Why Are Joint Disorders Becoming Increasingly Common? An Interview with an Orthopaedic Trauma Surgeon

Joint pain, fractures, sports injuries and modern treatment methods: what do global statistics tell us, and when is surgery truly necessary?

According to the World Health Organization (WHO), approximately 1.71 billion people worldwide live with musculoskeletal conditions. These conditions are among the leading causes of reduced mobility and disability.

The scale of the problem continues to grow. Population ageing, excess body weight, insufficient physical activity and the consequences of injuries are creating additional challenges for modern trauma and orthopaedic care.

At the same time, modern diagnostic, treatment and rehabilitation methods can, in many cases, relieve pain, restore mobility and improve patients' quality of life.

We spoke with Abduaziz Shadievich Babakulov, Head of the Traumatology and Orthopaedics Department at AKFA Medline, about the most common joint conditions, why injuries should never be underestimated and what modern orthopaedics can offer.

1. According to international statistics, musculoskeletal conditions affect more than 1.7 billion people. Why has this problem become so widespread, and what factors are driving the rise in cases?

There are several reasons, and they act simultaneously. The first is population ageing: people are living longer, and age-related changes gradually accumulate in cartilage, bones, ligaments and muscles. Conditions that previously did not have time to develop are now seen in millions of patients.

The second reason is lifestyle. Excess weight, sedentary work, long hours spent at a computer or in a car, and insufficient movement weaken the muscles that normally protect the joints and spine. Diabetes, smoking and vitamin D deficiency also deserve mention, as they adversely affect bone and connective tissue health.

The third is injury: road traffic accidents, falls at home and sports-related injuries. An inadequately treated joint injury can often develop into post-traumatic osteoarthritis several years later.

Finally, we have become better at diagnosing these conditions. However, it is important to understand that most are chronic: they do not simply disappear and their prevalence accumulates in the population. This is why, according to WHO, low back pain is now one of the leading causes of disability worldwide.

2. According to the Global Burden of Disease study, approximately 595 million people had osteoarthritis in 2020. Which joints are most commonly affected, and why is the condition now diagnosed in younger patients as well?

The knees are affected most often, accounting for the largest proportion of osteoarthritis cases. Next come the hips, the small joints of the hands (particularly in women), and joints in the spine and feet. These joints either bear much of the body's weight or are used continuously throughout the day.

Osteoarthritis is no longer exclusively a disease of older people. In younger patients, it most often develops after an injury, such as a meniscal tear, an anterior cruciate ligament tear or an intra-articular fracture. An injured joint no longer functions normally, so its cartilage wears out faster. Other causes include excess weight, congenital anatomical characteristics (such as hip dysplasia), altered leg alignment (bow legs or knock knees), occupational and sporting overload, and hereditary factors.

Warning signs include pain when taking the first steps after rest, morning stiffness, joint crepitus and progressively restricted movement. The earlier treatment begins, the longer it may be possible to preserve the patient's natural joint.

3. According to WHO, approximately 1.8 billion adults worldwide do not meet the recommended level of physical activity. How does a sedentary lifestyle affect joint health, and why do even young people experience knee and spinal pain?

Articular cartilage has no blood vessels of its own. It receives nutrients from synovial fluid, and this exchange takes place during movement, as loading and unloading alternate. In a sense, cartilage is 'nourished' by movement. A sedentary lifestyle makes this process less effective.

In addition, muscles weaken without regular exercise. The quadriceps muscle is particularly important for the knee, acting as a shock absorber and stabiliser. For the spine, the back, abdominal and gluteal muscles perform this role. When this muscular support is weak, more load falls directly on the joints, ligaments and intervertebral discs.

Among young people, knee and back pain is often associated with prolonged sitting, poor posture while using a computer or smartphone, and sudden transitions from inactivity to intense exercise, for example, sitting in an office all week and then playing football at the weekend. We see many patients with patellofemoral pain syndrome and non-specific low back pain.

WHO recommends that adults perform 150–300 minutes of moderate-intensity physical activity per week, such as brisk walking, swimming or cycling, together with muscle-strengthening exercises at least twice a week. For most people, this is the best 'preventive medicine' for their joints.

