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Melanie Cole (Host): If you get up in the morning and feel pain and stiffness in your body, you’re hobbling around; you might have arthritis. And you know that it can be debilitating and keep you from taking part in the activities that you really enjoy. When that pain begins to interfere with your daily life; it might be time to see a physician to assess your situation. I’m Melanie Cole. In this episode of Northfield Hospital and Clinics podcast series; we are talking orthopedics and osteoarthritis. My guest is Dr. Hans Bengston. He’s an orthopedic surgeon providing care at Northfield Hospital and Clinics. Dr. Bengston, I’m so glad to have you joining us today. People hear the words arthritis. Can you just tell us about the different types of arthritis?

Hans Bengston, MD (Guest): Absolutely. Arthritis is a vast diagnosis which can include things that people may have heard of including rheumatoid arthritis, psoriatic arthritis, maybe a general term of inflammatory arthritis. But the one we are talking about today specifically is osteoarthritis. This osteoarthritis is indeed the most common form of arthritis. Certainly affects millions of people worldwide. The issue with osteoarthritis is that it affects the protective cartilage on the ends of the bones related to wear and tear over time. The common wear tear arthritis.

Host: So, where are those spots? Where are they? Where in the body does it affect most?

Dr. Bengston: Osteoarthritis can certainly affect any joint in the body. The most commonly involved joints include the hands, or spine, hips, knees, shoulders. These affect any person out there. Typically in the adult age of life. As we age, the more and more we’re active in life, maybe some minor or major traumas occur in our life; these can all affect the joints in various ways and eventually cause that cartilage, that protective layer to wear down leaving us with that osteoarthritis.

Host: So, who is us? Dr. Bengston, who does it most commonly affect? Can it affect people of any age? Or mostly older people? Who gets it?

Dr. Bengston: Osteoarthritis is a problem that really affects most any adult. It doesn’t have a particular ethnicity or activity in that it’s isolated to but rather any adult. Certainly, the higher risk patients are those who are at an older age, mostly because over life; their joints have seen more wear and tear. Women actually have a higher propensity for arthritis development than men do. We don’t exactly know why that is. But it’s clearly something we’ve seen. Those who are obese, they carry extra body mass and that puts more stress across the joint and just like any other mechanical part if you will in a car; the more stress it sees, the faster it can wear out.

People who have had joint injuries in the past. Minor injuries that maybe you don’t think much about that add up over time or more significant injuries. Maybe an athletic injury or a car accident that caused a knee dislocation or a shoulder injury. These people have a higher risk for osteoarthritis. And certainly, certain occupations, those who place repetitive stress on a particular joint may have a increased risk for developing it. And then finally, we think about genetics. Certainly, we recognize that genes do play a role in a variety of medical issues and diseases and osteoarthritis is no different. Some people are more prone to it.

Host: Doctor before we get into treatments and I’m somebody who I know I’m probably going to get it in my hands and my mother had it. Can it be prevented? Is there anything we can do to slow down the progression if we know maybe we are at risk for it?

Dr. Bengston: Such a great question. We know that arthritis is a progressive problem. It seems to only get worse as time goes on. At this point in our world’s history and society; we don’t have a way to reverse it. We know that staying active is good though. Doing nothing or doing too much can both be painful or cause it actually to increase its discomfort. But doing something is helpful. We know that the joint lubricates itself with motion. And that’s why activities that have less stress on the joint but still allow motion are helpful. Things like bicycling, swimming, or even walking in the water, rowing, elliptical machine. These are all valuable things to help lower extremity joints move but with less stress on them.

Host: So, then the time comes when we need to seek out some treatments. So, start with some of the most conservative, least invasive like ice and heat. Are you an ice or a heat man? What about you mentioned exercise, but what about bracing or NSAIDs obviously, starting with medication? So, tell us about some of these other nonsurgical treatments including physical therapy. Where do these all fit into the picture before any other discussion takes place?

Dr. Bengston: Such a great question. And really there are a variety of things that we can try from a nonoperative standpoint before we even come close to talking about surgery. You’re right. Ice is one of the main things that can be used to help calm down that inflammation. When the joint is arthritic; it’s rough, it’s irritating and that creates inflammation. Ice helps calm that inflammation by decreasing the blood flow to the joint temporarily which can just help prevent that pain and inflammation.

Heat is good for muscles. But when you are talking joints; you want to think ice to calm it down. Medicines like ibuprofen, Naprosyn, Aleve; these are medicines that can help calm inflammation and definitely are good first line measures to try. Other medicines such as acetaminophen can help how the pain relief feels; but it may not actually change the inflammatory path.

