Don’t leap to surgery first – learn how medication, physical therapy, weight loss, assistive devices and injections help get people with knee or hip arthritis back to the activities they love
When it comes to treating hip or knee arthritis, you may have more options than you realize. The hip and knee joint move in different ways but the options for treating them are actually quite similar.
Arthritis is defined as inflammation of the joint. Osteoarthritis is the most common form of arthritis. It usually occurs as a result of wear and tear from everyday life, causing the cushion (articular cartilage) in one’s joint to wear down. Typical symptoms of arthritis include pain, swelling and stiffness, which all limit one’s ability to perform activity. When the cartilage eventually wears completely away, leaving bone against bone, that can feel as bad as it sounds.
There is not a cure for arthritis. Fortunately, there are options to reduce pain and improve mobility. The first move is to get help early.
Any person who believes he or she may have arthritis should be evaluated first by an orthopedic specialist. The sooner the problem is identified, the better chance we have to keep the patient active and pain-free.
The physicians at Muir Orthopaedic Specialists specialize in all parts of the body. I personally focus on the hip and knee joint. Management for both hip and knee arthritis are fairly similar. I believe it is important to offer the entire spectrum of treatment options for my patients, ranging from the most conservative, such as medications, to slightly more involved injection options, to eventually hip/knee replacements. Surgery is always the last resort.
I value honest communications with my patients, by providing education. I try to build a relationship with my patients through their entire orthopedic journey. The right treatment plan is different for every patient. As a surgeon who also offers regenerative medicine options, I can find the best option for each patient without referral to another provider.
Following are the five nonsurgical treatment options for hip or knee arthritis.
1. Medication for joint pain and swelling
The first line option for arthritis symptoms is medication. This includes predominantly both over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin, and prescription form, such as naproxen sodium. Acetaminophens (Tylenol) is solely an analgesic, which is a pain reliever, without anti-inflammatory effects. It is usually better tolerated by patients with kidney problems.
Do not take any OTC medications for more than 14 days without checking with a doctor. Taking them for long periods of time can increase the chance of side effects.
Additionally, I want to emphasize the importance of minimizing narcotics. Common narcotics used for arthritis include hydrocodone, oxycodone and morphine. While narcotics can be very effective in reducing pain, they can often lead to addiction and cause withdrawal when trying to quit. I typically prescribe narcotics as a part of a multi-modal pain protocol that I’ve developed specifically for short-term, post-surgical pain control. However, they are not a long-term solution.
2. Physical therapy for hip arthritis & knee arthritis
Physical therapy is one of the most crucial components in orthopedics. The goal of physical therapy for those with arthritis is to restore the use of the affected joint(s), by improving mobility, increasing strength to support the joint, reducing joint stiffness and maintaining the ability to perform daily activities.
A physical therapist will make an individualized plan for each patient to achieve optimal physical function including balance, strength, flexibility and coordination. The therapist can teach you stretching techniques and show you how to work out stiffness without further damaging the joint. One can then do so at home or at the gym as part of a home exercise program.
Our physical therapists may also use different “modalities” as part of the treatment. One example is transcutaneous electrical nerve stimulation (TENS), which involves placing electrodes on the skin to send weak electrical currents to stop pain signals from reaching the brain. Other forms of modality include cold-therapy and ultrasound, which can decrease soft tissue inflammation.
3. Maintaining a healthy weight – a DIY arthritis treatment
Extra weight is a problem for both hip and knee arthritis because it increases the load placed on the joint. Studies have shown that every pound on your body equates to four pounds exerted across your knees while walking, and nine pounds with stairs.
I recommend that patients use a body mass index calculator to learn if they are overweight or obese. We typically use this information to set goals to maintain a healthy weight and to reduce arthritis symptoms.
Prior to starting any major weight loss program, it is recommended to meet with a doctor so he or she can help customize a program and safely monitor your progress.
Maintaining an optimal weight has other important benefits. It will facilitate recovery from surgery if it is eventually needed. Being overweight is associated with significantly higher complications after hip and knee replacement. Some studies show a 9-times higher risk of infection in overweight patients compared with normal weight patients. Additionally, weight maintenance also helps the longevity of your hip and knee replacements.
Remember, every pound counts!
4. Hip & knee braces or assistive devices
A brace can provide external support for the joint, and therefore reduce load, improve stability, and relieve pain. While braces are more commonly used for knee arthritis, there are new brace options for hip arthritis as well. Braces are usually worn during activities. At MOS, we have a wide selection of bracing options and brace specialists to personally fit them for our patients.
Assistive devices are another option for hip arthritis or knee arthritis, such as a cane or walker. These can help with improving balance and providing support. A cane can support up to 25 percent of a person’s weight, while a walker can support up to 50 percent. I also utilize these assistive devices as a part of my post-surgical rehab plan after hip and knee replacements.
Prior to purchasing a brace, cane or walker, it is important to see an orthopedic specialist who can help determine if an assistive device is the best option for you.
5. Injection options for hip & knee arthritis
Injections can be a great alternative to surgery. They can delay surgery for months to years, or can even be used in place of surgery in some patients.
The most common injection is a steroid (cortisone) injection, which decreases inflammation. It can be used for both hip and knee arthritis.
The second option is a hyaluronic acid injection, which is a concentrated form of a protein that is naturally found in one’s joint fluid. This is used mainly for knee arthritis and is essentially a lubricating gel for the joint.
There are two other newer injection options: platelet rich plasma (PRP) injections and mesenchymal stem cells (MSC). While many studies have shown that these regenerative options are effective, unfortunately they are not covered by insurance.
Platelet rich plasma (PRP) is a concentrated form of a patient’s own platelets, obtained from a simple blood draw. Platelets are a potent inflammatory recruiter in the body and promote healing response to the area of injection. It can be used for arthritis, meniscal tears and tendon injuries.
Mesenchymal stem cell (MSC) injections utilize multi-potent cells in one’s body in a concentrated form. Stem cells have the potential to differentiate into cells of different lineages, including chondrocytes (articular cartilage cells). They also have the potential to recruit other cells to the area of injury and induce cell differentiation to promote healing. There are many ways to harvest stem cells, including bone marrow, fat and from donor tissues. I typically use fat from my patients’ own body because it provides the highest concentration of these MSCs.
Both PRP and MSC injections are still being researched, but early studies have shown promising results. The idea is to promote healing in an arthritic joint, therefore delaying, or in some cases eliminating, the need for surgery.
Surgery is the last resort! Hip and knee replacements (arthroplasty)
I believe that surgery should be the last resort. The goal of replacement surgery is to decrease pain and stiffness, therefore allowing my patients to return to an active lifestyle.
When nonsurgical options fail, I have an open discussion with my patients and their family about what surgery entails. I have devised a detailed plan for all my patients undergoing hip and knee replacements. It is part of a team approach, from pre-op to day of surgery to post-op.
There are many options when it comes to surgery. For example, there are multiple approaches to performing a hip replacement. Over 75 percent of surgeons in America perform the conventional posterior approach. I personally utilize the anterior approach, which I believe allows for a faster recovery. My patients are up and walking just a few hours after their hip and knee replacements. I am very particular about every step of this process because I want my patients to have the best results.
The most rewarding aspect of my job is seeing the drastic improvements in my patients after their hip and knee replacements. Many of them tell me it is the best decision they’ve made and wish they had done it sooner.
Arthritis is a common and growing problem, both for the young and the aging populations. If you have any concerns, schedule an appointment to learn about your treatment options. It is the first step for many patients in their journey back to an active and pain-free lifestyle!