What is degenerative joint disease (DJD)?

What is degenerative joint disease (DJD)?

Osteoarthritis or degenerative joint disease is a form of chronic arthritis that affects weight
bearing joints like the knee and may be characterized by progressive degenerative changes in  articular cartilage and bone formation at the margin of the joint.

What are the signs and symptoms of DJD?

• Morning stiffness
• Pain with movement
• Pain and stiffness become more severe with activity (less than 15 minutes in duration), and improve with
  a proper amount of rest.
• Decreased movement of joint
• Buckling or locking of the knee.
• Possible pain when touched
• Swollen or painful joints
• Knee pain may cause a limp when walking
• Cracking sounds can be heard upon movement.

Who are at risk?

• Age – osteoarthritis affects more people over the age of 45
• Female – osteoarthritis is more common in women than in men
• Certain hereditary conditions such as defective cartilage and joint deformity
• Joint injuries caused by sports,  work-related activity, or accidents
• Obesity
• Diseases that affect the structure and function of cartilage ,  such  as  rheumatoid  arthritis, hemochromatosis (a metabolic disorder), Paget's disease, and gout

What happens when you have DJD?
Your bones contain cartilages on each end that serves as cushion to prevent friction on joints.  As you age the protein make-up of this cartilage degenerates. Repetitive use of the joints over the years irritates and inflames the cartilage, causing joint pain and swelling. In advanced cases, there is a total loss of the cartilage cushion between the bones of the joints. Loss of cartilage cushion causes friction between the bones, leading to pain and limitation of joint mobility.
Inflammation of the cartilage can also stimulate new bone outgrowths (spurs) to form around the joints.

Healthy Knee Arthritic Knee

How is it diagnosed?
A physical exam can show limited movement range of motion, grating of a joint with motion, joint swelling, and tenderness. An x-ray of affected joints will show loss of the joint space, and in advanced cases, wearing down of the ends of the bone and bone

TREATMENT OPTIONS

MEDICATIONS

• Pain relievers that reduce swelling
• Steroids. These medications are injected right into the joint.  They can also be used to reduce
  inflammation and pain. - Supplements. Many people are helped by over-the-counter remedies such as glucosamine and chondroitin sulfate. There is some evidence that these supplements can help control pain, although they do not seem to grow new cartilage. - Artificial joint fluid (Synvisc, Hyalgan).  These
  medications can be injected into the knee. They may relieve pain for up to 6 months.

LIFESTYLE CHANGES

• Exercises – helps maintain joint and over all movement
• Applying heat and cold
• Joint protection
• Respect pain
• Avoid positions of deformity
• Avoid awkward positions
• Use strongest joints or Distribute the force over several joints
• Use adapted equipments
• Rest
• Good nutrition
• Weight control

PHYSICALTHERAPY
Physical therapy, which usually lasts between 4 and 6 weeks, is the most important part of your recovery process. The exercises are designed to increase the strength and mobility of your knee. You will also perform some strengthening exercises before your surgery. Some examples of exercises are provided. Only perform the exercises prescribed by your physician.

Seated Knee Flexion
The knee flexion/ seated stretch is performed while seated in a chair. Gently slide your surgical leg behind you using the non surgical leg to assist, while keeping your foot flat against the ground.  Move forward in your chair and hold the stretch for 10-15 seconds.  Repeat the recommended number of times.

Knee Extension Stretch
The knee extension/seated stretch is performed while seated at the edge of a chair. Gently slide your surgical leg forward and push down on the knee to straighten your leg.  Hold for 10-15 seconds then pull your leg back. Repeat the recommended number of times

KNEE EXTENSION PASSIVE
Prop foot of operated leg up on chair, while seated in a chair of the same height. Place towel roll under ankle and ice pack over knee.  Put 5-10 lbs. of weight on top of knee (a 5-10 lb. bag of rice works well). Do this for the recommended amount of time.

Knee Extension - Straight Leg
Lie on back, place towel roll under thigh. Lift foot, straightening knee.  Do not raise thigh off roll.  Repeat the recommended number of times.

Straight Leg Raise
The straight leg raise is performed in a reclined position, using your forearms to support your upper body. While keeping your leg straight, lift your leg twelve to twenty inches, hold for a count of ten, and slowly lower your leg back to the floor.  Relax.  Repeat the recommended number of times.

Ankle Pumps
The ankle pump is performed by slowly moving your foot back and forth as far as possible. Repeat the recommended number of times.

Quadriceps/Gluteal settings
The quadriceps/gluteal exercise is performed while lying on your back. Tighten the tops of your legs while squeezing your buttocks and hold for a count of ten. Do not hold your breath.  Repeat the recommended number of times.

BRACES

Splints and braces - can sometimes support weakened joints. You should use a brace only when your doctor or therapist recommends one.

SURGERY

Severe cases of osteoarthritis might need surgery to replace or repair damaged joints. Surgical options include:

• Total or partial replacement of the damaged joint with an artificial joint (knee arthroplasty, hip arthroplasty)
• Arthroscopic surgery to trim torn and damaged cartilage and wash out the joint
• Cartilage restoration to replace the damaged or missing cartilage in some younger patients with arthritis
• Change in the alignment of a bone to relieve stress on the bone or joint (osteotomy)
• Surgical fusion of bones,  usually in the spine (arthrodesis)

Possible Complications

• Decreased ability to walk
• Deformities
• Contractures
• Decreased ability to perform everyday activities, such as personal hygiene,  household chores,  or cooking
• Adverse reactions to drugs used for treatment
• Surgical complications

In The Medical City what are the services available for these?

• Consultations with physicians
• Surgery
• Physical therapy

References :
deleesportsmedicine.com
brashearre

Note:  This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.  If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

ORTHOPEDIC MULTISPECIALTY CLINIC

Tel. nos. (632) 988-1000 / (632) 988-7000 ext. 6521

DEPARTMENT OF PHYSICAL MEDICINE AND REHABILITATION

Tel. nos. (632) 988-1000 / (632) 988-7000 locals 6240/6241

CENTER FOR PATIENT PARTNERSHIP

Tel. nos. (632) 988-1000 / (632) 988-7000 locals 6444