You mentioned physical therapy. Absolutely. Again, it kind of goes back to that concept of staying active or moving to some degree. Therapy can help a person try to stay somewhat limber and move. The other thing that therapy brings is increased strength. We know that as the muscles surrounding the joint are strong, they can actually help dynamically take the load off the joint, almost like a shock absorber, if you will. I like to think of it that way.

There are other things that we can dabble with. People are asking a little bit more about home remedies, things that you can take over-the-counter. People are actually asking a little bit more about CBD oil. While we don’t have a lot of literature on this just yet; I do have some anecdotal evidence from patients that do say that it does seem to help here and there. There are creams that we can try. Creams over-the-counter you can get at your local pharmacy to help calm inflammation or pain. These are all very practical.

Once these nonoperative things have been tried we can get to the minimally invasive things. Things like injections. Cortisone injections are certainly well-versed when it comes to arthritis and definitely worth a try. If a person does get response from a cortisone injection; it definitely can be repeated down the road as well. There are other options out there like lubricant injections. Some of these lubricant injections are FDA approved for mild to moderate osteoarthritis of the knee. It’s not necessarily FDA approved for other joints, but it might be an option, something to talk with your surgeon about.

And then finally, people are talking more and more about stem cell treatment. Stem cells are things that we have obviously quite a hardy supply of when we’re young as we are infants and young children. And our bodies do still maintain some of them as we age into adulthood. People are talking about using stem cells, capturing them from your own body, putting them back into the arthritic joint with the purpose or goal of trying to get your body to grow new cartilage or heal that arthritic state. What we know about it again, is quite early. We don’t have a lot of long-term literature that shows or proves that this is truly successful. But obviously, it’s intriguing and if it’s a way that we could at least slow down that progression; well it’s something that will still be investigated as time moves forward here.

Host: What a great answer. You’re a very good educator Dr. Bengston. And I’m glad that you covered viscosupplementation and PRP and stem cells and cortisone because people always want to know about those things. So, then what? When does that discussion say let’s look into a hip replacement or if you’ve really got bad knees, let’s discuss replacement? What does that discussion look like?

Dr. Bengston: Absolutely and I think it’s really important that people acknowledge we as surgeons are still in favor of trying to help people stay healthy, stay active. Keeping our native joints as long as possible; there’s nothing like that. Nothing that can replace how that native joint feels. So, when the time comes that a person has exhausted the nonoperative routes, maybe they’ve tried the bracing that you mentioned earlier. Something to try to help support the joint.

They’ve tried the injections, that platelet rich plasma injection, the lubricant injection of viscosupplementation, a variety of things have been tried and they are just no longer successful. And now the patient is continuing to experience pain, stiffness, limited range of motion and really things that are affecting their daily life. Maybe it’s affecting their sleep. Maybe they can’t walk down the block like they used to be able to do very comfortably. Until this pain starts to become more significant and really limits how they live their life.

When that’s the time that comes around, then that’s a very appropriate time to talk about a total joint replacement. Total joint replacements are becoming more and more common and certainly we think of the classic hip and knee replacement procedures. They are prevalent though for shoulder replacement, even ankle replacement. Virtually every joint it seems that one can get common arthritis in is starting to have a joint that could be replaced.

One of the things that’s happening these days is that the materials we’re using are definitely improving, with the goal of trying to help these implants go longer and longer so that patients can remain pain-free with a good healthy function lifestyle.

Host: Well, therein lies the key, the good healthy function lifestyle. As you wrap up Dr. Bengston, give us your best advice for keeping healthy joints, hopefully preventing some of the onslaught of osteoarthritis and what you want us to know.

Dr. Bengston: I think one of the most important things is stay healthy. That is, keep a healthy body weight. Even if we are overweight right now in life; there is always a chance to change that. Yes, staying active is good and one way that we can do that, but modifying what we take in by food and drink. That’s as important and perhaps even more when it comes to regulating our body weight. So, staying healthy and active in the food that we eat and the drinks we consume.

Staying active physically. We know that as I said, our joints do like to have that motion and it’s worthwhile. But really, it’s enjoying life as best as you can. If you’re a grandparent who has young children, you want to get down on the floor with them. You want to interact with those grandchildren. If you’re a parent who has got a very intense occupation; that can be a difficult situation, but we want to keep you going, living the lifestyle that you are looking for.

And so when it comes to time to see that orthopedic surgeon, again, it’s when that pain is no longer relieved with those medicines or ice, you’ve tried that home therapy regimen and it’s not successful. Give your doctor a call. It’s a great conversation to have and find out what else can we try.

Host: What a great segment. That was excellent information. So beautifully put Doctor, thank you so much for joining us today. For more information please visit www.northfieldhospital.org, that’s www.northfieldhospital.org. I’m Melanie Cole. Thanks for listening.