Too many netball games as a teenager gave Kelly Hadfield permanently sore knees. The long-term consequences of her passion for sports, however, were more serious. By her early twenties, she was in so much pain that exercise was impossible.
"For a time, I just put on joint strapping and carried on," recalls Hadfield, who is now 28 and works in a children's nursery in Sheffield. But soon, bandages and painkillers were not enough. The pain had worsened and she was often unable to play with the children she cared for.
Doctors diagnosed osteoarthritis of the knees, a degenerative disease in which cartilage wears away, leaving bone surfaces exposed and prone to damage. In addition, as sufferers begin to avoid painful movement, muscles may atrophy, making movement even more difficult. "My right knee was particularly painful," she says. "I had X-rays and MRI scans to see what was going on and keyhole surgery in 2005 to clean out any debris caused by wear and tear in the joint — but nothing helped."
Gift of technology
In June 2008, she was referred to orthopaedic surgeon Paul Sutton, of Sheffield Orthopaedics and the Northern General Hospital. Patients with severe osteoarthritis are usually offered a replacement joint made of metal and plastic but in patients as young as Hadfield, the artificial knees would need to be replaced several times over the years. In extreme cases, the artificial joint can wear down the bone to which it is attached, leading to amputation.
Sutton decided a knee replacement was not for Hadfield and, instead, chose to apply the latest technology. His plans owed as much to engineering as they did to surgery. "Damaged joints often bear the weight of the body, which leads to pain and further wear and tear," he says. "I wanted to realign Hadfield's leg in an operation called an osteotomy, so the force was borne by the healthier, stronger part of the joint."
Sutton used a computer image-guided system to help him break and then realign her shin bone, so that instead of the inside of her knee taking all the force, the outside edge would do the work. The operation was carried out in March last year. Hadfield, who was slightly bow-legged before the operation, was deliberately left slightly knock-kneed afterwards.
This procedure is one of a range of new approaches to osteoarthritis, the most common form of joint disease, which is suffered by eight million people in Britain, according to the charity Arthritis Research UK. The disease affects the ankles, the knees, the hips and the back and problems occur when cartilage — the smooth, tough, elastic "gristle" that covers the ends of the bones — is damaged or breaks down. Cartilage is a natural shock absorber. Without it, bones grind against each other, causing pain, inflammation and disability.
Alan Silman, professor of Rheumatic Disease Epidemiology at the University of Manchester and a spokesperson for Arthritis Research UK, says: "Osteoarthritis is a growing problem. Not only are people living longer and therefore more likely to develop it but the obesity epidemic means more will be affected due to their weight."
There are many factors implicated in osteoarthritis: It rarely starts before the age of 40 — Hadfield is unusual — and women are more likely to develop it than men. Scientists believe this may be because women have less muscular strength than men and so find it more difficult to bear the effects of degeneration. Injury, abnormalities, genetic factors and damage from other diseases are also factors.
Until recently, doctors relied on painkillers to ease discomfort in the short term, physiotherapy to keep the patient moving and joint-replacement operations in the long term — the latest development being partial joint replacements, in which patches of damaged cartilage are replaced, rather than the whole joint. But these are not perfect interventions: Some painkillers can cause side-effects such as gastric bleeding while another group of drugs, the COX-2 inhibitors, is believed to increase the risk of heart disease. Meanwhile, artificial joints will wear out and, in young people, that may mean constant operations replacing them over time, with all the inherent risks of anaesthesia and infections.
Dr Raad Makadsi, a consultant rheumatologist based at the Spire Gatwick Park Hospital, says: "Physiotherapy is the cornerstone of treatment for every patient, as it helps the build-up of muscles to support the painful joint." He also uses injections of steroids and hyluronic acid, a component of the lubricating fluids that bathe joints to help the body build new cartilage. "But," he says, "no drug will halt or reduce the progression of the disease."
Simple measures
While the fruits of much of this research may be some time in coming, Dr Makadsi believes there are simple measures all those with osteoarthritis can take.
He suggests supplements of glucosamine — an amino sugar present in shellfish, animal bones and bone marrow and a natural building block of cartilage — can be useful. There is no quick fix but, Dr Makadsi says, simple lifestyle changes can significantly reduce the pain. "Everyone who suffers from osteoarthritis can help themselves by losing weight, carrying out gentle exercise and trying insoles, which are available from podiatrists, to help posture and change the way one walks, taking pressure off the knees."