How Can You Protect Your Joints?

Dr. Sarpong: There's a myth that if you've got arthritis, you shouldn't move, you should lay dormant and not be active. That's actually not true. Motion is lotion. So if you want to prevent further damage to your joint, it's imperative for you to get moving to prevent your joint from getting stiff.

Courtney: Welcome to Health Matters, your dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.

This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at the letter J for joints.

To help us understand our joints and how to keep them healthy, we spoke with Dr. Nana Sarpong, an orthopedic surgeon at NewYork-Presbyterian in Columbia. He explains how to protect our joints and manage painful joint conditions like arthritis. Dr. Sarpong also busts a few common myths about joints. Should you be cracking your knuckles as often as you do? Stay tuned to find out.

Dr. Sarpong, thank you so much for joining us today.

Dr. Sarpong: Thank you, Courtney. I'm looking forward to a great conversation about joint health.

Courtney: So let's start with the basics. What is a joint, and what is its function in our body?

Dr. Sarpong: A joint is basically the meeting of two bones, where two bony ends meet. It's oftentimes lubricated with synovial fluid, and then the ends of bones usually have cartilage, which allows the joint to move freely. A joint is where two bones meet.

Courtney: I was surprised to learn that we have more than 200 joints in our body.

Dr. Sarpong: We have a lot of joints in our body, and sometimes really big joints where the big, long bones of our body meet, and sometimes really, really small joints, including our hands, our feet, even our cervical spine. Usually we'll have muscles and tendons crossing the joints to allow movement of that joint. Any muscle or tendon that crosses the joint can impart motion, whether that's flexion or extension on that knee joint.

Courtney: Is arthritis the most common condition that negatively impacts joints?

Dr. Sarpong: I like to think of arthritis basically in two broad buckets. The first one being really mechanical, run-of-the-mill, primary osteoarthritis, would be patients who have what we call wear and tear. If they're heavy laborers, they spend a lot of time on their hips and/or knees or shoulders. The cartilage is worn out for no other reason outside of wear and tear and/or they have a genetic predisposition for their joints wearing out. The second bucket is what we call inflammatory arthritis, and there are several different flavors of that. Rheumatoid arthritis is one. Psoriatic arthritis. There's juvenile idiopathic arthritis, juvenile rheumatoid arthritis, and other inflammatory arthritides. Gout, I would put in the inflammatory arthritis bucket. The end effect is typically the same, where the cartilage wears out relatively fast, and because of that, the joint is not functioning as it should. It doesn't move as well as it should, and patients end up exhibiting symptoms of stiffness, pain, and difficulty ambulating, difficulty doing things that they enjoy doing.

Courtney: There are a few forms of arthritis that are talked about a lot, osteoarthritis and rheumatoid arthritis. Could you say more about those two and what makes them different from each other?

Dr. Sarpong: Rheumatoid arthritis and inflammatory arthritis and, um, any conditions that result in inflammatory arthritis usually are the result of antibodies in our bodies attacking the joint, attacking the cartilage within a joint that destroys the joint. The primary osteoarthritis usually is due to either trauma, genetic wear and tear of the joint, where cartilage is being worn out for mechanical reasons. Those are the main differences between the two.

Courtney: I heard recently that conditions ending in itis usually means it's an inflammatory condition. Is that right?

Dr. Sarpong: Yep. Arthritis is basically inflammation of the arth, which is arthro- the Greek definition of arthro is joint. So arthritis is joint inflammation. Bursitis is bursa inflammation. Tendinitis is tendon inflammation. When people have gastritis, so gastro being your stomach, itis is inflammation, so stomach inflammation.

Courtney: And so how do you treat these joint problems? For example, if someone has mild or moderate arthritis, what would their next step be?

