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Today I’d like to give you information about Osteoartritis. It’ll be about the arthritis that forms in our carrier joints, such as knees and hips.. As it commonly known as. We as doctors, call this “osteoarthritis”. If we dug deep to our subject with the questions like “What is the reason of it? When will it happen? In which ages will it happen?”, we can likely to say that this disease often happen in middle ages and after it. As we call it, this is a disease that emerges after the loss of cartilage surfaces on the joints, which likely happens after 65-70 year of life. Can it happen in earlier ages? Of course. It may arise in earlier ages. In this case, there might be a developmental disorder or our patient might have suffered from a trauma. There might be a fracture. There might be a fracture inside the joint or got infected. There might be infections inside the joint. Or, there might be another joint near the main joint that got inflamed, therefore it spreads to the main joint. Last but not least, it may happen due to misuse. This usually happens among housewives; they work hard at home and they can be misusing their knees and hip joints. This disease emerges by this reasons. As I was describing this use of hips and knees as misuse; this problem can also emerge by too much twisting the knees, climbing lots of stairs, taking far too long walks, doing excessive workouts.. By doing these, we can also be the cause of our joints, our carrier joints to suffer from cartilage abrasions.
The main reason of osteoarthritis, which emerge at an earlier age, like 35-40-45-50 years of age; is a developmental disorder. Another reasons are misuse and excessive body weight. Body weight is a very troublesome situation. By scheduling daily activities like sports and exercising, and ultimately losing weight; the load that is imposed on the joint can be decreased.
Let me give you an example: In every step we make, we receive a force that around 10 times more than our weight from the ground. What is this means? If you have a body weight of 80 kg; you will receive around 800-1000 kg of force from the ground. This force passes through our ankles, our knee joints and our hip joints. Let’s also think like this way: An average person makes 5 million movements annually. So, how can these joints resist these 5 million movements? So as you think, God creates our body in this shape. Normally it wouldn’t break. But if you gain much weight, or use them excessively,or climb stairs continuously and furthermore; if you don’t have enough power from your muscles, these joints can break. As I’ve said before; the consequences of developmental disorders or disorders that emerges in the period of pregnancy and maldevelopments causes these problems in the long run.
Osteoarthritis goes like this: The cartilage will be abraded, and with this abrasion; the body cannot find a place to carry its weight. When we check x-ray films of the knees or hips of our patients, we see that the bone is forming new surfaces. We explain this situation that there is an arthritis. What are the first symptoms? What happens, so the patient understands this problem? We might say that the patient have arthritis as a scenario. The main reason for it to be understood is the pain. Pain emerges in the knees, in hips and in ankles. But the areas the takes the most damage are the hips and the knees. When a cartilage abrasion occurs in these areas, our joints that carries 8-10 times of our weight cannot balance this, and these weight will not pass through the joint properly. These force will accumulate in somewhere. Because of the lessening of the carrying surface, patient suffers from bone ache. By the chemical changes in the synovial membrane, which is the membrane inside the joint; there will be pain in the knees or in groin area (I am considering that hips are the area of disorder for this case). While this goes for a while, another kind of sores appears at nights. We call this kind of sore as “rest sores”. Patient deals with his/her daily activities; and tells us “Doctor, I can walk, take a stroll, do my work, but at nights I have more pain.” This indicates that the disease progresses and takes a next level. A while later, the pain starts being continuous. It sores in the day, it sors at the night, it continuously sores. Usually at this point the patient comes and needs our counsel. They come up saying “I cannot resist anymore. Whatever happens, I need this to have an end.” At this point; while there were no restriction of movement and no problems in the beginning, our patients now telling us “I cannot twist my knee, I cannot move my hips, I cannot crouch, I cannot climb stairs, I cannot perform my prayers” and such. Because now we have a restriction of movement, patient continues to say that “I’m now just sitting on a chair.” At this stage, our patient needs surgery.
