- Why You Shouldn’t Delay Surgery
- There’s Never a Perfect Technology
- Pre-surgery can be an Emotional Rollercoaster
- Opioid Concerns, Work Interference Cited As Top Reasons To Delay Knee Replacement Surgery
- Risks of DelayingJoint Replacement Surgery
- Top 5 Ways to Delay the Need for a Knee Replacement
- Learn About the Risks of Delaying Your Joint Replacement Surgery
- The Reasons Why Patients Delay or Decline Knee Replacement Surgery
- Scheduling vs. Postponing Knee Replacement Surgery
- Delaying Surgery Because of Potential Risks
- Scheduling Surgery to Lower Costs
- Coping with Knee Pain Until Surgery
- Joint Preservation Strategies to Delay the Need for Hip or Knee Replacement Surgery – The Leone Center for Orthopedic Care
Why You Shouldn’t Delay Surgery
Deep down, you may know you need knee replacement surgery, but have been (sub)consciously putting it off. For some, it’s a fear of surgery. Others just don’t the thought of losing a body part. Heck, I put it off for a good year waiting for THE perfect knee implant.
Whatever the reason, there comes a point where you need to sit down and seriously weigh the pros and cons. It may in fact NOT be the best time to get surgery, but just make sure you come to terms with all the key factors.
In this article, we’ll bring up some of those common discussion points – hopefully, a couple resonate and help you come to a sound decision.
When your knees have deteriorated to the point of needing replacement, all the glucosamine and chondroitin in the world isn’t going to substantially improve your condition.
Sure, your symptoms may decrease for a while and your body may actually “heal” itself for a few days, but the underlying arthritic and anatomical conditions rarely permanently improve.
If you need to buy yourself a year or two, supplementation may be the way to go but at the end of the day, only knee replacement is capable of giving you that full-fledged freedom and mobility.
There’s Never a Perfect Technology
As mentioned earlier, I got heavily involved in the technology surrounding knee implants for a good year before my procedure. I researched different manufacturers, materials, sizes, methods, etc…almost to a fault.
Now, it’s generally a great (and highly recommended) thing to do your homework and discuss that info with your doctor, but don’t go overboard. If you’re ready for surgery, it shouldn’t take you any more than a few solid weeks to go over ALL the implant options and settle on a combination with your MD.
Some prefer to let their doctor make all the implant decisions and that’s perfectly OK as well.
Back to the engineering itself, as a general rule, knee implant technology changes multiple times a year, but the tweaks are typically incremental at best.
Manufacturers use any excuse to come up with a new model, all for the sake of lining their pockets. Implants rarely improve much from year to year, the biggest gains come in 5 to 10 year blocks.
So, if you’re holding off surgery in hopes of the next big, game-changing implant, you’ll probably be left disappointed.
Pre-surgery can be an Emotional Rollercoaster
The days, months and even years before your surgery can be a very trying time. For the most part, folks look forward to their improved lifestyle after surgery, but it’s human nature to let the concern creep in.
Day of, will everything go smoothly? Will I be able to get past rehab OK? Sometimes, those thoughts can (sub) consciously cause you to postpone your surgery, and for some indefinitely. The bottom line, though, is knee surgery is one of the more well-understood and successfully-completed procedures in the medical field.
Its success rate is extremely high and level of risk VERY low. When you weigh all the factors (including the positive impact to your day-to-day life), there aren’t many surgeries that match its benefit/risk ratio.
Sure, surgery is never fun, but the longer you wait, the more stress and concern that builds up.
If you’ve been cleared by your doctor for knee replacement surgery and everything else in your life points to it as being the right decision, do your homework, set a plan and go for it.
During my therapy sessions with patients, the single biggest complaint I get is, “Gee, why didn’t I get it done earlier?” Make knee surgery prep and research a priority in your life and, believe me, it’ll pay off in spades for years and years to come.
Opioid Concerns, Work Interference Cited As Top Reasons To Delay Knee Replacement Surgery
New survey shows patients often delay surgery for more than two years.
SPR Therapeutics LLC08.28.17
Patients in need of a total knee replacement (TKR) often delay surgery by two or more years because of concerns about the duration of postoperative pain, work interference, and the side effects opioids might have on their recovery and rehabilitation according to a new healthcare survey. The survey explores patient perspectives and factors related to the decision to delay knee-replacement surgery, which is an increasingly common procedure. In 2013 there were 727,000 primary and revision knee arthroplasty procedures in the United States and that number is projected to grow to 889,000 procedures by 2019, according to a Medtech Insight research report on U.S. surgical volumes. “Regardless of pain level, gender, education or income, the majority of respondents delayed knee replacement surgery,” said Angeline Carlson, Ph.D., adjunct professor, Department of Pharmaceutical Care & Health Systems at the University of Minnesota. “Results from this survey show that patients worry about the impact of surgery on their lives, have a very real concern about the ability to control pain during recovery, and possess an overwhelming desire to avoid using opioids to manage pain after surgery.” More than 650 surgical candidates suffering from knee osteoarthritis in the United States participated in the online survey, supported by SPR Therapeutics. Highlights from the survey include:
- More than half (54 percent) of respondents delayed a TKR for two or more years; 24 percent specifically cited concerns that postoperative pain and/or the side effects of opioids might extend their recovery and rehabilitation as reasons for delaying the procedure;
- Ninety-two percent of respondents said a new pain management approach that reduced or eliminated the use of opioid-containing pain medications would be an important factor in their choice of the surgeon they would select to perform their surgery;
- Sixty-six percent said they would ly switch surgeons to obtain access to a non-opioid pain management approach;
- Seventy-four percent of respondents were more concerned about the pain they were ly to experience within the first several weeks following surgery compared to the pain they were ly to experience within the first three days following surgery.