4. International studies indicate that approximately 178 million new fractures occurred worldwide in 2019. Which types of fracture are the most dangerous, and how effectively can modern treatment restore the function of an injured limb?

I would identify several particularly dangerous groups. These include proximal femoral fractures in older people (including femoral neck fractures). Without timely treatment, patients may become bedridden and develop pneumonia, thrombosis or pressure sores, while mortality in the first year remains high. Pelvic fractures are dangerous because of the risk of major bleeding; spinal fractures because they may damage the spinal cord; open fractures because of infection; and fractures involving blood vessel or nerve injury.

Intra-articular fractures also deserve special attention: even if the bone heals successfully, an inaccurately restored joint surface may lead to osteoarthritis later on.

Modern trauma surgery can achieve very good outcomes. Minimally invasive fixation techniques are used, including intramedullary nails and locking plates inserted through small incisions. We aim to operate on older patients with hip fractures within the first 24–48 hours and help them stand as early as the following day. For femoral neck fractures, we often proceed directly to joint replacement.

With prompt and appropriate treatment, most patients return to their usual lives. The timing of medical assessment, the quality of surgery and subsequent rehabilitation are decisive.

5. WHO estimates that approximately 37 million falls require medical attention each year. Which symptoms after a fall or other injury require an immediate assessment by a trauma specialist?

You should seek immediate medical attention or call an ambulance if, after an injury:

– a limb looks visibly deformed or is in an unnatural position;

– you cannot bear weight on a leg or move an arm or your fingers;

– pain is severe and does not ease at rest, or swelling or bruising increases rapidly;

– your fingers become numb, tingle, feel cold or turn pale, which may indicate nerve or blood vessel damage;

– there is a wound over the injury, particularly if bone is visible;

– a crack or pop was heard during the injury and the joint subsequently gives way or feels unstable;

– back pain after a fall is accompanied by leg numbness or weakness, or problems with urination;

– there has been a blow to the head, loss of consciousness, vomiting or a severe headache.

Older people need particular attention. Even a seemingly minor fall from standing height can cause a femoral neck fracture. Pain in the groin or hip and difficulty putting weight on the leg after a fall warrant urgent investigation.

As a general rule, if pain following an injury does not resolve within a few days, you should see a doctor, even if it 'doesn't seem serious'. Before being examined, do not attempt to straighten or reset the limb yourself, do not apply heat to the injured area and keep it at rest.

6. MRI, CT and digital X-ray imaging are now used to diagnose musculoskeletal injuries. How is the appropriate imaging method selected, and which injuries can remain undetected during a routine examination?

The choice always begins with a clinical examination. The doctor assesses how the injury happened, considers the patient's symptoms and performs specific clinical tests before deciding which investigation is needed. We treat the patient, not the scan.

X-ray imaging is the basic and most accessible method. It shows bones clearly, including fractures, dislocations and signs of osteoarthritis. Digital radiography produces higher-quality images with lower radiation exposure.

Computed tomography (CT) is needed when a detailed assessment of bone is required, such as in complex intra-articular fractures, pelvic and spinal fractures, and surgical planning. Three-dimensional reconstruction allows the surgeon to 'see' the fracture from every angle in advance.

MRI is the preferred method for soft tissues: menisci, ligaments, cartilage, tendons and the shoulder's rotator cuff. It can also identify bone marrow oedema, stress fractures and occult fractures. Ultrasound is sometimes added to assess tendons and joint effusions.

Injuries that may be missed during a routine examination or even on X-rays include scaphoid fractures of the wrist, undisplaced femoral neck fractures, stress fractures, osteoporotic vertebral compression fractures, anterior cruciate ligament and meniscal tears, ankle ligament injuries and osteochondral lesions.

The reverse is also important to remember: MRI is very sensitive and often detects age-related changes in the menisci or intervertebral discs in people over 40–50 who have no symptoms at all. MRI findings must therefore always be interpreted alongside the clinical picture.

7. The ESCAPE study, published in JAMA Network Open, showed that exercise therapy can be no less effective than arthroscopic surgery for certain degenerative meniscal tears. When is surgery genuinely necessary, and when can it be avoided?

