Degenerative osteoarthritis is a common condition among all aging populations and is an increasingly common secondary condition (see Co-morbidities) among polio survivors as they age into their 50s and beyond. It usually occurs from a wearing-out of joint cartilage that is accelerated by trauma, including repetitive high use/overuse microtrauma. Thus, it is especially common in weight-bearing joints of polio survivors who have residual leg muscle weakness, muscle imbalances and/or joint deformities. These joints are often strained from unusual gait patterns. Symptoms are often worse in “unaffected” limbs that are relied on more because they are stronger, for example, the middle-aged onset of hip or knee osteoarthritis in the “normal leg” of some polio survivors who have walked for years using only one leg brace. Arthritis of the shoulders, wrist and hands is more common among polio survivors who have used crutches and canes for partial weight-bearing and balance over many years.
Joint replacement surgeries are now a common and accepted treatment option for severe symptomatic osteoarthritis. These procedures can be safely done on selected polio survivors, particularly on hip and knees of unaffected or minimally-affected lower limbs. Careful individualized planning for post-operative care and unique rehabilitation needs is essential for good outcomes. For example, post-operative assistance from others can be expected when a stronger limb is operated on and one’s independent mobility will be compromised during early recovery. Comprehensive evaluation by a non-surgeon rehabilitation physician specialist and a physical therapist is strongly recommended whenever joint replacement in a limb with significant chronic post-polio weakness is being considered.
Pain in the shoulders, wrists and/or hands is frequently associated with using canes or crutches for many years. Arthritis of the knees frequently occurs with back-kneeing (genu recurvatum) and with ligamentous laxity conditions (see Joint Deformities), particularly in individuals who have walked with weakened quadriceps, hamstrings, and calves. Splints, braces, crutches, and other orthotic appliances (see Orthotics), physical therapy, and anti-inflammatory medication can all be helpful in controlling or, in some cases, eliminating pain from arthritis.
Cervical osteoarthritis is particularly common in some polio survivors because of abnormal head and neck positioning associated with upper trunk or arm weakness. Looking up at people from a low seating position in a wheelchair may also lead to cervical disk degeneration and/or nerve root pinching (radiculopathy) and secondary weakness in the hands. Diagnostic tests, if cervical osteo-arthritis is suspected from a medical evaluation, should include imaging studies (x-rays, CT scans, MRI, etc.) of the cervical spine and possibly electrodiagnostic examination of the cervical paraspinal and upper extremity muscles.