dave: That's a good question. So yeah, I think we can basically cover all our. Arthritis. Because in general terms, I can define it in a way that's kind of applicable to every type of arthritis, every joint in our body is where bones meet to allow movement. And where they meet, there's this cartilage coating of the ends of the bone. And that cartilage coating is nice. It has a certain thickness that, variable dependent on the joint we're talking about. And unfortunately for us with use and everything else it wears away and multiple factors add to the wearing away, which, involves use with time. So age is a factor. But certainly other factors play into it, like hard use or how Strenuously the joints have been used.

So ultramarathon runners might notice wearing away some of their cartilage a little bit quicker. Same with some high level athletes. kind of Counterintuitively Now that wearing away of that cartilage coating the end of the bone, that's arthritis in a nutshell. And there are many reasons for arthritis starting the general wear and tear form of arthritis, which is just what accumulates, that's osteoarthritis. It can occur for inflammatory reasons like rheumatoid arthritis or other like post-traumatic arthritis. But they all get to the point of basically being wear and tear of that cartilage surface. And as that cartilage wears away, the bone feels more pressure and you have pain nerve endings in bone, and people get all the symptoms that we're familiar with.

Scott Webb: Yeah. Good to understand, doctor, exactly what's going on and why it's happening. And of course, many of us probably nodding our heads listening to this thing. Yeah, you get to a certain age, the quality of life begins to suffer and there's things that we used to be able to do that we can still do, but we have more trouble and there's more pain. Let's talk about when someone's been diagnosed with any form of arthritis, but especially maybe the most obvious one for most people like osteo the wear and tear. What do you try to do before we get to surgery, which we'll talk about, but is that physical therapy, medications what do you try to do to help folks before surgery?

Dr. Rishi Dave: The answer to preventing arthritis is partly you can work on basically trying to preserve the cartilage as best you can, and that's basically prolonging the life of the cartilage that you do have in, all of your joints technically. Things you can do for it. The one most important factor that probably plays into it and comes up again and again is kind of a simple biomechanical thing, which is weight. So weight control and weight loss can play a really big part in preserving the cartilage we have and preventing any excess cartilage from being, worn down or the remaining cartilage should be worn down quicker.

So that helps. In addition, absolutely we try pretty much everything available, which includes anti-inflammatories. There are recommendations that I normally review with people, including from the American Academy of Orthopedic Surgeons and I would say that includes medications like Tylenol or acetaminophen, and also NSAIDs, which are non-steroidal anti-inflammatories. Now, generally speaking, I like to talk to my patients about how to use these because it's sporadic use when needed.

And then, if they do need a short course of more regular use, just making sure that we're watching for the important signs and things to just be cautious of. Other than that, I think healthy diet with anti-inflammatories included and light aerobic exercise are also really important to maintain. Light aerobic exercise is definitely a recommendation from most of our academies and have been shown to good all around. Joint motion is good and as is the weight loss that comes with that sometimes.

Scott Webb: Yeah, so it sounds like we can. Is sort of prevent arthritis or at the very least we can slow it down the progression of it. Kinda hold it back a little bit and sounds like some things to do to treat it along the way, as you say, some medications, losing some weight, light aerobics, things like that. Let's assume that we've tried all of those things and we get to the point where we're like, okay, doctor my quality of life, my life, my family, everything is suffering so much. I think I want to consider at least have a conversation about replacements of things. Be that hip, knee, or ankle. Yeah. So let's talk about that. I know that's right in your wheelhouse. Let's talk about joint replacement surgery. Maybe start with hip and let's go through these. What's involved recovery times and so on?

Dr. Rishi Dave: Generally, I also wanna mention that I welcome people and patients who come in anytime and talk to me anytime there isn't a right time or a threshold or barred across. It's whenever the questions pop up, that's the right time to come in and discuss it. Certainly the vast majority of the patients that come in and walk outta my office are not getting joint replacements. And certainly not right away. We try other things first including what we didn't. Expound too much on, but physical therapy and injections are a possibility, that's normally physician prescribed.

So that's one of those things that we can do when you come in. So in regard to patients, after they've tried these other options, If someone's tried these other conservative or non-operative options. And they're still having significant pain and we know that they have bone on bone arthritis, or severe arthritis. That looks like it's the reason for the pain. Then absolutely joint replacement is a good option. We've, in my field, certainly refined joint replacements. And they've come a long way.

They've been done for many decades already, and they've improved in many different aspects, including in the materials we use and also the techniques we use. In addition, we're also using robotics now for robotic assisted surgery for. Some improved alignment, at least getting rid of some of the outliers of alignment. So getting back to joints, where joints are, were bones meet and the loss of that cartilage is what's leading to the pain and changes in the bone. We basically handled a problem at the root of it, and that means replacing the bone surfaces at the joint.

Example for hips, the joint is basically the femoral head and the acid tabula from the pelvis. It's the closest to a bone socket joint we've got, and it functions pretty similarly. As the cartilage wears away, you'll actually see it on x-rays and the ball will basically approach the cup part of the joint, the s tabula and. After we've tried all those other options total hip, arthroplasty, or total hip replacement is a viable and great option for people.

