Conditions & Treatments

Post-Traumatic Arthritis

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)This is arthritis that results from direct injury to the joint surfaces. The injury occurs to the cartilage and / or bone tissues of the joint, and the resulting damage leaves the joint surface uneven and roughened.

This can result from athletic injuries or falls. But more often these occur from higher-energy injuries such as automobile, ATV or motorcycle accidents.

The original treatment for the trauma will include putting the injured joint back together as perfectly as possible. Often a fracture into the joint is reduced back into position and the underlying fractures of bone are stabilized in place by screws, pins, plates and rods.

Unfortunately, in some cases the damage to the joint surfaces progresses to arthritic degeneration of the joint that becomes unacceptably painful and stiff.

Conservative treatment measures include modifying one's activities and unloading the joint with cane, crutches or walker. Also, supplemental glucosamine, Tylenol, anti-inflammatories, pain medications may help. Physical therapy to regain motion and strength and coordination is often helpful. Weight loss in the overweight patient is important.

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)Injections of corticosteroid can be helpful, but can be used only 3-4 times per year. 'Viscosupplementation' injections with hyaluronate (Synvisc) may also help. If successful, these may work for 6 months or longer.

A compartment –unloading brace for the knee can relieve pain and delay progression of knee arthritis.

When all these measures are not working, then surgery may be recommended.

If the joint damage is in a very small, localized area, possible options include:

  • a localized transplant of bone and cartilage
  • a microfracture technique to encourage 'scar-cartilage ' to grow

In most cases the joint damage involves larger areas and some form of realignment or resurfacing in recommended:

  • realignment osteotomy of the knee
  • partial replacement of the joint such as a Uni-compartmental replacement of the knee
  • total joint replacement of the hip or knee

In the border to your right click to view animations of hip and knee anatomy, arthritis and procedures.

Osteoarthritis

Osteoarthritis is the most common form of arthritis and is also called degenerative arthritis. This is when the cartilage in the joint has deteriorated by thinning and wearing away. The smooth rubbery cartilage that glides painlessly is gradually worn away to the point that exposed bone rubs against exposed bone. This results in stimulation of nerve endings and pain. Absence of cartilage is also mechanically irritating to the joint, and the joint lining makes extra joint fluid causing swelling of the joint.

Over time the joint will make extra bone at the edges of the osteoarthritic joint called osteophytes or 'spurs'. This causes the joint to enlarge and to stiffen as the osteophytes can change the joint shape and block how far the joint can move.

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)Conservative treatment measures include modifying one's activities and unloading the joint with cane, crutches or walker. Also supplemental glucosamine, Tylenol, anti-inflammatories, pain medications may help. Physical therapy to regain motion and strength and coordination is often helpful. Weight loss in the overweight patient is important.

Injections of corticosteroid can be helpful, but can be used only 3-4 times per year. 'Viscosupplementation' injections with hyaluronate (Synvisc) may also help. If successful, these may work for 6 months or longer.

A compartment –unloading brace for the knee can relieve pain and delay progression of knee arthritis.

When all these measures are not working, then surgery may be recommended.

If the joint damage is in a very small, localized area, possible options include:

  • a localized transplant of bone and cartilage
  • a microfracture technique to encourage 'scar-cartilage ' to grow

In most cases the joint damage involves larger areas and some form of realignment or resurfacing is recommended:

  • realignment osteotomy of the knee
  • partial replacement of the joint such as a Uni-compartmental replacement of the knee
  • Total Joint Replacement of hip or knee

In the border to your right click to view animations of hip and knee anatomy, arthritis and procedures.

Inflammatory Arthritis

Inflammatory Arthritis is another type of arthritis that is less common then degenerative or osteoarthritis. These type of arthritic diseases occur when there is a malfunction of one's immune system and the immune system errantly recognizes joint cartilage as 'foreign' and attacks the joints and attempts to destroy the cartilage in the joint. This can cause severe destruction of joints and has been called the 'crippling arthritis'.