In the period of surgery, there are a few thing that has to be done. In this case, for the patients who has the final stage of this disorder, we need to make prosthesis implantations. Most of those patients are at the period which we define as “middle ages”. After 65 years of age, a need of prosthesis would emerge. But also, as I’ve said before, it has earlier stages. In this stages, when the patient is at his/her earlier years, like 20’s, 30’s, 40’s, 50’s; we can make some fixing surgeries on these patients. You remember the normal structure that is lost due to cartilage abrasion? In order to provide that -which sadly it won’t be like the old one- there can be fixing surgeries for the carrier surface to gain its ability back and for providing the load to spread to the entire of the joint. To these fixing surgeries we call “osteotomy”. In other terms, we cut the bone, we fix it and we let it to unify. These are the saving surgeries that could be done in the earlier stages of the disorder. When these surgeries are successfully carried out, whichever area we operate on, we can gain at least 10-15 years. Here, the most important thing that I want to say is this: Please do not miss this period. This period is the most precious period for our patients. What is that mean? When you suffer from pain, see a doctor. Let them guide you. Fixing surgeries may be made. Prosthesis surgeries may be made. They have enormous advantages. They have excellent results. But before that, we should not lose the chance of doing these surgeries that I call “osteotomies” which gives us the opportunity to move with our very joints and bones. This is an important phase, we should not miss this.
What happens except this? Hip dislocation surgeries, congenital dislocation surgeries can be done. These also may cause osteoarthritis or aches. Of our patients with a hip dislocation; these kind of aches may occur aside of the pains in waistline, knees and hips. We’re not taking into account of the patient’s age. When these aches occur in the patient, and when these aches reduces the capability of making daily activities, we’ll do the same just like the osteoarthritis. In this case, we’re not taking into account of the patient’s age. But, it’s not good doing this at an early age. After 20-25 years of age, prosthesis surgeries can be made. These have their own technical difficulties, of course. My request to the patients, and it is important: Please research and check. Nowadays the orthopedics has been separated into branches. We have 7 sub-branches. For example, I’m operating in the arthroplasty, in other words, joint surgeries around 30 years. Other branches consists of spinal surgeries, hand surgeries, trauma surgeries and others, like child orthopedics. These all are separate branches, and are carried out by different doctors. What I am doing is joint surgery. That’s why I’m discussing arthritis. There are many different surgeries that is carried. My request from our patients is to meet with physician friends who are doing this job well, in good centers and who are truly devoted to this job, and to have their treatment done in this sense. Because, these surgeries have several peculiar problems. These are large operations. These needs to be carried out precisely. The follow-ups of our patients should be done precisely. In order to take possible problems under control, our patients needs to be under control for 4-5 months, maybe even a year, whichever surgery may be done. These processes must be carried out precisely. Because, these are the processes that is related to the movement system. For example: when you have a general surgery, you can eat your meals, your stomach moves, your intestines works and usually there should be no problem. But, it’s not like that in our department. In my expertise area, the patient immediately has an usage limit. A prosthesis surgery must be done in order of the prosthesis to do its job for 30 years. After the day of surgery, this period starts. That’s why what you’ve done, how you’ve done matters, in order to reach 30 years with it. That’s why, the used materials, knowledge and capability of the operating doctor, the qualification of the hospital and its surgery room is important. There are many hospitals that can provide these qualifications in Turkey. Our patients may find a doctor and hospital that suits up their needs and fulfill these surgeries. Arthroplasty has been developed in the recent years, there are many improvements on this area. These needs to be followed. Our patients can already search up and examine these improvements online. All in all; joint diseases are such diseases that affects our life quality and our daily activities, emerging the most important problems. It’s not like in the old days. Our patients are not telling to themselves “I’m sitting at home. I’ll wait. Whatever happens”. Naturally, they are thinking like “What should be done, should be done, so I can walk and live actively in my lifespan.”, which is the correct way of thinking. I’ve wanted to discuss with you about this matter. I wish healthy and good days to all of you.