The ESCAPE study and several other studies have indeed changed treatment approaches. They concern degenerative meniscal tears in middle-aged and older adults, when the meniscus gradually wears down, often against a background of early osteoarthritis, without a significant injury. In such cases, a structured exercise therapy programme lasting several months produces results comparable to arthroscopy in terms of pain and function. Some patients who do not improve with exercise therapy subsequently undergo surgery, so conservative treatment does not rule out an operation later.

For a degenerative tear without a locked joint, we therefore start with conservative management: therapeutic exercise, weight management, short courses of anti-inflammatory medication and, if necessary, intra-articular injections. It is important to understand that arthroscopy does not treat osteoarthritis itself.

Surgery is genuinely indicated when:

– the tear is traumatic, especially in a young, active patient, in which case we aim to repair and preserve the meniscus;

– the joint becomes mechanically locked, meaning the knee 'jams' and cannot straighten because a meniscal fragment has moved;

– the meniscal tear is accompanied by an anterior cruciate ligament tear and knee instability;

– there is a meniscal root tear that causes complete loss of its function;

– approximately three months of conservative treatment have failed.

The decision is always individual and takes into account age, the type of tear, cartilage condition and the patient's activity requirements.

8. Global Burden of Disease researchers predict that the number of people with osteoarthritis could approach one billion by 2050. Can the progression of the condition be slowed, and which preventive measures have proven effective?

Yes, it is possible to slow the progression of osteoarthritis, although modern medicine cannot yet fully restore worn cartilage. There are currently no medications proven to stop cartilage deterioration. The foundation of treatment is therefore lifestyle change rather than tablets.

The measures with the strongest evidence base, included in international guidelines, are:

– regular therapeutic exercise: strengthening the thigh and gluteal muscles, flexibility and balance exercises, and aerobic activities such as walking, swimming or cycling on a stationary bike;

– weight loss and weight management;

– patient education: understanding the condition and pacing physical activity appropriately;

– comfortable footwear and, when needed, orthotic insoles or a walking stick for significant pain;

– timely and comprehensive treatment of joint injuries, including ligament restoration and meniscus preservation;

– injury prevention for athletes through dedicated warm-up programmes and neuromuscular training.

As for popular chondroprotective supplements, hyaluronic acid and platelet-rich plasma (PRP) therapy, evidence of effectiveness is limited and conflicting, and leading international guidelines do not regard them as essential treatments. Their use is decided individually, but relying solely on them without making lifestyle changes is a mistake.

9. According to NICE clinical guidelines, losing 10% of body weight may provide greater benefit for people with osteoarthritis than losing 5%. How much does excess weight affect the knees and hips, and can weight loss reduce the need for surgery?

The effect is substantial. While walking, every additional kilogram of body weight increases the load on the knee joint by approximately 4 kilograms, and even more during stair climbing or squatting. Consequently, losing just 5 kg reduces the load on the knee by approximately 20 kg with each step.

But it is not only about mechanics. Fat tissue is a metabolically active organ that produces substances contributing to chronic inflammation throughout the body, including in the joints. This is why osteoarthritis is more common in people with obesity even in joints that do not bear body weight, such as the finger joints.

Studies confirm that weight loss of 10% or more, combined with exercise, substantially reduces pain and improves joint function, with a noticeably greater effect than a 5% reduction. This is why NICE recommends aiming for that target.

Can losing weight reduce the need for surgery? In the early and moderate stages of osteoarthritis, yes: it can delay joint replacement for years. In advanced disease, when cartilage has been destroyed, weight loss cannot replace surgery, but it can make the procedure safer. Severe obesity increases the risks of infection, thrombosis, other complications and wear of the prosthetic joint. Weight loss is therefore beneficial at every stage.

10. According to the International Osteoporosis Foundation, one in three women and one in five men over the age of 50 may experience an osteoporotic fracture during the rest of their lives. Why does fracture risk increase with age, and which preventive methods are most effective?

Bone tissue loses density and strength with age. In women, this process accelerates sharply after menopause because oestrogen levels decline, which is why osteoporosis is considerably more common among women. Osteoporosis can remain asymptomatic for a long time, and the first sign is often a fracture itself.

Another part of the problem is falling. As people age, muscle mass decreases (sarcopenia), balance, vision and coordination deteriorate, and some medications cause dizziness or drowsiness. Fragile bones combined with frequent falls are a major reason for fractures of the femoral neck, vertebrae and radius.

