Legs, ligaments and longevity

CHRIS HATZIS
Eavesdrop on Experts, a podcast about stories of inspiration and insights. It's where expert types obsess, confess and profess. You'll meet people you wouldn't normally meet but will be glad you did. I'm Chris Hatzis. Let's Eavesdrop on Experts and see how these 21st century explorers are changing the world, one lecture, one experiment, one interview at a time.

Today we have a rare treat, the privilege of being in the Harry Brookes Allen Museum of Anatomy and Pathology at the University of Melbourne. It's a restricted collection not normally open to the public except on Open Day in August each year. The collection provides valuable education resources to University of Melbourne anatomy students. It's one of Australia's largest collections of real human specimens of tissues and bones, as well as historical anatomical models. It offers students and researchers a unique insight into the human body.

In an unassuming corridor in the medical building, walking into the museum opens up a tranquil, light-filled space where students can quietly contemplate the vast collection and study with peers. It's also the ideal place to eavesdrop on an anatomy expert, Professor Stefan Lohmander, Senior Professor in Orthopaedic Surgery at the Department of Clinical Sciences at Lund University in Sweden, who visited the University of Melbourne in May 2017. He's chatting with Dr Andi Horvath, who is fascinated as much as I am walking around this amazing museum.

ANDI HORVATH
Professor Stefan - can I call you Stefan? I have the privilege today to be here in this anatomy museum with you, and you are a joint specialist. Take me towards some examples of skeletons I can see here in this museum, and explain joints to non-medical people.

STEFAN LOHMANDER
Let's go over to some of these specimens over here, and we have a couple of skeletons here, for example. The purpose of the joints is for you to be able to move, otherwise you'd be just either a soft blob of jelly or you would be a stiff rod, but the joints connect between the different parts of the limbs and the different parts of the body and help the limbs, for example, your hips, your knees, to move with a very low friction between the parts.

ANDI HORVATH
Can you see anything special about the joints in these specimens? Is there wear and tear?

STEFAN LOHMANDER
Well, these are joints that I can't, because they're in a cabinet here, examine closely but clearly these skeletons are from individuals who had a skeletal disease called fibrodysplasia ossificans progressiva, a long name, but anyway, which meant that the skeleton, as you can see, is not normal here but it's somewhat deformed. So they had presumably problems in moving their joints actually with increasing age and in adulthood. You can also see perhaps on this joint here, the hip joint of this skeleton here, that it doesn't have the normal shape actually of hip joints, which we can see in some other specimens later on here in the museum.

ANDI HORVATH
Let's go to those specimens now.

CHRIS HATZIS
I have to say, these specimens in the Harry Brookes Allen Museum are quite magnificent. What a truly amazing collection. I really wish you could all see them, but you're all going to have to wait until Open Day.

STEFAN LOHMANDER
Here is a skeleton with - from a visual inspection shows normal joints, they're nice, they're softly rounded with no protrusions and no obvious damage to the joints that you can see, and they are well preserved, both in, as I can see here, the knee joints, and in the hip joints here. If you were to look at a specimen that would show signs of joint disease, you would see that the joint would be differently shaped from the normal joints that I can see here. There would be extensions around the rim of the joints, like a pie crust coming out, what we call osteophytes in anatomy language or radiology language, and you would by close inspection sometimes of a skeleton be able to see that the joint surface, the bone surface, which is what we see in the skeleton here, has been worn. Even the skeleton, even the bone has been worn by bone wearing against bone in a diseased joint over time.

ANDI HORVATH
Can you tell the approximate age from a person's joints?

STEFAN LOHMANDER
Well, I can't. I'm not a specialist in that, but yes, you can in general give a pretty good estimate of the age of an individual, both perhaps most easily, during the growth period in childhood and the young adults, but also in the adults depending on skeleton showing certain age associated features.

CHRIS HATZIS
Yeah, I can understand that. Some days we feel older than we actually are. I'd be interested in the condition of my joints on those particular days.

ANDI HORVATH
Stefan, when people talk about you, or the students that might talk about you, what are you famous for? What would they be saying?

STEFAN LOHMANDER
If they knew about me, they would probably know that I've been spending a lot of time doing research in osteoarthritis, the most common joint disease. It's something that actually affects a large proportion of the adult population, especially with age, over-fifties. I've spent both time looking at the very detailed molecular features and signs of the disease and working with patients and trying to develop and test new and old treatments to find out which works best.

ANDI HORVATH
Let's talk about those old treatments and new treatments. What has changed in the area of our understanding of osteoarthritis?

STEFAN LOHMANDER
Well, when I started my medical studies, the perhaps most successful treatment of all for osteoarthritis didn't exist, which is joint replacement. I started my medical studies, I hesitate to say, but more than 40 years ago, so quite a long time ago. That was developed during essentially - and introduced during the period of my early medical studies and when I got into orthopaedics, joint replacement for the hip had been introduced and was being used slowly and gradually more increasingly, and after that, a few years later followed joint replacements for the knee.

ANDI HORVATH
Can I get more of an understanding of osteoarthritis? My mum's had a knee replacement and my cousin's had a hip replacement. Is there a strong genetic sense that this is something I can look forward to?

