Bone and Joint Disorders Affect People of All Ages

Orthopedic Specialists Help People Get Back to Living the Quality of Life They Desire

In the U.S., around 126.6 million people (about half the adult population) experience musculoskeletal (bone and joint) problems, says a report by the United States Bone and Joint Initiative. These issues include bone and joint diseases that can cause serious pain, loss of the ability to move freely and even, in the case of bone cancer, death. One in two women and up to one in four men over age 50 will break a bone due to osteoporosis.

While it is true that age is a contributing factor for some people, bone and joint health issues impact children, and adults under the age of 50. It’s not just an “old folks” health challenge.

Bone Disorders
Some common issues you may have heard of include:

• Osteoporosis—bone loss, affecting as many as 53 million Americans, that weakens bones, making them more likely to break
• Osteomalacia — bone softening
• Hyperparathyroidism — calcium loss caused by an overactive parathyroid gland
• Paget disease — enlarged, weak bones
• Developmental bone disorders occurring in children
• Spine disorders — including scoliosis (or curvature of the spine), herniated (or ruptured) disc, stenosis (narrowing of spaces within the spine), axial spondylitis (a type of arthritis that can cause the bones in the spine to fuse) and spinal osteoarthritis (arthritis of the spine)
• Fractures — broken bones
• Bone cancer — abnormal cells that attack the bones and joints. It can start in bones and joints, or spread from cancer elsewhere in the body

Although these disorders, taken together, make up the bulk of bone problems for people in the U.S., osteoarthritis is the largest contributor. More than half of adults 65 and older experience osteoarthritis. However, two thirds of men and women with osteoarthritis are under 65. Predictions call for osteoarthritis to affect about 67 million people in the U.S. by 2030. That’s about 25 percent of the adult population.

Bone Fractures
Breaking a bone is an injury that happens to people of all ages. Some bone breaks, or fractures, are more common among children. Others occur more among adults or seniors. Depending on how the bone breaks treatment and recovery will vary.

Some common bone fractures include:

• Collarbone Fracture • Wrist Fracture
• Ankle Fracture • Vertebral Fracture
• Hip Fracture • Forearm Fracture
• Shinbone Fracture

Joint Disorders
That so many people develop arthritis means the number of joint problems keeps orthopedic physicians busy. Joint issues can have several causes, but the most common is some type of arthritis. The possibilities include, among others:

• Osteoarthritis. Resulting from cartilage breakdown as people age, leads to pain and stiffness
• Rheumatoid arthritis. An autoimmune disorder in which the immune system attacks cells in the joint, causing inflammation and destroying bone and cartilage, the tissue that prevents the bones of the joint from rubbing together.
• Spondyloarthritis. A disease group including enteropathic arthritis, which might be an inflammatory bowel disease complication; and psoriatic arthritis, which usually affects hand and foot joints.
• Juvenile idiopathic arthritis. Arising from unknown causes, can affect children’s muscles, ligaments, joints, internal organs and eyes. It can also disrupt growth.

Arthritis begins in the joints and can damage the bones that make them up. Although medication and other measures, including less-invasive surgery, such as arthroscopy, as well as medications and physical therapy, can ease the pain and stiffness arthritis causes, they can’t make it go away. Eventually, a partial or total joint replacement will likely be necessary.

Joint Replacement

Scott Abraham, MD, an orthopedic surgeon with the Kansas City Orthopedic Alliance, said, “The main reason for knee or hip replacement would be severe, degenerative knee or hip arthritis (a disease in which the function or structure of the affected tissues or organs changes for the worse over time).” Dr. Abraham replaces about 100 knees and 250 hips a year. Nationally, knee replacements account for 600,000 orthopedic surgeries a year, and hip replacements make up 300,000, placing knee and hip replacements among the most frequent orthopedic surgeries.

For hip and knee replacement, more and more doctors and patients are opting for robot-assisted surgery.

Daniel Reinhardt, MD, of the Kansas City Orthopedic Alliance, said the main advantage of using robots is that “you’re reliably putting the implants where you think you’re putting them.” A robot, he said, increases accuracy, which improves the likelihood of the best outcome. Shoulder replacements number about 53,000 a year in this country. Not surprisingly, arthritis often gets the blame for shoulder pain, as well as hip and knee discomfort.

“For what we consider a total or anatomical shoulder replacement, the typical indication is arthritis of the shoulder joint,” said Scott Ellsworth, MD, who specializes in the procedure at Kansas City Orthopedic Alliance. “The cartilage of the ball and socket joint is completely worn away.”

“People opt for total shoulder joint replacement when the pain is bad enough and nothing else has worked,” Dr. Ellsworth said. He added that a partial joint replacement might be called for in case of a shoulder fracture or avascular necrosis, in which the top of the arm bone—the ball that fits into the socket—dies. The surgery replaces the bone ball with a metal one.

Other Joint Treatments
Other treatments for joint disease are still in the experimental stages. Dr. Abraham said these options include stem cells to regenerate tissue, such as cartilage, and platelet-rich plasma (PRP), which also helps tissues regenerate. He emphasizes that, although these treatments show some promise, “they’re unproven and not yet covered by insurance.”

Bones and joints give the body stability, protection and the freedom to move about. Aging and disease can put limits on their ability to provide these services. It’s important to learn ways to keep bones and joints healthy for a high quality of life. A visit to a physician can help prevent long-term disability and promote life without pain.

L. Nathan Gause, MD, and Josh Niemann, MD, are MU Health Care orthopedic surgeons who practice at Liberty Hospital Orthopedics.

When should consultation start with an orthopedic surgeon in your specialty?

The most common reasons a patient will seek out an orthopedic surgeon are: generalized pain in the lower extremity, fractures, sprains, deformity, bunions, hammertoes, arthritis and sports injuries.

What is arthroscopy and how is it used?

Arthroscopy is a surgical procedure used to look at, diagnose, and treat problems inside a joint. Arthroscopy is minimally invasive and used to treat a number of diagnoses (lesions, inflammation, removal of foreign body, joint infection and diagnostic exploration). It is also used when treating ankle fractures, to diagnose and treat injuries to the joint that are not necessarily visible on an X-ray or CT scan.

Dr. L. Nathan Gause specializes in foot, ankle and lower extremities.

What things should patients know before they decide on robot-assisted bone and joint surgery?

“Not all “robotic” procedures are identical, and patients should carefully evaluate the technology with their surgeon before proceeding,” states Dr. Neimann. “Most robotic platforms require pre-surgical imaging, usually a CT scan, to thoroughly evaluate the anatomy of the joint. The patient will need to check with their insurance provider to see whether this additional expense is covered or would fall back to them. “Robotic surgery for joint replacement is well established for hip and knee reconstruction surgery,” says Dr. Niemann. “Over time, I believe the technology will advance into shoulder, and soon, ankle replacement.”

Sources: American Association of Orthopedic Surgeons, The Orthopedic Clinic