Journal of Orthopedic Oncology
Open Access

Osteoarthritis is that the most typical sort of arthritis. It affects humans and other animals, notably dogs, but also occurs in cats and horses. It can affect both the larger and the smaller joints of the body. In humans, this includes the hands, wrists, feet, back, hip, and knee. The disease is one acquired from daily wear and tear of the joint; however, osteoarthritis may also occur because of injury. Osteoarthritis begins within the cartilage and eventually causes the two opposing bones to erode into one another. The condition starts with minor pain during physical activity, but soon the pain will be continuous and even occur while in a very state of rest. The pain is often debilitating and stop one from doing a little activity. In dogs, this pain can significantly affect the standard of life and should include difficulty intensifying and downstairs, struggling to urge up after lying down, trouble walking on slick floors, being unable to hop in and out of vehicles, difficulty jumping on and off furniture, and behavioral changes (e.g., aggression, difficulty squatting to the toilet). Osteoarthritis typically affects the weight-bearing joints, like the rear, knee, and hip. Unlike arthritis, osteoarthritis is most ordinarily a disease of the elderly. The strongest predictor of osteoarthritis is increased age, likely because of the declining ability of chondrocytes to keep up the structural integrity of cartilage. Quite 30 percent of ladies have some extent of osteoarthritis by age 65.

Whilst the teaching of ethics has improved markedly over the past few decades, more work is required to make sure that ethics is taught and assessed well. The fear amongst our patients is that the moral behaviour of medical staff is often sub optimal. However, it's unknown if this results in a change in behaviour. An understanding of medical ethics is prime to all or any branches of orthopedics including the relatively new subspecialty of foot and ankle surgery. The essential principles that everyone clinicians should understand are those of beneficence, autonomy, non-maleficence, and justice. These principles are relevant within the management of ankle arthritis which could be a common clinical problem which will be treated conservatively or surgically. It is often treated non-surgically with analgesia, activity modification or mucopolysaccharide Visco supplementation which has been used “off label” for symptom control. This is often a proposition because it seems logical that each one synovial joint troubled by degeneration should take pleasure in Visco supplementation. However, the priority has been that this breaches the principle of beneficence; that this intervention might not benefit our patients but may rather cause pain and hence breach the principle of non-maleficence, suggest just this; their recent randomized, double blinded and placebo-controlled study demonstrated no difference between mucopolysaccharide Visco supplementation and an injection of saline. The moral considerations of surgical intervention in ankle arthritis become even tougher. Whilst non-maleficence remains a crucial principle, one must accept that it's impossible to always avoid harm as complications inevitably do develop following surgery. Open tibiotalar fusion has historically been related to poor outcomes with a nonunion rate of up to 35%; recent results are more encouraging. The principle of justice dictates that we intervene arthroscopically as our patients are going to be in hospital for a shorter period which can afford us to admit other patients faster for his or her pain-relieving surgery. The role of total ankle arthroplasty remains currently being established and therefore the relative indications for it are evolving. This presents its own ethical problems; the way to make sure that we perform this surgery within the correct patient group? Ankle arthroplasty surgery is technically demanding particularly within the context of deformity and is related to a learning curve. This can be further compounded by the low volume of such surgery being performed. Amongst knee arthroplasty surgeons, it's accepted that top volume units have less complications than low volume units. Such evidence doesn't exist within the ankle arthroplasty population but by extrapolating data from our knee colleagues it seems pertinent to ask if it's ethical to dilute experience instead of concentrating it in a very few units where patients may go onto have better outcomes. Finally, to confirm that we meet the four basic principles of medical ethics we must robustly evaluate the many ankle replacements commercially available to make sure that we only implant those who will provide good pain relief and survivorship. We must make sure that we meet the stress of our patients which specifically we do no harm.

An issue like ankle arthritis which one may assume doesn't pose any real ethical challenges is, in fact, full of them. In part, we shall meet this challenge by ensuring that we perform good quality research to spot the most effective possible interventions out of the multitude available to us. However, we must even have a full and detailed with our patients to make sure that they understand the boundaries of our knowledge otherwise we shall not be respecting their autonomy.