Dr. Sarpong: For people typically coming to me presenting with mild to moderate or mild arthritis, generally I start with the most conservative options, so the least invasive options. That's usually starting an anti-inflammatory. Things like over-the-counter ibuprofen, or sometimes a prescription strength anti-inflammatory. And that oftentimes will be paired with acetaminophen, which is good for pain. Because arthritis is an inflammatory condition, it's important to have an anti-inflammatory on board. Then I will oftentimes send patients to physical therapy to get their knee and/or hip moving. In joint health, you probably have heard this, Courtney, motion is lotion, and so getting the knee moving or getting a hip moving will help strengthen the muscles around the joint to prevent further cartilage injury. And on the knee side, sometimes bracing can be helpful as well. And then depending on how bad their pain levels are at the time of consultation, if it's above a seven in a one to 10 scale, or if they've got a big event coming up that they want to knock out their pain for, for example, they've got a big wedding that they want to be active and dance for, then I'll offer them an injection.

Courtney: When do you know surgery is the right option?

Dr. Sarpong: Usually we will talk about surgery when they have failed all non-operative options and/or they are in severe pain. I'll typically examine the patient first to make sure that their exam correlates with their imaging findings, and then I will talk to them about surgery. If you've got bone-on-bone arthritis, oftentimes the injections are not gonna be as helpful. We call them band-aids. You know, it may give very transient or very minimal relief. So then the real treatment, the definitive treatment for that would be joint replacement, whether that's a hip replacement or a knee replacement.

Courtney: Could you describe what that surgery is, and how does it help the bones? How does it help our function?

Dr. Sarpong: Joint replacement surgery, it's basically a resurfacing of the ends of the bone, meaning the joint. It's a reconstruction of the joint. In arthritis, the cartilage is completely worn out, and in its most severe form, the cartilage is completely denuded, and so you have bone rubbing on bone. And so what a joint reconstruction does is reconstructs just the ends of the bone, not the whole bone, the ends of the bone that's arthritic, and it's basically a resurfacing of the ends of the bone, and it's replaced with metal, oftentimes it's a titanium, which has got a strong affinity to bone and very similar modulus of es- elasticity to bone, and then the plastic. The plastic is a medical-grade plastic called polyethylene. In contemporary plastics, contemporary polyethylene, wear rates are incredibly low, and so these plastics are now lasting. In a joint replacement, we're not cutting any muscles or tendons typically, and so that lends itself to the joint being able to move immediately after surgery. Patients are walking the same day of surgery. For most people, this is an outpatient procedure, meaning an ambulatory going home the same day. And with our rapid recovery protocols, patients are not bed-bound. People are walking the same day after surgery, initially with a cane. And the whole goal of surgery is to get them back to their pre-arthritic function and to get them really back to independence. Hip replacements tend to recover a little bit faster than knee replacements. Pain tends not to be as high for hip replacements. Typically, I'm telling patients hip replacement recovery anywhere from six to eight weeks, and then for, for knee replacements, really to feel 90 to 95% near normal, I'm usually citing anywhere from eight to 12 weeks after surgery.

Courtney: I imagine it's rewarding to help restore patients to their function.

Dr. Sarpong: Absolutely. I love orthopedics, and why I w- pursued this was this sense of always instant gratification, being able to really get tangible results almost right away. Really brings a lot of joy and satisfaction to me and the patients.

Courtney: What's the most important thing people can do to protect their joints and maybe not end up in your office earlier than they need to?

Dr. Sarpong: There's a myth sometimes that if you've got arthritis, you shouldn't move, you should lay dormant and not be active. That's actually not true. Motion is lotion. If you want to prevent further damage to your joint, it's imperative for you to get the knee and/or hip moving to prevent your joint from getting stiff, especially as the mechanical nature of the arthritis sets in and progresses. So, I would say from a preventative standpoint, motion is actually really important, and that's why as part of our initial first step in treatment, we send patients to physical therapy to get that motion going and get their joints moving.

Courtney: Are certain exercises more helpful than others?

Dr. Sarpong: So we typically talk about aerobic exercises, things like swimming or even light jogging. You know, walking can be really helpful. The muscles are moving, but not overly being strained. So those are exercises that I'll typically tell patients to do. Exercises that I'll tell patients to avoid include things like squats and, and deadlifts, things that will put too many forces around the knees. I tell patients, if you can lose one pound of weight, that translates to five pounds less forces around the joint. And so even if it's 10 pounds, 10 pounds would translate to 50 pounds less forces and less weight a- across the joints.

Courtney: It's a really eye-opening way to think about it. You know, even just two pounds is 10 pounds.

