Read on: danhwilliams.com

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So, if you haven't suffered from any trauma, infection or rheumatoid arthritis.
From the causes I wrote about last week here..

..is it good enough to write that our own osteoarthritis is ‘something that just happens’?
 
I don't think so..

BUT that is actually what medical school taught me
(Well, it was last century)

NOT in so many words.
We called it ‘primary’ osteoarthritis.


‘Primary’ osteoarthritis

That label came with a shrug of the shoulders: 
‘it’s primary... it just happens’. 
And I nodded along.
 
I accepted the terminology. 
No questions asked. 
 
NOW I realise that, back then, we simply did not know
We didn't know what was underlying most osteoarthritis.

The knowledge, information and, indeed, the data wasn't there to describe what was happening.


Our understanding has got much better over the last 30+ years of my career. 
Crumbs, I can’t believe THAT's the number I’m writing down..

To be fair to 20th century pathologists and surgeons.
Our imaging has got dramatically better..

Better measurement + data is one of my key themes.
And better scans are part of that..


Better scans 

Better scans now measure the really detailed anatomy of our joints.

Better scans => Better data => Better information => Better Knowledge => Better Outcome

• Information is data in context.
• Knowledge is applied information.
• The Outcome = ⬇ pain ⬆ function.

Better scans reveal the anatomy that leads to inflammation
That leads to cartilage damage, from..

• mild to
• moderate through to
• bone-on-bone osteoarthritis. 

Better measurement / data has been and is key.
 
Let's look at some examples..


Knees first

Long leg x-ray film taken from pelvis to foot show subtle deformities in the long bones of the leg..

And those deformities are subtle.
Dropping a line from the

• Centre of the Hip to
• Centre of the Ankle

..shows where the line of force passes through the Knee

• Inside
• Outside
• dead Centre.

Higher peak force through one side of the knee can lead to more inflammation + wear. Especially if other factors contribute..

A few millimetres out might not seem a lot..
BUT, we put 5x bodyweight
through our knees..

AND we take 3 million steps per year.

A few millimetres out and we're putting a lot of force through one part of the knee. That can inflame the knee
And..


Inflammation leads to..

Cartilage damage
Cartilage thinning (on that side of joint) 
And that itself increases the deformity leading to..

MORE force and MORE inflammation.

The problem accelerates.
Osteoarthritis, once it starts, self-perpetuates.
 
Intact ligaments restrict cartilage loss to a characteristic pattern.
A bow-legged deformity of the knee leads to cartilage loss

• on the inside of the knee, and
• at the front of the knee*

*~half of patients have this pattern of OA.


If spotted it can be effectively treated with a partial knee replacement.

A partial knee is proven to get a slightly better result than total knee replacement.

Less is more in the right patient.
A bow-legged deformity commonly affects both knees
..as was the case with Iain, one of the four men in Newsletter #025.

Iain said he had always been bowlegged:

‘I couldn’t stop a pig in a passage’

..which made me chuckle.

An under-developed end to the outside of the femur or thigh bone
..leads, less commonly, to a knock-kneed deformity.
It’s once again quite subtle..

The line of force now passes through the outside of the knee
And peak forces, inflammation and osteoarthritis do the same.
 

As well helping us understand the true underlying cause of knee OA
(useful in itself)

..these (subtle) deformities point towards the best choice of knee replacement:

• medial (inside)
• lateral (outside)
• total.

Coming up next week: the Hip.
And deformities in the hip
..were even harder to spot.


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