Arthritis is the loss of cushion on a joint surface-period. The cushion called articular cartilage is an amazing multi faceted structure that allows us to walk, run, jump, and lift without pain.
Deep to the cushion is bone. If bone is exposed then this causes pain as there are nerve endings in the bone. When bone rubs against bone the joint becomes painful, swollen and stiff. There is no cure for arthritis and treatment is directed towards pain relief.
Diffuse arthritis is not to be confused with a localized chondral defect or a pothole surrounded by healthy tissue. That can be treated with drill holes to stimulate bone marrow healing, placing cartilage plugs or cartilage transplantation.
The treatment plan for arthritis is tailored to the patient. That means treatment is based on the patient’s age, how long they have had symptoms and what other treatments they have tried or had. For an initial diagnosis of arthritis the treatment usually starts with therapy exercises working on range of motion and strengthening. After exercises, medications can be tried like Tylenol®, Advil® or Aleve®. Supplements can also be tried as well as creams and gels. If the pain persists and activity levels are decreasing and x-rays show definite joint narrowing with arthritis, then injections can be entertained.
These are broken up into three different categories:
- Gel (or viscosupplementation)
- PRP (platelet rich plasma)
Cortisone is a tricky substance because it can help pain but if given too many times it can increase arthritis. So used sparingly is reasonable especially if there is already terrible arthritis in the joint. Gel injections are designed to lubricate the joint and decrease the friction between the bones. PRP has been shown to have some anti-inflammatory properties and can be used to treat arthritis, although studies show it works better on tendonitis.
If none of these work then replacement can be considered. Taking knee replacement as an example, recovery is based on range of motion and getting strength back. Typically it takes six weeks to three months to get good strength back.
For the CrossFit athlete with knee arthritis, rehab should be faster because of the increased muscle strength going into surgery. Exercises that can be performed early on in recovery like in two to three weeks would be air dyne, biking or rowing. These should be cautious and gentle with no stress focusing on range of motion and not stressing the tendon repair part of the surgery. Squatting with no weights is reasonable to work on strengthening and range also. Increased resistance and weights will be introduced when tendons are stronger. Now comes the question about running, jumping, and weightlifting.
One of the variables for how long a knee will last is how long the cushion or the polyethylene between the pieces of metal last. If one stresses the knee too greatly, then wear of the knee theoretically would be a factor. The material used is much better than what was used when replacements were invented. However, if these particles break down from wear then the body attacks them and releases cells to digest them called macrophages. These cells in doing so release enzymes which can then cause erosion of the bone. So in fact the bone to metal replacement interface can then loosen. It is for this reason that people should probably not get back to long distance running or jumping from heights. However a study in 2010 looked at high impact activities after knee replacements and found no difference in symptoms or revision for high impact sports versus low impact sports in patients who had knee replacements. Of those who needed a revision were two weightlifters.
The main reason to have a knee replacement is severe pain from arthritis that has not gone away with conservative measures. Studies also have shown that people who have mild arthritis do not fare as well as people who have more involved arthritis. The recovery can be substantial and any surgeon wants to make sure that the arthritis is bad enough and that the x-ray findings correlate with the level of pain. The pain should be everyday and limit functioning like stairs, standing, and walking. Knee replacements should not be performed for mild pain or nuisance pain relieved by other measures.
Knee replacement is a great surgery that allows people who have lost independence and function to regain their lifestyle. One survey asked people to rate their LIVES not their knees when they had severe arthritis on a scale of 0 to 100. The average response came back with a 30. After knee replacements, that number jumped to 90! So it can make a significant difference and allow people to enjoy life and exercise again.