Dr. Sarpong: Yeah, exactly, and sometimes that's easier said than done because they're in so much pain, and the arthritis hurts. But even if it's one pound, like you said, that can translate to pretty significant less forces across the joint.

Courtney: So you mentioned exercises to avoid. How about for the runners out there? Are there too many marathons you can do?

Dr. Sarpong: Yeah, I mean, that's all wear and tear. When you're running 26.2 miles, especially if you're carrying a lot of weight on you, that can translate to a lot of forces around the knee joint. I hate to tell patients that they can't do things that they enjoy doing, i.e., running marathons, but if you've got arthritis already setting in and/or if you've got a pretty strong genetic history, maybe don't run more than three.

Courtney: Okay. And on the opposite end of the spectrum, can too much sitting be bad for our joints?

Dr. Sarpong: Too much sitting could be potentially bad for your joint because, again, motion is lotion. Getting the knee moving, getting the cartilage gliding, um, w- and getting the muscles moving will prevent further damage. And so if you're dormant, if you're laying still, if you're bed-bound, you can definitely get deconditioned and get further injuries to your joint.

Courtney: Are there any supplements you recommend to patients looking to protect their joint health? A lot of people ask about collagen. Is that something you feel comfortable recommending?

Dr. Sarpong: The literature is just so mixed, and there's been no real difference at all with patients who take collagen, patients who take glucosamine, for example, so that's not something that I typically talk about in my office. I mean, if people come in already taking it, I don't tell them to stop taking it, but it's not something that I'm typically prescribing for patients. Unfortunately, we don't have great options that can reliably regrow cartilage once we've lost that cartilage. There are a lot of things on the market like glucosamine, chondroitin, collagen, but unfortunately, there's been no real high-level evidence to show that it really can reliably prevent or even reverse cartilage wear.

Courtney: Are there any foods or diets that can help protect our joints?

Dr. Sarpong: Turmeric. Turmeric is a great anti-inflammatory that people will sometimes get good relief from it. It's a nice easy homeopathic option once people are feeling pain and inflammation.

Courtney: I'd love to just spend a little time on myths or just some common questions. Like why do our joints crack? Why do we hear that snap?

Dr. Sarpong: The snapping and the cracking of the joints are basically the synovial fluid bubbles moving as the joint is moving. It's not necessarily a bad thing.

Courtney: That's so interesting. It's fluid bubbles.

Dr. Sarpong: That's correct.

Courtney: I did not know that. Thank you. Any other common myths? Like does weather actually affect our joints? Some people, it'll start to rain, and they'll say their joints are sore. Is there any validity to that?

Dr. Sarpong: A lot of patients tell me that they can tell when it's about to rain, for example, because their arthritis flares up. I don't know a scientific reason for it, but it's definitely something that we hear quite a bit, and I believe.

Courtney: Any other myths you hear a lot?

Dr. Sarpong: One myth that I definitely would like to debunk is that joint replacement only will last 10 years. That's clearly not the case anymore with contemporary joint replacement devices that we're using. The wear rates are so incredible. Implants are lasting 40, 50, 60 years. And so if you're coming in in your 50s and 60s undergoing joint replacements, more likely than not, you will not need a redo or revision for wear-related issues.

Courtney: That's incredible. Is there any important takeaway message, or if listeners remember just one thing about protecting their joints, what would it be?

Dr. Sarpong: The one main takeaway that I want listeners to remember is to get your joints moving. Motion really is lotion for joint health. If you can get your knee and your hips and your shoulders and your wrists, elbows moving, you can potentially avoid further damage to the joint.

Courtney: Dr. Sarpong, thank you so much for such a great conversation about joint health. I learned so much, and I'm going to go for a swim.

Dr. Sarpong: Pleasure was mine, Courtney. Thank you.

Courtney: Our many thanks to Dr. Nana Sarpong. I'm Courtney Allison.

Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests.

To learn more about Dr. Sarpong's work with patients, check out the show notes.

NewYork-Presbyterian is here to help you stay amazing at every stage of your life. Join us next time when we discuss how kindness can impact our mental and physical health. That's in two weeks right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.