Stay away from bad joints

Philip J. Goscienski, M.D.

November 2005

We're not talking about creepy joints, but creaky ones, especially hips and knees. Joint replacement is one of medicine's hottest markets. My orthopedic colleagues will replace about 300,000 hips and knees this year but replacing shoulder, ankle and wrist joints is becoming common, too. If you think that you'll contribute to those numbers in your lifetime, consider some ways that you can avoid it.

Most persons over the age of 60 have osteoarthritis. Those who have unbearable pain are driving the boom in joint replacement surgery. Our aging but generally healthier population will not settle for decades of pain and disability. Persons with accidental joint injury, rheumatoid arthritis and other disorders also benefit from joint replacement.

Osteoarthritis has been part of human life since the Stone Age but fossil studies show that it was much less common then than it is today. Among modern hunter-gatherers who still live a Stone Age lifestyle the incidence of osteoarthritis is low and it's not because they don't live long enough. Among the 20 percent who live beyond the age of 60 there is very little osteoarthritis. Joints do wear out but not because of aging. Repetitive injury does the damage as one joint surface collides with another. That's why ballet dancers develop osteoarthritis in the ankle and baseball pitchers in the elbow.

For those of us with an ordinary lifestyle it's the day-to-day impact within hip and knee joints that gradually wears away the cushion of cartilage that separates the bones from each other. When bone meets bone the result is usually painful.

Exercise decreases the risk of arthritis of the hip and the knee because it helps us to avoid obesity and to develop strong leg muscles. Obesity triples the likelihood that a woman will develop severe osteoarthritis.

Anyone can maintain strong leg muscles throughout life by being physically active and especially by doing resistance exercise with free weights or exercise machines. When the muscles around a joint are strong they provide a braking action so that the repetitive impact is not as severe. When strong muscles contribute to the stability of the joint there is less chance of injury from a twisting movement. Exercise also promotes overall joint health by improving blood supply.

One of the most important reasons why you should do what you can to avoid joint replacement surgery is that in any surgical procedure there is always some risk. Modern operative methods and the skill of surgeons usually guarantee a good outcome but every operation exposes a person to complications and those risks increase as we grow older. Wound infection is certainly not rare and the germs that lurk in hospitals are often resistant to our newest and most powerful antibiotics. Deep vein thrombosis, the formation of blood clots within the leg, is more common in knee replacement or hip replacement compared with other surgical procedures. Occasionally, further surgery is necessary to revise or to replace the artificial joint.

What if you already have arthritis? For some persons, glucosamine works fairly well to relieve pain. It's a normal constituent of joint tissue and may even help to rebuild damaged cartilage.

And it's never too late to start exercising. Even when osteoarthritis is well established, proper physical activity will take some of that pain away.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.