The most effective prevention includes:

– sufficient calcium, vitamin D and protein intake;

– strength and balance training, which improve bone and muscle health and reduce the risk of falls;

– avoiding smoking and excessive alcohol consumption;

– bone density testing (densitometry) for women after 65 and men after 70, or earlier when risk factors are present;

– prescribed medication for confirmed osteoporosis, which has been shown to reduce fracture risk;

– a safer home environment with good lighting, no slippery rugs and grab rails in the bathroom.

It is very important that anyone over 50 who has already experienced a fracture from a minor injury be assessed for osteoporosis. One such fracture substantially increases the risk of another.

11. According to a systematic review published in The Lancet, approximately 82% of total knee replacements remain in place without revision for 25 years. How reliable are modern artificial joints, and when is joint replacement the best treatment option?

Modern joint implants are among the most reliable and successful devices used in surgery. The cited figures for 25-year knee implant survival were largely obtained with earlier generations of implants; today's materials, designs and surgical technologies are even more advanced. For most patients, this means that a joint replacement will last many years and, for older people, often for the remainder of their lives.

Joint replacement becomes the best treatment when:

– a patient has severe osteoarthritis with persistent pain, including pain at night or at rest;

– pain and restricted movement seriously interfere with walking, working or daily self-care;

– several months of conservative treatment have not helped;

– there is avascular necrosis of the femoral head or severe joint deformity;

– an older patient has sustained a femoral neck fracture.

I would emphasise that indications are determined not by an image alone but by how much the condition reduces quality of life. Sometimes an X-ray shows severe changes while the patient remains active, and sometimes the opposite is true.

It is also important to know that the entire joint does not always need to be replaced. If damage is confined to one compartment of the knee, a partial (unicompartmental) knee replacement may be possible. After modern surgery, patients can often stand the following day, and the outcome depends greatly on the quality of rehabilitation.

12. WHO estimates that approximately 2.4 billion people worldwide may need rehabilitation services. What role does rehabilitation play after fractures and orthopaedic surgery, and what advice would you give patients to maintain joint health for years to come?

Rehabilitation is not an optional addition to treatment; it is a complete and essential part of it. An operation can be performed perfectly, but without proper recovery the patient may still have a poor outcome: a stiff joint, weak muscles and an abnormal walking pattern.

Early mobilisation reduces the risk of thrombosis, pneumonia, muscle wasting and contractures. After joint replacement or fracture fixation, we aim to get patients on their feet within the first 24 hours. Rehabilitation then continues for weeks or months, restoring range of motion, muscle strength, balance and normal walking, followed by a return to work and sport. Much depends on the patient's own commitment and regular exercise at home.

My recommendations for maintaining healthy joints in the long term are:

– move every day and include strength training;

– keep your body weight under control;

– warm up before sport and increase exercise intensity gradually;

– wear comfortable shoes and lift heavy objects correctly, bending your knees and keeping your back straight;

– do not smoke, as smoking impairs fracture healing and tissue repair;

– do not ignore pain or delay seeing a doctor after an injury;

– after the age of 50, pay attention to bone health and have your bone density assessed.

13. Many patients complain of sharp heel pain, particularly when taking their first steps after waking up. This is often called a 'heel spur'. What actually causes the pain, can the condition be treated without surgery, and which treatments are genuinely effective?

This is one of the most common misconceptions. Heel pain, especially during the first steps in the morning or after rest, is most often caused by plantar fasciitis: overload and degenerative changes in the plantar fascia where it attaches to the heel bone. The 'spur' itself, a bony projection visible on X-ray, is also present in many people who have no pain at all. It is a consequence of prolonged tension on the fascia rather than the cause of the pain. We therefore need to treat the overloaded fascia, not the 'spur'.

Contributing factors include excess body weight, prolonged standing or walking, running, flat feet or high arches, tight calf muscles and a shortened Achilles tendon, and stiff or worn-out footwear.

The good news is that in roughly 9 out of 10 cases, the condition resolves without surgery within several months. The most effective measures include:

– daily stretching of the plantar fascia and calf muscles, particularly before the first steps in the morning;

– comfortable, well-cushioned shoes and orthotic insoles with arch support;

– weight loss and a temporary reduction in high-impact activities;

– short courses of anti-inflammatory medication;

– shockwave therapy for persistent cases.

