Degenerative Arthritis: Understanding, Management, and Treatment Options with Orthopedic Surgeon Baek Seok-ho

tooth[인터뷰] Baek Seok-ho, an orthopedic surgeon
toothDegenerative arthritis, a chronic disease, management is the most important
toothAt the end of the disease, there are not many options, consider surgical treatment

In 2016, as a result of a survey conducted by the Health Insurance Review and Assessment Service on the subject of ‘Diseases I’m worried about,’ the opinion that ‘degenerative arthritis is scary’ was the second highest after cancer at 10.2%. It means that many people are aware of this uninvited guest who suddenly comes along with aging.

As Korean society enters a super-aged society, the number of patients with degenerative arthritis in Korea is rapidly increasing. According to the data announced by Shimpyeongwon in 2022, the number of patients who visited hospitals for degenerative arthritis in Korea as of 2019 exceeded 4 million (4,042,159).

Although the number of patients with degenerative arthritis is rapidly increasing, there are many unfortunate cases in which degenerative arthritis is mistakenly recognized as one of the natural processes of aging and left unattended to develop the disease. The problem is that once damaged cartilage does not heal or regenerate naturally, and as the disease progresses, various symptoms cause great difficulties in daily life. Therefore, it is important to take measures such as active lifestyle correction, regular examinations, and treatment with the help of a specialist in the early stages of a disease with little cartilage damage. Learn more about degenerative arthritis with orthopedic specialist Seok-ho Baek (Madisesang Hospital).

Director Baek Seok-ho｜Source: Madisesang Hospital

Q. Why are the elderly afraid of degenerative arthritis?

Knee cartilage reduces friction between the femur and tibia, facilitating joint movement and protecting the subchondral bone. If this structure is damaged, bones constantly collide with each other, resulting in pain and swelling. If left untreated, the symptoms may worsen and the shape of the legs may be deformed. That is, degenerative arthritis occurs.

Many people know that degenerative arthritis is simply a disease that causes pain due to damage and wear of knee cartilage. However, in reality, it is a chronic disease that causes problems not only in the cartilage but also in the knee joint, such as the meniscus, the synovial membrane, and the subchondral bone. In general, the prevalence tends to increase with age, and among many degenerative diseases, it is a disease with so many patients that it is the fifth most expensive disease.

Recently, with the movement craze blowing, arthritis is often observed even at a relatively young age. Cartilage does not recover on its own once damaged, so it is important to manage the condition so that it does not deteriorate through regular checkups and early treatment.

Q. I wonder why the biggest risk factor for degenerative arthritis is ‘aging’. Also, besides aging, what are some lifestyle habits that accelerate degenerative arthritis?
As we age, degenerative changes in the meniscus occur and the synovial membrane becomes inflamed. As a result, the shock absorption function of the meniscus decreases, and the impact directly applied to the cartilage increases. Eventually, the cartilage begins to be damaged, and the cartilage damage is further accelerated by the inflammatory response of the surrounding soft tissue.

In addition, △weight gain △muscle weakness around the knee △sedentary lifestyle △women are considered as representative risk factors for deteriorating knee health. In the past, degenerative arthritis was often neglected as an inevitable phenomenon of aging. However, if you take good care of your knee health from a young age, you can have strong knees in old age.

Q. Degenerative arthritis can be divided into early, middle, and late stages depending on the stage of progression. How does the treatment method differ by stage?
Degenerative arthritis is classified into early, middle, and late stages according to ‘joint gap’ and ‘degree of osteophyte formation’ based on the results of X-ray imaging and the Kellegren-Lawrence Grade (KL Grade).

Fully automatic knee osteoarthritis severity grading using deep neural networks with a novel ordinal loss pubilsed in Europe PMC by

In the early stages of arthritis, non-surgical and conservative treatment is sufficient. Systematic and steady management such as ‘muscle strengthening exercise around the knee’, ‘weight management’, and ‘lifestyle change’ can effectively slow down the progress of the disease. However, if there is swelling and effusion in the synovial membrane of the knee, drug therapy and injection therapy can be considered to improve it.

Even in the mid-term, there are relatively many treatment options available. You still need to manage your knee health through exercise, weight management, and lifestyle changes. Here, if you have knee pain, you can treat what is causing your symptoms. For pain treatment, ‘arthroscope surgery’, ‘cartilage regeneration’, and ‘osteotomy’ are used. However, at the end of the disease, there are not many treatment options. You may need to have knee arthroplasty.

In the early stages of arthritis, there are often no symptoms. However, if the disease progresses without proper treatment, the knee becomes sore, stiff, and swelling symptoms begin to appear. At the end of the disease, the knee is not fully extended or bent, and walking on stairs or level ground becomes difficult. Therefore, the most important thing is to manage degenerative arthritis from the beginning so that it does not progress to a later stage. However, if the disease has already progressed to the end, appropriate measures such as surgery are needed before bone deformation and knee joint rigidity occur.

Q. Do I have to undergo artificial joint replacement at the end of arthritis?

Arthroplasty is an operation that replaces a joint with an artificial joint after removing damaged articular cartilage and bone. However, even if the results of the X-ray examination show that arthritis is severe, it does not necessarily mean that artificial joint replacement surgery is required. Arthroplasty is best considered when a patient has:

1. If it is difficult to walk on level ground or go up and down stairs
2. Knee pain that makes daily life difficult
3. When bending and straightening becomes increasingly difficult due to pain or stiffness of the knee
4. Pain that is not controlled by medications or injections
5. Severe kneecap deformation

As arthritis progresses to a terminal stage, there are cases accompanied by bone deformation. The more severe the deformity, the greater the amount of bone to be resected during surgery, and the surrounding ligament contracture and relaxation may change the long-term outcome of the surgery. Therefore, surgery should be avoided unconditionally, but it is also important to receive surgical treatment at the right time so that it is not too late.

*Continued from Part 2.

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