We generally speaking with all joint replacements, replace the bone surfaces, and that means basically taking out the portions that are actually articulating and replacing them with the materials that we use. In the case of a total hip replacement that involves metal highly cross-linked polyethylene and also ceramic, which we use for the Femaral head in most cases nowadays. So total hip replacements work very well. Patients normally feel that their biomechanics are restored, and oftentimes total hip replacements are one of the. Best joints for replacements.

And a lot of patients forget that they had a hip replacement. That's not easy to do after a hip replacement. Certainly surgery is not something we jump to and it's a major thing. But to get to the point where it feels as natural as your own point is a good point to be at for patients. And it's very comforting for surgeons too when that happens, recovery does take a little bit of time but you are walking the same day after a joint replacement of the hip or knee and you can start walking the same day with new updated ambulatory protocols.

If you really feel like leaving the hospital and you're healthy and we make sure that everything checks out well. There's even the possibility of leaving the hospital the same day. And the acute recovery involves, healing the tissues around the joint. And with hip replacements there can be some restrictions in terms of what motions you do and the kind of movements. So you want to avoid like extreme motions. And certainly if you do yoga or anything like that you're gonna be avoiding that for a little bit of time.

Normally I say somewhere in the range of six weeks to three months if you're doing a posterior and for knee replacements. There isn't really too much to avoid. There's just some extra work to be done in terms of stretching it as soon as possible. In a way, joint replacements are treating arthritis and they're done for the purpose of pain that's originating from the joint due to the arthritis. So what they do by replacing the surfaces is basically replace the joint and thus the arthritis is also gone at the same time.

Scott Webb: Yeah, it's kind of a one stop shopping, right? Get rid of the arthritis, new hip, new knee, hopefully. Begins to feel like your old stuff, your original stuff. You know, ankle was on my list too, to talk to you about. I think most of us are really familiar with hip and knee replacements. It seems very common. Seems like everybody knows somebody. My mom had a knee replacement and so on, but just not as familiar with ankle replacement. Maybe you could just touch a little bit on that.

Dr. Rishi Dave: Ankle replacements have been around, but certainly have been less common than total hip and total knee arthoplasty. There's been a lot of development in the ankle world, I would say at a very quick pace, even outpacing a lot of orthopedic fields. And the biggest development in terms of ankle arthritis treatment recently has been the updated components that we're starting to use for ankle replacements. So I think ankle replacements have come a long way. And recently, within the last, now five to 10 years we've had some pretty good data showing that the modern ankle replacement components are lasting so far very well in people.

And so that's a big improvement from prior iterations of ankle replacements that had been done in, the eighties or nineties. So we've definitely gained a lot of ground in the ankle world regarding replacements. It's still not the go-to surgery for everyone, for ankles, certainly there's indications, there's some people that it's better suited for. And there's still other options for ankles. We still talk about the gold standard of ankle surgery, including ankle fusions because they work very well and they're as solid as could be after they're healed.

And certainly for people who are younger, active, heavy laborers or really, either high use athletes or just very active young people. Certainly fusions are more reliable in terms of longevity at this stage, but ankle replacements are certainly improving.

Scott Webb: Before we wrap up here, doctor, I wanted to ask you that my wife often jokes because my ankles crack so much that I would never have made a good cat burg, you know that. I'm just not someone who can surprise someone. I can't sneak up on anybody because of my ankles. Just wanted to ask you. For those of us who have joints that crack, which maybe more or less all of us, whether that's cracking going up the stairs or getting out of bed, that series of cracks that many of us experience in the morning, what are those cracks? Exactly. Are they a sign of something serious and should we maybe see a doctor about it?

Dr. Rishi Dave: That's a very common question. before I did orthopedics, I asked another orthopedic surgeon that myself, the answer I got was a little unsatisfying in that basically it's very non-specific. Cracks happen for a number of reasons and we hear a lot of different sounds associated with joints. The main thing I would focus my attention on is pain. So if you're having pain, then absolutely it's something to go get checked out and come in and see me anytime. Because I think that is something that could be an indication that there's something that needs to be treated in one way or another.

If it's completely asymptomatic and it isn't painful and you have a crack here and there, or a pop or some other sound, it's not something that inherently needs to be treated. I would say certainly if it's associated with pain or it's associated with even instability, where a joint moves in a way that it shouldn't be moving, then it's something to get looked at. It's not something to get too worried about if none of those other things are happening, and it's just kind the sound in and of itself.

Scott Webb: Yeah, the sound, it definitely is unpleasant, but I see what you mean. Like If the sound. Is accompanied by pain, then that's a good time to reach out to someone like yourself. If it's just that sort of funny thing where you're walking up the stairs and your knees and your ankles and everything's cracking, but you feel fine for the most part, then you know, just have a good laugh and move on. So thanks again, doctor. This has been awesome. You stay well.

Dr. Rishi Dave: Thank you very much. You too.

Scott Webb: And learn more about orthopedics at Emerson at emersonorthopedics.org. And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify, or wherever podcasts can be heard.