08
THE HEALTH | NOVEMBER , 2022
| Column |
Joint Preservation Is Key
BONE TO PICK
THAT ’ S a surface that ’ s never straightforward to navigate . Once you lose your bearings on such a surface , it is difficult to , although not impossible to recover from . So , where am I going with this ? Which part of the human body could I possibly be referring to ?
It ’ s the articular cartilage . Found in the joints of our body , it primarily acts as a surface on which two articulating bones meet and form a joint . Simply put , it functions to reduce friction and distribute loads in the joints .
Without these slippery surfaces , we could never have joints , and humans would probably have to move around like a massive tree from a cartoon .
Looked at under a microscope , the cartilage comprises layers of cells called chondrocytes stacked on top of one another . They make up one of the substances found in cartilage . Others include water ( up to 60-80 per cent of the total cartilage mass ) and collagen .
When looked at by the naked eye , cartilage is a white , shiny and smooth material . When this surface is bathed in synovial fluid ( a gel-like substance found naturally in joints ), it becomes lubricated and thus slippery . It makes up an essential part of a well-functioning joint .
Being the surface on which two bones move on each other can have its downsides . Like an old shirt , no matter how good the quality , it will eventually have wear and tear effects . It is usually my go-to analogy when explaining to patients why the cartilage in their joints , the knee especially , isn ’ t like what it used to be .
Reasons for cartilage defects
With age , the cells within the cartilage increase in size but reduce in number . The amount of water found within the cartilage also decreases , making it stiffer and less elastic .
Although degeneration is the most common cause of cartilage defects , there are many other reasons why this can happen . Chief among them is acute trauma , be it from a sporting injury or an accident .
During these events , the joints experience abnormally high pressure on their surfaces , resulting in focal damage . This is not to say that exercise
The slippery slope
Cartilage damage never heals well ; even when it does , it ’ s never to its original self
is bad for the cartilage , quite the opposite in fact .
Under everyday loads / stress , cartilage thickness can increase . However , when there is excessive force , the opposite effect may take place . A pressure of over 24 MPa ( Megapascal ) will disrupt normal cartilage .
In the elderly , cartilage disease tends to present as osteoarthritis , which may be primary , after a previous trauma or even as a form of inflammatory disease . This form of articular damage is more diffuse within a joint .
Treatment options
Treatment , as described in my earlier column titled “ Getting stuck in , literally ”, ranges from conservative to surgery . Surgery will involve either a realignment surgery or a partial or total joint replacement .
For younger patients , articular cartilage damage tends to be smaller and more focal . As mentioned above , these injuries occur in younger people due to a particular trauma . However , in some younger patients , it can occur due to a vascular problem or hereditary .
For younger patients , articular cartilage damage tends to be smaller and more focal . As mentioned above , these injuries occur in younger people due to a particular trauma . However , in some younger patients , it can occur due to a vascular problem or hereditary .”
This particular presentation of cartilage disease is called osteochondritis dissecans . As with everything else , it can be treated conservatively with physiotherapy and bracing in its milder forms . Surgery is indicated in patients who have failed
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ). non-operative measures . Surgical options depend on the size and depth of the cartilage defect . Treatment may range from something less invasive , like bone marrow stimulation to stimulate cartilage growth or arthroscopy and stabilisation of a defect .
In more severe cases , something more extensive , like bone grafting ( taking bone and cartilage from elsewhere and pasting it at the site of the defect ), may become necessary . More recently , the use of BioPoly implants to “ patch up ” these defects is gaining popularity .
So again , why the title slippery slope ? Well , we now understand that the surface of the articular cartilage is slippery . But why a slippery slope ? The cartilage damage never heals well ; even when it does , it ’ s never to its original self . This disease often tends to progress . It ’ s usually not a matter of if but a matter of when .
While we can ’ t completely halt the progress , we can try and slow it down . The slope may be slippery , and you may fall , but your friendly neighbourhood doctor can help you get back up again and prevent you from tumbling down the hill . – The Health