Don’t ignore joint pain if it interferes with daily life, warns India’s top orthopaedic surgeon Dr Ashok Rajgopal

Arthritis is an umbrella term for multiple health conditions that cause pain, stiffness and swelling in joints, which are the meeting point of two bones in a body. As many as 100 types of arthritis exist, and the most common types of arthritis worldwide include osteoarthritis and rheumatoid arthritis. Cases of both these forms of the condition have witnessed a steep increase globally. According to the World Health Organization, from 1990 to 2019, there was a marked increase of 113 percent cases of osteoarthritis worldwide. And in 2019, 18 million people worldwide were living with rheumatoid arthritis. Women are more susceptible to the condition due to multiple factors. But being aware of risk factors as well as early signs and symptoms of arthritis, can help people seek timely intervention to improve their quality of life, asserts senior orthopaedic surgeon Dr Ashok Rajgopal, who has conducted over 39,000 total knee replacement surgeries and over 60,000 arthroscopic surgeries for sports injuries during his career.

On the occasion of World Arthritis Day 2024, Health Shots interviewed Dr Ashok Rajgopal, currently Group Chairman, Institute of Orthopaedics at Medanta, to discuss the prevalence of arthritis in women, the prevention and management of this health condition, and why total knee replacement surgeries are on an upswing.

Excerpts from the interview:

Q. Arthritis is often considered an inevitable part of aging, especially for women. How true is this, and how much can be prevented through proactive measures?

Dr Ashok Rajgopal: Arthritis is marked by joint pain, inflammation, stiffness, and reduced mobility. Research shows that women are twice as likely as men to develop arthritis, and 3.5 times more likely to suffer from knee arthritis, which is the most common reason for knee replacement surgery.

Taking simple steps to prevent the progression of arthritis can help keep it from impacting our daily lives. The condition is linked to several risk factors, both modifiable and non-modifiable. While we cannot control the non-modifiable factors, managing the modifiable ones can help reduce the risk of arthritis. Maintaining a balanced diet, managing your weight, and staying physically active are key strategies for avoiding knee issues.

Q. The women-to-men ratio of arthritis cases is quite skewed globally. What are the primary risk factors that make women more susceptible?

Dr Ashok Rajgopal: Women have more chances of getting arthritis than men, due to the anatomical differences. Women have broader hips (to aid with childbirth), which leads to an abnormal limb alignment when compared to men. This causes increased stresses across the knee joint which may lead to arthritis. Women’s joints are also more flexible, making them more prone to injuries and subsequent arthritis. Genetics also influence the development of arthritis. According to studies, certain genes can raise the possibility of having arthritis. Women with a family history of arthritis are also more prone to get affected.

Q. What is the role of hormonal changes, especially during post-menopause, in accelerating the onset of arthritis in women?

Dr Ashok Rajgopal: There is a potential link between oestrogen and cartilage, which acts as a cushion between the joints and the bones. Oestrogen protects the cartilage from inflammation, but as oestrogen levels drop after menopause, this protection disappears, predisposing them to arthritis of the knee.

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Q. Knee replacement surgeries are rising globally. What is contributing to this increase?

Dr Ashok Rajgopal: There are multiple reasons that have helped more and more arthritis patients choose total knee replacement surgery — the gold standard for the treatment of advanced knee arthritis — over a life of pain, dependence and immobility. Better-designed implants, better materials, newer technologies, improved access and awareness have improved patient outcomes, contributing to the rise in the number of knee replacement surgeries being done globally. Better post-operative rehabilitative techniques mean patients recover faster and more effectively.

Q. It is clear that technological advancement has revolutionised knee replacement surgery, and the recovery period for patients. What are some recent innovations that you are most excited about as a specialist in this field?

Dr Ashok Rajgopal: Robot-assisted total knee replacements have helped improve surgical accuracy in the positioning and the alignment of the knee. This technology also helps balance ligaments and reduce the risk of unbalanced knees. These improvements over manual surgery have helped greatly improve patient satisfaction, and quality of life.

Q. Are 80s a safe age bracket for knee replacement surgery?

Dr Ashok Rajgopal: There is no specific cut-off age and older patients can benefit from knee replacement surgery as much as the younger ones. Longer lifespan, improvements in medical science and better access mean an increasing number of people want to and have the option to retain their quality of life well into the advanced years. Most people in this age bracket live normal, healthy and active lives after undergoing knee replacement surgery. However, it is important to undergo a medical evaluation in consultation with the doctor to determine the best possible procedure for relieving arthritis-related pain and symptoms.

Also read: 10 simple ways to ease joint pain naturally

Q. Health is best protected earlier in life. For women in their 30s and 40s, what early signs of arthritis should they watch for?

Dr Ashok Rajgopal: While women are more prone to arthritis, the risk can be mitigated through early awareness and proactive steps. Understanding the warning signs and risk factors — such as menopause, family history, and weight management — can help women take charge of their joint health before arthritis becomes severe. If you are experiencing joint pain or stiffness interfering with activities of daily living, don’t ignore your arthritis symptoms. Regular exercise, maintaining a healthy weight, and timely medical guidance can significantly lower the risk of arthritis-related complications.

Q. Given that this condition often leads to reduced mobility and quality of life, what role do physical activity and diet play in both preventing and managing the disease?

Dr Ashok Rajgopal: Obesity is a well-established risk factor for arthritis. Engaging in regular exercise can help, with activities like walking, cycling, and yoga. Diet also influences arthritis risk, and certain nutrients, such as omega-3 fatty acids and vitamin D, have been linked to a lower likelihood of developing the condition. Omega-3 fatty acids, known for their anti-inflammatory properties, are found in plant and nut oils like walnut, soybean, flaxseed, and olive oil.

Q. Mental health is often overlooked in such conditions. What advice would you give to women managing the emotional toll of arthritis, especially when mobility is compromised?

Dr Ashok Rajgopal: Stress and anxiety are common among patients dealing with arthritis-related conditions. Persistent pain and difficulty with movement can intensify these feelings, often resulting in reduced interest in daily activities, low energy, and reduced concentration levels. Despite this, staying active and practicing self-care are essential. Strategies such as meditation, music therapy, art, and social engagement can help manage symptoms. Above all, it is crucial for patients to consult their doctor regularly to keep the disease under control.

Q. What are your top 5 daily practices to maintain bone health and overall wellness?

Dr Ashok Rajgopal: Regular exercise, healthy eating, cutting down on sugar, oil and salt, managing stress adequately, and maintaining a good work-life balance are all crucial to musculoskeletal well-being.