Os­teo­ar­thri­tis: A Wi­de­spread Disease

Priv.-Doz. DDr. Ma­xi­mi­lian Kas­pa­rek was in­vi­ted as an ex­pert on os­teo­ar­thri­tis and its tre­at­ment on OE24.TV.

You can watch the full in­ter­view with Dr. Kas­pa­rek here:

Dr. Ma­xi­mi­lian Kas­pa­rek, you are a spe­cia­list in or­tho­pe­dics and trau­ma­to­logy. Why are so many peo­ple af­fec­ted by os­teo­ar­thri­tis that it can be cal­led a wi­de­spread disease? 

Thank you for the in­vi­ta­tion. Os­teo­ar­thri­tis can un­fort­u­na­tely be con­side­red a wi­de­spread di­se­ase, as 15% of those un­der 60 and one-third of the po­pu­la­tion over 60 suf­fer from it, lea­ding to a si­gni­fi­cant re­duc­tion in their qua­lity of life. 

Are there any risk fac­tors, or what fac­tors play a role in the de­ve­lo­p­ment and pro­gres­sion of the disease?

The cau­ses of os­teo­ar­thri­tis are di­verse. They range from ge­ne­tic pre­dis­po­si­tion, con­ge­ni­tal de­for­mi­ties such as hip dys­pla­sia, ove­r­use due to oc­cu­pa­tion or sport, and long-term con­se­quen­ces of in­ju­ries. In­cre­asing age and se­vere obe­sity, which in­crea­ses the risk of hip or knee os­teo­ar­thri­tis four to five times, are also risk factors. 

Can you briefly ex­plain when os­teo­ar­thri­tis is dia­gno­sed and how the dia­gno­stic pro­cess works?

Our ar­ti­cu­lar car­ti­lage acts as a shock ab­sor­ber, lo­ca­ted in a joint on the two bone ends that form the joint. As we age, the car­ti­lage layer be­co­mes thin­ner and roug­her, and its lu­bri­ca­ting ability de­crea­ses, al­most al­ways lea­ding to nor­mal, age-re­la­ted wear and tear of the joints over time. When na­tu­ral wear and tear ex­ceeds the usual age-re­la­ted ext­ent, it is re­fer­red to as os­teo­ar­thri­tis. These si­gns of wear of­ten re­main un­no­ti­ced for a long time. Pain and func­tional li­mi­ta­ti­ons of the af­fec­ted joint of­ten only ap­pear in ad­van­ced stages of the di­se­ase. Ge­ne­rally, the dia­gno­sis of os­teo­ar­thri­tis con­sists of a me­di­cal history in­ter­view, a cli­ni­cal ex­ami­na­tion, and an X‑ray examination. 

What are the ty­pi­cal sym­ptoms, and what li­mi­ta­ti­ons are as­so­cia­ted with the disease?

Ty­pi­cal sym­ptoms in­clude load-de­pen­dent pain in the af­fec­ted joint and in­cre­asing rest­ric­tion of mo­ve­ment. Also clas­sic are mor­ning stiff­ness or start-up pain, which im­pro­ves af­ter a few steps. In la­ter stages, joint swel­ling, as well as rest and night pain, up to con­stant pain, oc­cur, lea­ding to a si­gni­fi­cant re­duc­tion in the qua­lity of life for af­fec­ted patients. 

Is os­teo­ar­thri­tis a di­se­ase that only oc­curs in old age, or can youn­ger peo­ple also be affected?

Un­fort­u­na­tely, youn­ger pa­ti­ents can also be af­fec­ted. These in­di­vi­du­als usually have a ge­ne­tic pre­dis­po­si­tion and re­port that their mo­ther or fa­ther had al­re­ady suf­fe­red from os­teo­ar­thri­tis, as well as af­ter a se­vere joint injury. 

Is there any­thing that can be done pre­ven­ta­tively to pro­tect and main­tain one’s joints?

Ba­si­cally, ever­yone can con­tri­bute to pre­ven­ting the on­set or pro­gres­sion of os­teo­ar­thri­tis. Re­gu­lar exer­cise is im­portant, with joint-fri­endly sports such as cy­cling or swim­ming be­ing par­ti­cu­larly re­com­men­ded. A ba­lan­ced diet and, above all, avo­i­ding over­weight are also im­portant com­pon­ents in os­teo­ar­thri­tis prevention. 

It is ca­te­go­ri­zed into va­rious de­grees of se­ve­rity. Does ti­mely dia­gno­sis also play a role in tre­at­ment success? 

Os­teo­ar­thri­tis is di­vi­ded into four de­grees of se­ve­rity, and ti­mely dia­gno­sis is na­tu­rally im­portant, as it al­lows for pro­tec­tive in­ter­ven­ti­ons such as life­style mo­di­fi­ca­tion (e.g., weight loss and exer­cise the­ra­pies) to slow down the fur­ther pro­gres­sion of os­teo­ar­thri­tis. Un­fort­u­na­tely, it must be no­ted that os­teo­ar­thri­tis can­not be cu­red, and one can only slow down the pro­gres­sion of wear and tear. 

