Chiayi Chang Gung Memorial Hospital Deputy Superintendent Lee Hsuan-sheng "Hong Chun-pei Culture and Education Foundation" Public Interest Lecture

(Taiwan Business News) Walking, running and jumping every day, our joints bear the weight of our whole body. On March 9, the Hong Chun-pei Culture and Education Foundation invited Professor Lee Hsuan-sheng, Deputy Superintendent of Chiayi Chang Gung Memorial Hospital, to speak on "Joint Health, Happy Living." Drawing on his many years of background in joint disease treatment and research, Deputy Superintendent Lee shared his experience, and the audience benefited greatly.

Lee Hsuan-sheng stated that inflammatory reactions occur in the body every day. Inflammation is defined as a reaction of "redness, swelling, heat and pain," because the body attempts to repair tissue damage. Its main tasks are two: remove broken-down old tissue and regenerate complete new tissue. When tissue is injured, blood circulation becomes vigorous, bringing white blood cells to the injured tissue and activating phagocytes to dissolve the damaged tissue and add complete new tissue.

Joints are the places where adjacent bones meet and can move. They are divided into immovable joints, slightly movable joints and movable joints. For example, the skull is made up of five immovable bones and normally cannot move, so it is called an immovable joint; the sternoclavicular joint between the clavicle and the sternum is a slightly movable joint; the frequently moving hip joint and knee joint are movable joints.

Chiayi Chang Gung Memorial Hospital Deputy Superintendent Lee Hsuan-sheng Public Interest Lecture: Joint Mobility, Maintain Them Well and Walk into Old Age

The bone ends where bone meets bone are covered with a thin layer of cartilage, which reduces impact between bones and has the effect of absorbing shock and lowering friction. Jiang Hong-sheng pointed out that cartilage is a tissue in the joint, and its regenerative capacity is very limited. It is worn down and also regenerates every day. If the amount of wear exceeds the amount of regeneration, the cartilage is worn away and arthritis appears.

Cartilage is mainly composed of chondrocytes, cartilage matrix and water. Healthy cartilage should be elastic and have a smooth surface. The cartilage matrix also contains collagen and glucosamine. Collagen is easily obtained from ordinary foods; glucosamine is a key player in helping cartilage retain water, but from food it can only be obtained from animal cartilage.

Lee Hsuan-sheng stated that the causes of arthritis include aging, overuse, excessive ligament load, congenital cartilage defects, malnutrition, joint infection and a poor internal joint environment, among others. Reducing these risk factors that wear down cartilage can lower the risk of arthritis. Taking the most common degenerative arthritis as an example, Lee Hsuan-sheng explained that with increasing age the quality of cartilage becomes less elastic and its growth rate slows, causing the cartilage thickness to become thinner. Combined with overuse of the joint, or being overweight or carrying heavy objects so that the joint bears too much load, this accelerates the appearance of arthritis.

As for ways to treat arthritis, Lee Hsuan-sheng stated: a balanced diet, supplementing the glucosamine needed to make cartilage, moderate exercise, and so on. Glucosamine is relatively rare in ordinary diets and can only be obtained from animal cartilage such as pig ears. The human body also synthesizes it on its own from glucose and amino acids. The ingredients of commercially available health foods are largely similar, mostly extracted from the chitin of crustaceans; recently glucosamine has also been added to milk powder, which can supply calcium at the same time and help prevent osteoporosis. However, it should be noted that foods have no therapeutic effect, and glucosamine supplements cannot treat arthritis. Moderate exercise, meanwhile, can stimulate chondrocytes to produce cartilage matrix, activate circulation near the joint to bring blood and supply nutrients, strengthen nearby muscles, help stabilize the joint, and also help improve cardiovascular and metabolic function.

In addition, slowing the rate of cartilage wear is also an important way to maintain joint health. Lee Hsuan-sheng stated that controlling body weight, adjusting the pace of activity, improving joint stability, controlling pathological factors harmful to cartilage and surgical treatment are all ways to reduce joint wear. After being active for a period, one must rest for a period, or alternately perform heavy and light work, to avoid overuse of the joints. Joints that have previously been injured should receive active treatment or muscle strength training, and protective gear can also be used during exercise to protect the joints.

Lee Hsuan-sheng emphasized that many patients have the problem of being overweight or even obese, which is the biggest killer of the knee joint. Women are limited by the fact that their innate cartilage material is not as good as men's, and after menopause they lack hormones, which easily causes wear of the joint cartilage and makes knee replacement surgery unavoidable.

Generally speaking, if the cartilage wear is relatively mild, doctors may inject hyaluronic acid into the joint as a lubricant; for severe cases, artificial knee replacement surgery is recommended. Its current success rate is as high as over 99%, and the replacement can be used for 10 to 12 years or longer.

After surgery there is still an unpleasant rehabilitation period, and there is even a risk of infection. To maintain the knee joint, the first thing is to remove the culprits that accelerate cartilage wear. For example, gout patients need to control uric acid, and rheumatoid arthritis patients need to suppress antibody activity so that the synovial bursa produces lubricating fluid normally. In particular, those who are overweight must find a way to lose weight in order to reduce wear on the knee joint cartilage.

Profile of Chiayi Chang Gung Memorial Hospital Deputy Superintendent Lee Hsuan-sheng

Deputy Superintendent Lee Hsuan-sheng formerly served as director of the hyperbaric oxygen center and director of the Third Orthopedics Division at Linkou Chang Gung Memorial Hospital, visiting scholar at Nagoya University in Japan, visiting assistant professor of orthopedics at Stanford University School of Medicine in the United States, director of the Joint Reconstruction Division of the Department of Orthopedics and director of the Department of Orthopedics at Linkou Chang Gung Memorial Hospital, among other posts; he currently serves as Deputy Superintendent of Chiayi Chang Gung Memorial Hospital, professor-level attending physician in the Academic Group of Chang Gung Memorial Hospital, appointed professor at the College of Medicine of Chang Gung University, question-setter and review committee member for the senior physician examination of the Ministry of Examination of the Examination Yuan of the Republic of China, council member of the Taiwan Orthopedic Research Society, supervisor of the Orthopedic Medical Association of the Republic of China, council member of the Republic of China Hyperbaric and Undersea Medical Association, and secretary-general of the Republic of China Joint Reconstruction Medical Association, among other posts; his specialties include artificial joint replacement, minimally invasive joint surgery, ischemic necrosis of bone and difficult joint reconstruction.

Hong Chun-pei Culture and Education Foundation 2014 Public Interest Lecture