Corticosteroid injections provide only temporary relief and carry a risk of fascia rupture and thinning of the heel's fat pad, so their use is limited. Surgery is rarely needed and is considered when comprehensive conservative treatment has failed over 6–12 months.

If heel pain occurs at night, is accompanied by numbness or begins after an injury, an examination is necessary: a stress fracture, nerve compression or another cause may be responsible.

14. Sometimes a person notices that their shoulder is starting to hurt and that lifting the arm or reaching behind the back is becoming increasingly difficult. Could this be a sign of a so-called 'frozen shoulder'? Why does the condition develop, and can full movement be restored?

Yes, these symptoms may indicate adhesive capsulitis, also known as 'frozen shoulder'. In this condition, the shoulder joint capsule becomes inflamed, then thickens and contracts with scar tissue, effectively tightening around the joint.

It most commonly affects people aged 40–60, with women affected slightly more often than men. The risk is significantly higher in people with diabetes or thyroid disorders and after injuries, operations or prolonged immobilisation of the arm. Frequently, no clear cause is identified.

The condition has three stages: pain and stiffness first increase (the 'freezing' stage); then pain subsides but movement remains severely restricted (the 'frozen' stage); and finally mobility gradually returns (the 'thawing' stage). The entire process can take one to three years.

It is important to distinguish frozen shoulder from rotator cuff injuries, impingement syndrome and osteoarthritis. In capsulitis, both active and passive movement are restricted: even the doctor cannot fully raise or rotate the patient's arm. An orthopaedic assessment is therefore necessary.

Treatment is conservative in most cases: therapeutic exercises with gentle stretching within tolerable pain limits, anti-inflammatory medication and, in the early stage, an intra-articular corticosteroid injection that can effectively relieve pain. Patients with diabetes also need to control their blood glucose. If treatment is unsuccessful, hydrodilatation or arthroscopic capsular release may be considered.

Most patients regain full or nearly full mobility, although some have a minor residual restriction. Patience and regular exercise are essential.

15. Many people, especially women, develop a 'bump' near the big toe. Why does hallux valgus (a bunion) develop, can special footwear and orthotic insoles stop it from progressing, and when does surgery become necessary?

First, let me dispel a common myth: the 'bump' is not a deposit of salts. It is a foot deformity in which the first metatarsal bone deviates inwards and the big toe moves outwards towards the other toes. The prominent head of the metatarsal bone is what looks like a 'bump'.

Heredity plays the main role: the condition often occurs in several generations of the same family. Narrow, pointed shoes, high heels, flat feet and weak ligaments make the deformity worse. This is why women are affected much more frequently.

Comfortable shoes with a wide toe box and soft uppers, orthotic insoles, toe spacers and night splints can reduce pain, pressure and friction. But we must be clear: they cannot correct a deformity that has already developed, and there is no reliable evidence that they halt its progression. These measures relieve symptoms rather than cure the condition.

Surgery becomes necessary when:

– pain persists despite appropriate footwear and insoles;

– finding suitable shoes becomes difficult;

– the deformity continues to progress;

– secondary changes develop, such as hammer toes, calluses and pain beneath the metatarsal heads.

Surgery solely for cosmetic reasons, without symptoms, is generally not recommended. Modern surgery involves corrective osteotomies, including minimally invasive techniques performed through small incisions. Patients can usually begin walking in special postoperative shoes almost immediately, return to ordinary footwear after approximately 6–8 weeks and achieve full recovery in around 3–6 months.

Global medical statistics show that musculoskeletal disorders and injuries remain among the most significant challenges facing modern healthcare.

However, timely diagnosis, individually selected treatment and properly organised rehabilitation can often preserve mobility, prevent complications and improve quality of life.

Particular attention should be paid to symptoms that patients often dismiss as temporary discomfort: heel pain, restricted shoulder movement, foot deformity or intermittent knee pain. These may indicate conditions that require professional assessment and an individualised approach to treatment.

Modern trauma and orthopaedic care focuses not only on treating injuries but also on restoring people's functional abilities.

AKFA Medline — a comprehensive approach to diagnosing, treating and restoring musculoskeletal health.