What tre­at­ment op­ti­ons are ge­ne­rally available, from con­ser­va­tive ap­proa­ches to ar­ti­fi­cial joints, as a last resort?

Tre­at­ment de­pends on the stage of wear and tear as well as the sym­ptoms. On the one hand, non-phar­ma­co­lo­gi­cal the­ra­pies are available, such as exer­cise the­rapy, weight re­duc­tion, and phy­sio­the­rapy for mus­cle buil­ding. Phar­ma­co­lo­gi­cally, we have the group of NSAIDs, which pri­ma­rily have an anti-in­flamm­a­tory and pain-re­li­e­ving ef­fect, espe­ci­ally in ca­ses of in­flamm­a­tion si­gns such as joint swel­ling. Ad­di­tio­nally, in­tra-ar­ti­cu­lar in­jec­tions, i.e., in­fil­tra­ti­ons with cor­ti­sone, au­to­log­ous blood, or hyalu­ro­nic acid, can be used. Ge­ne­rally, all these the­ra­pies and me­a­su­res are more suc­cessful the ear­lier they be­gin. The goal is to re­li­eve pain and pre­serve or im­prove joint function. 

If con­ser­va­tive the­ra­pies no lon­ger pro­vide suf­fi­ci­ent pain re­lief due to the ad­van­ced stage of the di­se­ase, then there is an in­di­ca­tion for an ar­ti­fi­cial joint replacement.

If joint re­pla­ce­ment be­co­mes ne­ces­sary, where and how is the pro­ce­dure performed?

I per­so­nally work at the Evan­ge­li­cal Hos­pi­tal in Vi­enna, where I per­so­nally care for my pa­ti­ents. In other words, my pa­ti­ents are per­so­nally ac­com­pa­nied by me th­rough the ope­ra­tion and re­ha­bi­li­ta­tion. We rou­ti­nely use the most mo­dern mi­ni­mally in­va­sive sur­gi­cal tech­ni­ques. In the area of ar­ti­fi­cial hip joints, the AMIS me­thod, which is one of the most mo­dern, mus­cle-spa­ring sur­gi­cal tech­ni­ques, en­ables ra­pid re­ha­bi­li­ta­tion and the best pos­si­ble joint func­tion can be achie­ved. The great ad­van­tage of the AMIS me­thod is that du­ring the im­plan­ta­tion of the ar­ti­fi­cial hip joint, no mus­cles, ten­dons and ner­ves have to be cut on the way to the hip joint, but only held away to the side. As a re­sult, all hip mus­cles re­main fully func­tional and this en­ables par­ti­cu­larly ra­pid rehabilitation. 

In the area of ar­ti­fi­cial knee joint re­pla­ce­ment, we now take in­di­vi­dual ana­tomy into ac­count and, with the more mo­dern sur­face pro­s­the­ses, we can enable our pa­ti­ents to live a life with high ac­ti­vity and wi­t­hout pain again.

Many of my pa­ti­ents for­get that they have an ar­ti­fi­cial hip or knee joint and prac­tice their fa­vo­rite sports as be­fore the ar­thro­sis di­se­ase. Many of my pa­ti­ents are also en­thu­si­a­stic ski­ers and full of joy that ski­ing and even deep snow ski­ing are now pos­si­ble again wi­t­hout pain with an ar­ti­fi­cial joint. This also ap­plies to many other po­pu­lar sports. 

What is your per­so­nal tre­at­ment approach?

It is per­so­nally im­portant to me to ad­vise and treat each pa­ti­ent in­di­vi­du­ally ac­cor­ding to their needs in or­der to enable my pa­ti­ents to live a life wi­t­hout pain and mo­ve­ment again. Per­so­nal care is par­ti­cu­larly im­portant to me. In other words, if an ope­ra­tion is ne­ces­sary, I per­so­nally ac­com­pany my pa­ti­ents from the in­itial con­sul­ta­tion to rehabilitation. 

Do you of­ten see pa­ti­ents co­ming to you very late be­cause, for ex­am­ple, they think it is nor­mal for the joints to start hur­ting in old age?

Un­fort­u­na­tely, we of­ten see this and pa­ti­ents of­ten suf­fer greatly from ar­thro­sis. Not only from the pain, they are rest­ric­ted in their ever­y­day life and can no lon­ger do many things, even though they could be hel­ped well. That is why it is im­portant to see an or­tho­pe­dist for com­plaints and pain and have yours­elf ex­ami­ned. Be­cause the ear­lier a the­rapy be­g­ins, the more can be achieved. 

What ad­vice or words of en­cou­ra­ge­ment can you give our view­ers at this point?

If you have com­plaints and pain with your joints, see an or­tho­pe­dist in good time. Be­cause as the ar­thro­sis pro­gres­ses, the com­plaints con­ti­nue to in­crease and the soo­ner you start the­rapy, the more you can achieve. 

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