Chaper 7: Arthritis and Joint Preservation Surgery

INTRODUCTION

The Arthritis Foundation reported that there are over 100 types of arthritis. And about 91.2 million adults either have physician-diagnosed arthritis and/or report joint symptoms consistent with a diagnosis of arthritis. This translates to almost one in three persons aged 18 to 64 years. After the age of 65, half of men and two-thirds of women have arthritis. The incidence is on the rise, and it is estimated that by 2040, almost half the population will have physician-confirmed arthritis. Arthritis and polyarticular arthritis, in particular, are more common in females and obese people. Age significantly increases the prevalence. One estimate puts the total costs related to arthritis (eg, medical care, earning losses, lost time) at 1% of US gross domestic product equaling about $304 billion for the 2013 fiscal year. Among people with arthritis, 33% have depression or anxiety, 25% have cardiac problems, 20% have respiratory conditions, and 16% have diabetes. It is likely that arthritis predisposes people to these comorbidities through physical inactivity.

The pathophysiology of noninflammatory arthritis is primarily mechanical but introduced cellular and biochemical processes will also change the normal slow cartilage remodeling process. There will be excess degeneration, less regeneration, and abnormal separation of the cartilage. Progressive cartilage loss, increased thickness of the subchondral plate, and cyst formation will happen. With time, the cartilage gets thinner, looser, and weaker; bone will rub against bone, causing remodeling of the bone and osteophytes formation. Friction will cause mild inflammation. All these changes will make the normal movement and gliding of the joint more difficult and uncomfortable, and eventually painful. The pathophysiology of inflammatory arthritis can be infectious, crystal-induced, reactive, or autoimmune. Inflammatory cytokines and autoantibodies create an inflammation cascade and pannus formation, which can invade the cartilage and bone and damage them. Diagnosis and treatment of multiple forms of arthritis will be discussed in this chapter, as well as surgical joint preservation options and techniques.

ARTHRITIS AND RELATED CONDITIONS

Evaluation of Arthritis

To treat arthritic conditions of the joints appropriately, an understanding of the disease process is essential. This begins with accurate diagnosis and a history of the progression of the disease, so that the future progression can be predicted and appropriate decisions regarding treatment can be made. The physician must evaluate the possibility of traumatic, inflammatory, developmental, idiopathic, and metabolic causes of the arthritis (Table ...