STEFAN LOHMANDER
Yes. As with many diseases, your parents really play a big role, and so they do in osteoarthritis. I would say on the average for hip osteoarthritis, the proportion of your risk that's associated with your genetic background, with your parents and your forefathers, is roughly 50 per cent. For the hip, it may actually be almost 60 per cent. For the knee, the genetic risk may be slightly less, but that's not because genetics in a sense is less important, it's because the environmental influence is stronger and more important. We have more injuries, sports injuries, for example, to the knee than to the hip, and since risk is always 100 per cent, if you see what I mean. If one risk increases, then the others have to proportionally decrease.

ANDI HORVATH
I've done lot of tap dancing; I'm now worried about my joints. Should I be?

STEFAN LOHMANDER
Not because of the tap dancing. I think that we have good evidence from research studies that have been done on marathon runners, for example, and they very rarely show any increased risk of osteoarthritis as compared to the average population.

What we do know increases the risk of osteoarthritis is for example, if you have a joint injury, if you tear your ligaments and injury your cartilage in your joint. If you are seriously overweight or obese, that's another well-known risk factor for osteoarthritis in the knee and the hip. Those are the main environmental factors that interact together with your genetic background.

CHRIS HATZIS
Oh, well, that's a relief. I thought all of my marathon running was having an effect on my knee joints. I can breathe easy.

ANDI HORVATH
Now, Professor, the joints are not just your bones, right? They're the other things, the strings and rubbery bits.

STEFAN LOHMANDER
There are lots of other things. There is, I think, importantly, the joint surface made up of cartilage, that gristle kind of thing. When you eat your chicken and you see that shiny low-friction surface on the end of the joints, that's cartilage, which is a fascinating tissue which provides the joint with a very low friction and at the same time can dampen the loading that goes through our joints to make our landing more soft when we walk, et cetera, so very sophisticated. Then in addition to that of course we have tendons, we have a joint capsule and we have the muscles which makes things move, which we use when we walk.

ANDI HORVATH
What does osteoarthritis do to your muscles? Does it make them pull in a different way?

STEFAN LOHMANDER
Good question, as you say when you can't quite answer it. There are two sides to the question. Number one, if you have osteoarthritis and you have pain, you will use instinctively your leg less on that side which has a problem, and your muscles would actually decrease. Your muscle mass and your muscle, the way the muscles work, will be less good than on the normal side. Then there is the reverse issue where we're actually discussing whether in some individuals loss of muscle mass is a very early sign of osteoarthritis.

ANDI HORVATH
This has made me think then, exercise. It keeps coming up in every interview, the old chestnut, diet and exercise, but I'd like to explore that idea a bit further. Let's say there are alternatives to joint surgery, which there is, particularly too if you've paid attention to exercise and diet. So what are the alternatives to joint surgery?

STEFAN LOHMANDER
That depends on who you are, if I can put it, what patient you are, where - how old you are, where you are in the development of osteoarthritis. Osteoarthritis doesn't begin this morning suddenly because something happens, it's actually a disease that sort of sneaks up on you, which you gradually develop over years usually, and where finally one day you recognise hmm, I do have a problem with my knee, it hurts when I walk and it hurts afterwards and sometimes I wake up at night because my knee hurts or my hip hurts or something like that.

So depending on where you are in that stage of different stages of development, my advice would be different. But I would say if you are a patient that consults your family doctor, your GP, for example, then if I was a GP and you have early symptoms of osteoarthritis, I would really strongly recommend you need to quite likely increase your physical activity level, you need to exercise, you need often to lose weight, commonly to lose weight, and yes, it's a bit of a boring lifestyle advice but it is actually at the core of the problem, because these two things actually together work in increasing your risk of osteoarthritis.

CHRIS HATZIS
And finally, the question Dr Andi has been dying to ask since we got here.

ANDI HORVATH
How many steps a day do I need to do, Professor?

STEFAN LOHMANDER
I think you at your age, you're young age, should be taking like seven to 10,000 steps a day. That is the recommendation.

ANDI HORVATH
Every day?

STEFAN LOHMANDER
Every day.

ANDI HORVATH
But that will add up to millions.

STEFAN LOHMANDER
It will, exactly. Think of a lifetime, let's say at least as an adult of 50 years of lifetime, and multiply that by 10,000 steps every day, 365 days times 50, that makes quite a number of steps, hundreds of millions of steps in your lifetime, and still the chances are your joints will actually work fine all the way, as long as they need to. That's quite a feat from biological design, actually. If you were to design a car tyre or something like that that works as well through as many load cycles as that, that would be fantastic.

CHRIS HATZIS
Hear that, people? We're going to be walking hundreds of millions of steps in our lifetimes. And if you're not feeling that great about yourself, just keep in mind that our body and joints are an engineering marvel, beautifully designed. So keep on moving, and way to go, us. Thanks to Stefan Lohmander, Senior Professor in Orthopaedic Surgery at the Department of Clinical Sciences at Lund University, Sweden. And thanks to Michelle Le Roux, Collection Manager, and Dr Ryan Jefferies, Curator at the Harry Brookes Allen Museum of Anatomy and Pathology for allowing us access to this wonderful and fascinating museum. And of course, thanks to our reporter Dr Andi Horvath, who I believe is about 2000 steps short of her 10,000 daily step goal. Keep walking, Andi.

[Music]

Eavesdrop on Experts, stories of inspiration and insights, is a production of the University of Melbourne, Australia. This episode was recorded on 24 May 2017. Recording by Arch Cuthbertson, co-production by Dr Andi Horvath. Production assistance by Claudia Hooper. I'm Chris Hatzis, producer and editor. Join me again next time for another Eavesdrop on Experts.