Types of inflammatory arthritis include:

  • Rheumatoid arthritis
  • Lupus arthritis
  • Sjogren's disease
  • Ankylosing Spondylitis
  • Inflammatory Bowel Disease-associated arthritis

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)Conservative treatment includes resting the joints, modifying one's activities, walking aids and medications such as Tylenol, Ibuprofen or Alleve.

More aggressive medical management is available. An entire field of medical specialists called Rheumatologists is devoted to treating these diseases. Many new (and some old) regimens to suppress the immune system's joint destruction activities now exist that are limiting this damage and preserving joints better that ever before. Multi–modal therapy using low doses of several different medications seems to be particularly effective.

Unfortunately, the joint destruction does become severe in some patients and when the symptoms and loss of function are too great, then, joint replacement can bring marked improvement in pain, function and mobility.

In the border to your right click to view animations of hip and knee anatomy, arthritis and procedures.

Dysplasia of the Hip

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)Dysplasia of the hip can lead to disabling hip pain due to the cartilage wearing out prematurely. This results from abnormal development of the hip joint during in utero development and in infancy the hip is not positioned properly to form the normal deep socket that is needed for a normal hip.

Fortunately, now there is a very high awareness of this problem, and pediatricians and obstetricians always screen for this routinely. Every newborn is examined many times in infancy to find and treat this problem. When caught early it can be treated by simply wearing a harness for several months.

Discovered as an older child, more complicated surgical interventions are needed to reposition the hip.

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)It is not unusual for an adult to start experiencing a new pain in the hip only to learn from X-rays that the hip has deteriorated due to a mild dysplasia of the hip previously un-diagnosed. If the deformity and damage are mild, the hip socket or acetabulum can be rotated by making some very precise bony cuts around the outside of the socket and restore a more normal and deeper shape to the socket. These bony cuts comprise the Ganz Osteotomy procedure. This is sometimes treated with a bony cut of the femur bone as well to re-position the head in the socket.

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)Far more often the degenerative change has progressed so far that the best option is replacement of the joint, and Total Hip Replacement is performed. With newer, longer–lasting bearing surfaces such as Ceramic on Ceramic and Metal on Metal, we believe these replacements will last many years longer than the conventional metal on plastic replacement that historically has lasted 10 -15 years.

In the border to your right click to view animations of hip and knee anatomy, arthritis and procedures.

Avascular Necrosis (AVN)

Is a condition affecting the Hip, Knee or Shoulder that can cause pain and joint damage. It occurs when an area of the joint loses its blood supply and some of the supportive bone in the joint undergoes bone death. Initially, there can be inflammation and swelling in the bone that causes pain. Later, as the body attempts to heal the dead bone, some of the bone may become soft and collapse and flatten beneath the overlying cartilage. The joint cartilage is no longer smooth. The joint becomes painful when the roughened, irregular surfaces move across each other.

Arthritis Treatment | Hip Displacement Treatment | North Little Rock Arkansas (AR)The hip is affected most often, followed by the shoulder and knee.

Certain factors such as heavy alcohol use, sickle cell anemia, scuba diving, bone marrow storage diseases, and prolonged high steroid doses can all predispose one to having AVN. However, about fifty percent of cases are 'idiopathic' – meaning no identifiable cause is present.

Diagnosis can be made by plain x-rays, but often MRI scan is required to find it in earlier stages.

Treatment of early AVN, before there is any collapse of the joint surface, is with a 'venting procedure'. This is also termed a 'core decompression' of the involved bone.

This entails a brief procedure under anesthesia during which a drill hole tunnel is placed into the involved area of the bone. The tunnel reaches the involved area by a pathway that avoids damage to the joint surfaces. Pain relief occurs by the tunnel relieving the pressure that has built up in the affected area. By relieving this pressure, further bone death is prevented.

In advanced AVN, when the bone surface has collapsed, then conservative treatment involves unloading the joint with walker, crutches or cane and modifying ones activities. Anti-inflammatories, Tylenol, pain medications may also help.

When the pain and dysfunction is too great then some form of arthroplasty is recommended for the joint. Often the most durable solution is a Total Joint Replacement.

In the border to your right click to view animations of hip and knee anatomy, arthritis and procedures.