Treating osteoarthritis to avoid functional limitations

Dr. Reverberi, what are the conditions you encounter most often?

The diseases most frequently encountered orthopedic nell’ambulatorio are undoubtedly those of arthritic type. The increasing age of the population has meant that the arthritic disorders have become more frequent and more severe. In Italy the number of people affected by osteoarthritis is about 4,000,000; over 75 years resulting affected 67.9% of women and 49.6% of men. costs related to arthritis therapies currently amount to about 7 million with a global annual spending, per capita, of 455 Euro. Those who suffer from arthritis also has functional limitations, that has movement disorders that are reflected in performing daily activities or work. For this reason, the problem is assuming increasing importance and proportions.

Is it possible to heal arthritis?

Much can be done to prevent osteoarthritis; once established, arthritis can be cured but, until now, you can not heal completely.

Moderate exercise allows you to keep your joints healthy and in good condition. Instead articular overload can lead to premature wear; such as a sport too intense or a deviation of the anatomical cause the concentration of loads that alter the normal balance between consumption and production. The joint behaves in a manner similar to the tire of a machine: if the car is traveling at very high speed, or if the toe of the wheel is incorrect, the tread tends to wear out soon. Similarly the articular cartilage thins, if the load to which it is subjected is excessive.

For the same reasons the weight plays a major factor in arthrosis. The overweight person submits the articular cartilage in efforts that determine wear faster than normal, that sooner or later will manifest with pain that will tend to reduce the motor activity and work skills.

So if osteoarthritis can not be cured, what can you do to relieve the pain?

An effective treatment should be able to remove the cause of the disease.

If the problem is related to inflammation (such as in the case of un’artrosinovite lag) is logical to use anti-inflammatory drugs. If, however, the pain of mechanical origin (eg in case of a deviation of the limb, congenital or post-traumatic), the problem should be solved mechanically and then also surgically.

Depending on the type and severity of osteoarthritis then you can choose a nonoperative treatment (physical therapy, infiltration, braces, etc.) Or bloody (arthroscopy, osteotomy, joint replacement, etc.).

What role do the infiltration?

In the treatment of osteoarthritis initial or moderate severity infiltration can be used to reduce the painful symptom. The infiltrations are most commonly used in the joints are those with corticosteroids and those with hyaluronic acid. While those with cortisone aim to remove or at least reduce the inflammatory component that causes pain, those with hyaluronic acid (also called viscosupplementation because it increases the amount of joint fluid) allow better lubrication and therefore the better sliding of the articular surfaces. The hyaluronic acid is in fact a viscous liquid present in the joint fluid, which facilitates the sliding of the cartilage surfaces. Does not rebuild the articular cartilage, as some patients mistakenly think. So the best indication is for the treatment of patients with arthrosis phenomena initial or chondropathies (cartilage erosions) of degree not higher. In severe osteoarthritis overt should not be used except in cases where a replacement surgery is contraindicated

The products and food supplements chondroprotecting orally have useful functions?

A normal person, with a balanced diet, already assumes all precursors of cartilage and therefore does not require further contributions. The oral intake of the precursors of cartilage makes sense only in people who have disorders of absorption (and therefore require a higher intake than the norm); apart from these rare cases, it has not been shown that a supplement reduces osteoarthritis. There is no scientific literature based on evidence that justifies the use in osteoarthritis occurred.

What are the most frequent interventions in case of severe osteoarthritis?

The severe osteoarthritis, which does not respond to any medical care and physical properties for a period of time of at least 6 months, is an indication for surgery. If the patient is over 60-65 years and the pain and joint limitations are important, the intervention of choice for the hip and the knee is the joint replacement.

The hip replacement has become a routine procedure and is to replace both components (femoral head and acetabulum) with metal parts (generally using special alloys containing titanium) in contact with the bone and ceramic at the level the joint. The joint made using the coupling ceramic-ceramic is currently the most widely used because it seems to give the best results as durability, safety and reliability.

What are the characteristics of your prosthetic surgery in Villa Verde?

Now the knee replacement has become a common intervention, currently the most frequent of the same hip.
In fact, inVilla Verde my team and I, perform more arthroplasty of the knee that hip replacement. The use of careful surgical technique, an appropriate antibiotic prophylaxis and postoperative meticulous controls allow us to have never had cases of post-operative infection. This achievement is certainly the result of teamwork and cooperation of all the various services of Villa Verde (not only doctors, nurses and physiotherapists but also of the administrative and support staff).

There are other interventions usually realized and that characterize your team?

My team, in addition to realizing the most common orthopedic surgery (hip and knee joint replacement, arthroscopy of the knee and shoulder, hand surgery, foot and shoulder, etc.), is characterized by the habitual use of techniques minimally invasive and the Ilizarov technique.

The minimally invasive techniques allow us to do complex surgery (osteotomy, bone resections, etc.) Using a small hole in the skin through which is introduced a mini-cutter that can cut the bone and appropriately modify the shape. This saves damage to the soft tissues (tendons, muscles, etc.) Surrounding the bone, bleeding is minor and functional recovery is significantly faster. The surgery of the foot and the hand he had a great benefit. The correction of hallux valgus, for example, in our department is now routinely done with minimally invasive technique.

The Ilizarov technique allows us not only and not so much to treat serious problems such as those constituted by the pseudarthrosis (fractures that do not consolidate months apart) but also to perform stretches of bone segments (for example, elongation of the metatarsals to correct the Brachymetatarsia, ie the brevity of congenital one or more metatarsals). One action which exploits the Ilizarov technique, and that is very effective is the lengthening of the phalanges of the fingers. In the case of a finger amputee with a mini-external fixator manage to slowly lengthen a phalanx residual to recover the original length (see figure) improving both the appearance that the functional one. In Italy there are very few centers, including university, who have experience in this type of intervention and for this reason patients come to us from all regions.

Unfortunately for talking about these interventions it would take much time and argument, I think, would affect only a few people. We present only so few pictures of the possibilities offered by modern Orthopedic Surgery, leaving the reader interested in the subject the opportunity to ask questions by sending a message to the e-mail: