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Intro: This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm Caitlin Whyte. Osteoarthritis is a very common condition affecting more than 3 million in the US each year, but unfortunately it cannot be cured. Here to tell us more about the diagnosis and options for treatment is Dr. William Cooper, an orthopedic surgeon at BayCare. Dr. Cooper to start our conversation off today, tell us what is osteoarthritis?

William A. Cooper, DO (Guest): So, osteoarthritis is a structural arthritis, and it's important to understand that there's many different types of arthritis. Arthritis itself, the word arthritis just means inflammation of a joint. And so there's different types of arthritis. There's inflammatory arthritis, there's structural arthritis like osteoarthritis. Osteoarthritis really comes down to loss of cartilage overlying the bones in the joints and you lose that cartilage and it exposes the underlying bones to stresses that it wouldn't have with cartilage over top of it. And so when the bone gets stressed, the bone gets angry and it turns into things like pain and swelling and ultimately stiffness. And then, you know, as osteoarthritis progresses, you can have changes to the bone where you'll develop bone spurs and actually increase the density of the bone, where it becomes more sclerotic and even more painful.

Host: So osteoarthritis, how does this compare to other types of arthritis?

Dr. Cooper: So other types of arthritis, primarily what it comes down to is inflammatory versus structural and things like inflammatory arthritis are things like rheumatoid arthritis, even things like gout and pseudogout, where it's the body essentially attacking itself. And ultimately things like inflammatory arthritis can result in that structural osteoarthritis. Osteoarthritis is, is a structural problem. It's a structural loss of cartilage. And so that's what makes it different from other types of arthritis is it can be an end point of inflammatory arthritis, but it also, you know, osteoarthritis can develop from things like post-traumatic injuries where you've injured a joint or torn a ligament, those type of things.

It can come from a genetic problem where your structural alignment is, is a little bit off in terms of how your, the alignment of your lower extremities, where maybe the knees turn in or turn out a little bit. And so that's, that's really the basic difference between an osteoarthritis versus other types of arthritis.

Host: So what are some of the symptoms of this specific arthritis?

Dr. Cooper: So osteoarthritis, when I most commonly see it in clinic, people are complaining of pain. Pain is the most common symptom of osteoarthritis, but then you can have some corresponding symptoms, primarily consisting of swelling of the joint. You can develop fluid within the knee and you can also develop sort of a secondary stiffness more so, because of the pain that occurs within the joint. The pain ultimately leads to individuals not wanting to either ambulate or not wanting to move as much. And then the stiffness sort of develops because people are not moving and it hurts to move it. So, you stop moving, things tighten up and it hurts to move it. And so you move it even less and you sort of get stuck in this cycle of pain and stiffness where things will progress and worsen.

Host: Gotcha. Okay. So let's talk about our options for treatment. What are some nonsurgical options?

Dr. Cooper: The main nonsurgical treatments involve some type of motion. I'm personally a fan of physical therapy as a first-line treatment for osteoarthritis. There's lots of good published studies and data that support physical therapy as a first-line treatment. And that's really to sort of break that cycle of pain and inflammation and stiffness to get the knee moving again. And it's so crucial to getting back to normal life and normal function. And so activity, exercise, motion, physical therapy is really one of the main nonsurgical treatments, but I always recommend combining things like that with ice.

Ice is good for pain, swelling, inflammation, really generally you cannot overdo icing. And so I recommend that people ice at least a couple times a day. I recommend that, if possible, people take anti-inflammatories, things like ibuprofen, Aleve, meloxicam, those types of medicines that will reduce inflammation. And they've, they've been proven, again, through research to reduce symptoms associated with arthritis. Those are really the main nonsurgical treatment options for somebody that comes in with osteoarthritis of a joint, whether it's the knee, whether it's the hip, whether it's the shoulder, whether it's the elbow, is ice, anti-inflammatories and exercise, physical therapy. The one last thing that I also recommend is rest. But rest it's important to know that rest to me should not be immobilization. When I tell somebody that they need to rest it, they need to go easy on it that is not meant for them to go home and not move, because again, then you're stuck in that cycle of inflammation.

So rest means going easier on it. Let's say you are an athlete that you've been overdoing. It means resting it relative to your level before, scaling it back, working on mobilization exercises, working on, you know, just simple range of motion exercises. And so rest is sort of relative to the user in that it should not be considered immobilization.

Host: Now, unfortunately, there are some cases where these nonsurgical options don't work. What are our surgical options?

Dr. Cooper: Well, before we get to surgery, there are additional interventions that consist of injections. And so before we touch on surgery, I think it is important to note that, you know, injections are an option for different types of arthritis. And in particular, let's say the knee. And in terms of the knee, I provide three main types of injections in my clinics. And number one, injection is cortisone. Cortisone is a steroid and there's different types of formulations of steroids, but it's generally sort of the overall term is you get a cortisone injection. And what that does is reduce pain and inflammation in the joint. And I do my injections under direct visualization with an ultrasound machine where I watch the medicine, watch the steroid, watch the injection go directly into the joint. There's no question that the injection is in the right spot with the ultrasound.

And so cortisone is always first-line injection, or almost always first-line injection. For the knee, in particular, there is something called viscosupplementation. That is an injection with hyaluronic acid, which essentially is a gel. And you inject this gel into the knee that can produce cushioning and lubrication and reduce inflammation. And most insurance companies will authorize gel injections if you've had a cortisone injection first or at least within the last 12 months. So that's a direction that I can go in terms of injections. And then lastly is I perform PRP injections in the knee, and PRP stands for platelet rich plasma.

It's where we take a sample of blood. Put the syringe of blood in a centrifuge, spin it around, separate it out into layers and pull out the platelets. Platelets contain growth factors. Those growth factors are a few steps down from what people consider undifferentiated stem cells, but you inject the platelets with the growth factors into the knee. And the simplest terms is it creates kind of a microscopic healing response within the knee and also reduces pain and inflammation. And those work quite well, but the downside to the PRP injections are at this point, it is not covered by insurance as a standalone injection. And so that's an out-of-pocket expense that I have to discuss with the patient ahead of time that, you know, they will be paying for this, but they do work quite well.

In my setting, in my experience, I've had, I've had very good results with PRP injections in the knee. When it comes to other joints around the body, no insurance company, or it's not recommended to do any of the gel injections. And I will perform time to time PRP injections on various body parts and still get good results.

But typically, other than the knee, the main injection is cortisone. And then of course, we get to the surgical options. In terms of the surgical options, it can vary anywhere from, you know, minimally invasive type things like arthroscopy, arthritic issues can result in issues, let's say again, I'm falling back to the knee, cause it's the easiest to describe and people commonly understand or are knowledgeable with arthritic issues of the knee, but arthritis of the knee can lead to secondary problems like meniscus tears, and cartilage flaps that may move around or flip around, or ultimately result in loose bodies that can float around in the knee.

And so if in my opinion, the osteoarthritis is not significant enough to warrant a surgical procedure, like an arthroplasty or a knee joint, or a total joint have some capacity, or a partial joint of some capacity, then I would look towards arthroscopy, which is, you know, minimally invasive, small incisions. You go in with the camera and you essentially clean up that joint, clean up any associated problems like meniscus tears, pull out any loose bodies. Shave down any cartilage flaps to smooth it up and kind of contour it to the normal joint surface. And so that's sort of baseline most basic management for an arthritic condition.

There are at times, areas that we'll perform cartilage salvage procedures, where they will attempt to regrow cartilage in the body. And that's not something that I typically do, but it can be done. And some people do that type of procedure around the country, but it's a little less common and it, it does have, it's sort of not always perfect success rate with that. What I frequently encounter is in my population, which tend to be, you know, on the, the middle to elderly aspect, is you try everything from a non-surgical standpoint, you try the injection, consider the arthroscopy, but ultimately in my world, I'm looking at some sort of arthroplasty or a total joint replacement or in some cases, a partial joint replacement, especially in the knees where if it's a very localized area of osteoarthritis, you can sometimes replace just a part of that joint, whether it's the medial side of the femur and the tibia and that you replace primarily versus doing a total joint arthroplasty, which is as everyone is familiar with is usually a total knee replacement.

Host: Well, as we wrap up our discussion on osteoarthritis here, Doctor, is this preventable at all?

Dr. Cooper: Yes some of the time, because it's important to know that there are modifiable risk factors and there are non-modifiable risk factors. I mean, people are born with genetic predisposition to developing osteoarthritis. And for those people, you can do some things to minimize the damage, but you are genetically predisposed to having osteoarthritic conditions. But in terms of the modifiable risk factors, the main things are diet and exercise. That really is the most important thing. Where I see unfortunately, a high prevalence of osteoarthritis is in the obese patients that, you know, that increased weight results in increased force and that increased force can result in increased friction that leads to the breakdown and destruction of a joint. And so, weight, obesity is one of the main modifiable risk factors at reducing and preventing the development of osteoarthritis. And people that have even are in the early stages of osteoarthritis, if they're able to lose some of the weight, then it decreases those forces and friction, and ultimately they can slow down the progress or prevent worsening of the osteoarthritis.

And so diet is very important. Maintaining a good weight is very, very important. And also exercise is very important. It keeps the joints moving. I keep falling back to the knee, but really any joint in general, exercise keeps the joints moving. It maintains motion. It maintains strength. It maintains mobility and balance. So exercise is very important. Exercise stimulates the good fluid that spreads through the joints to nourish and hydrate the cartilage to keep them healthy. Exercise also strengthens the bones so that if you decrease some of that cartilage, that's in there, your bones are nice and strong to accommodate those extra stressors.

And, and I do see it, you know, in people that advanced or advancing osteoarthritis, but if they're healthy and they're fit and they're active and they exercise, generally, they tend to have less pain than somebody that is more sedentary, you know, higher weight, those types of things.

Host: Well, Doctor, a lot of information to cover this episode. Is there anything else that we didn't touch on that you want patients to know?

Dr. Cooper: I think the most important thing I could convey and the thing that I hear the most, that is the biggest misconception among patients that come in and they say that their shoulder has been hurting. Their knee has been hurting and they come in frustrated and they say it's been bothering them and they have done nothing over the last two weeks, four weeks, and it still hurts them. And it's important that people understand the misconception that exercise and activity and mobility really is what's needed during those times, not complete immobilization and inactivity. I really, really encourage people to maintain their activity levels and do as much activity as they can with the discomfort that they're experiencing.

Host: Well, thank you, Doctor, for this information and for your time today. And thank you for listening. You can find out more about us online at BayCare.org. And please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts.

For more health tips and updates, follow us on your social channels. This has been another episode of BayCare HealthChat. I'm Caitlin Whyte. Stay well.