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Delaying the need for joint replacement, the "last resort" for Osteoarthritis patients

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CHILDRENSHOSPITAL.ORG
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Thirty to sixty percent of people who undergo surgery for an ACL injury develop Osteoarthritis within five years, and a University of Delaware researcher is trying to understand why.

Thomas Buchanan, the director of UD’s Delaware Rehabilitation Institute, has been examining X-rays for early stages of joint deterioration - or Osteoarthritis. He said early signs of Osteoarthritis caught on X-rays could project issues within five years, leading patients to seek artificial joint replacements.

“And that’s a problem because people who tear their ACL do so at about the age of 20,” Buchanan said. “That means by 25, we’re seeing them start to have [Osteoarthritis] and then by 30, they’re having pain; at 35, that’s way too young to have artificial joints put in.”

Common traditional treatments for Osteoarthritis include prescribed medication and ointments; and Steven Dellose, an orthopedic specialist at Christiana Care Health System, said there are other options as well.

“Whether it’s surgery such as ACL surgery which tries to restore some of the mechanics of the knee, all the way to losing weight, which decreases joint reactive force across the joint, those things typically should help slow down the progression of arthritis,” Dellose said.

Joint replacements, Dellose said, are a last resort.

“Joint replacement is a pretty big operation and carries risks and doesn’t reverse time,” Dellose said. “It’s not going to give a lot of patients exactly what they want. It might restore their function, it might get rid of their pain, but it certainly won’t make them 25 again.”

Dellose said operation risks include infection, blood clots, fractures, residual pain, or even death.

According to Health Grove, which draws from the Centers for Medicare and Medicaid Data, the Delaware was reported to have a 30.7 prevalence of arthritis (including Osteoarthritis and Rheumatoid Arthritis – an autoimmune arthritis) in 2013. A similar Center for Disease Control report claims 26 percent of Delawareans have arthritis. Adam Marmon, a physical therapy professor at UD, said about 8 percent of this group is in the 18-44 demographic, which is concerning.

“The pain and functional impairments associated with arthritis can be debilitating, leading to reduced activity levels and lower quality of life,” Marmon said. “Seeing a prevalence of 8 percent of the population, which equates approximately 15,000 plus in Delaware under the age of 45, is concerning for such a young cohort.”

Buchanan and his collaborator, Lynn Synder-Mckler, a professor of physical therapy, are measuring the way people with early signs of Osteoarthritis walk over a five-year period. Subjects that have early stages of arthritis exhibit a different force on their joints than subjects that don’t have it, he said.

“That’s what seems to be the strongest correlate with them ultimately getting arthritis,” Buchanan said.

His goal is to help fix the walking style of those with early stage arthritis and delay the need for more serious treatment, like artificial joints.

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