“These results raise significant concerns because postponing surgery can often lead to deconditioning, weakening or lost function in muscles and ligaments and greater difficulty doing everyday activities,” said survey co-author Keith Berend, M.D., clinical assistant professor in the Department of Orthopaedics at The Ohio State University. “Particularly here in Ohio, we face an epidemic of narcotic-related deaths, and we need access to innovative drug-free pain relief options that can carry patients through the rehabilitation period without opiates and help expedite their decision to have a surgery they should not postpone. As one of the investigators currently using the SPRINT PNS System in clinical trials, I’m eager to offer it to my patients undergoing knee replacement surgery.” The SPRINT PNS System includes a proprietary thread lead and a small, wearable stimulator patch. The lead is placed percutaneously, or through the skin, and connects to the wearable stimulator, which activates peripheral nerves to achieve pain relief. SPRINT was specifically designed to preferentially activate target nerve fibers, delivering sustained, significant pain relief without opioids, permanent implants or tissue destruction. The U.S. Food and Drug Administration (FDA)-cleared therapy was developed to address a wide spectrum of chronic and acute post-surgical pain conditions affecting millions worldwide. “Opioids are routinely provided for several weeks to manage postoperative pain with approximately 20 percent of patients using them for 90 days or longer after surgery,” said Maria Bennett, SPR Therapeutics founder, president and CEO. “The results of this survey reinforce the need for alternative, non-narcotic pain relief therapies such as SPRINT, that could significantly reduce or even eliminate the use of opiates providing a much-needed medical advance for patients during the post-operative recovery period.”
Detailed results from the survey are published in a peer-reviewed article of Reconstructive Review, the official journal of the Joint Implant Surgery and Research Foundation.
SPR Therapeutics LLC is a private company headquartered in Cleveland, Ohio.
The company is commercializing its SPRINT technology which provides opioid-free, peripheral nerve stimulation for the relief of chronic and acute pain, and is advancing additional clinical trials to treat low back pain, neuropathic pain and pain following total knee replacement. The SPR-patented SPRINT technology received FDA clearance for commercial use in the United States.
- total knee replacement
Risks of DelayingJoint Replacement Surgery
Medically Reviewed by David M. Woodbury, MD
As you talk with your Orthopaedic Surgeon about a knee or hip joint replacement, here are two facts to keep in mind:
- The reason most people need total joint replacement is because of osteoarthritis, which is a degenerative disease. It doesn’t improve on its own. It’s not Mom told you, “Wait and it will get better.”
- Technology for replacing knee and hip joints is continually improving; however it is very good right now.
“If you need a knee or hip replacement and you’ve tried physical therapy or other non-surgical treatments, don’t delay surgery too long,” says McLeod Orthopaedic specialist David Woodbury, MD. “Research shows that to gain the full benefit of your joint replacement, timing is important.”
CHECK THE NUMBERS
Studies by a consortium of orthopedic surgeons have reduced the potential improvement from a total joint replacement to a mathematic formula.
- A normal adult scores 50 on a “function scale.”
- A person with a problem knee or hip joint, on average, scores 32.
- Typically, a total joint replacement patient gains a fixed mount of improvement — about 12 points on this function scale.
- If done at the appropriate time, total joint replacement can bring your “function” score up to 44 – not normal, but close.
- If a patient waits until they are in so much pain they can’t sleep or their mobility is limited, their score drops and their post-surgery score may only rise to 32 – way below where you want to be.
If you wait too long for surgery you may not achieve the full benefit to your quality of life that a total joint replacement can offer.
WOMEN ARE MOST AT RISK
women with heart problems, women with joint problems are more ly to wait too long to see a specialist about their pain. Women are more ly to wait until their knee or hip function is markedly worse than their male counterparts. Women may focus on taking care of their family. They may be able to tolerate pain better than men.
Yet, delaying the surgery can result in more complicated and longer surgery, because the joint has deteriorated seriously. You may be under anesthesia longer than normal.
To regain your quality of life and preserve your mobility, early intervention is preferable.
ACTION YOU CAN TAKE
Having pain in your knee or hip? Trouble walking or taking stairs? See an orthopedic surgeon for diagnostic testing. Take their advice and don’t wait too long.
To quote one study, “Performing surgery earlier in the course of functional decline may be associated with better outcome.”
You may also find these articles helpful:
Is Total Joint Replacement Worth It?
Total Hip Joint Replacement: The Basics You Need to Know
Total Knee Joint Replacement: The Basic You Need To Know
To find Dr. Woodbury or an Orthopedic Specialist near you, click here.
Sources include: McLeod Health, National Institutes of Health, American Physical Therapy Association, American Academy of Orthopaedic Surgeons
Top 5 Ways to Delay the Need for a Knee Replacement
by Sportsdoc Raj
Knee replacement surgery is becoming a more common, with osteoarthritis becoming more prevalent in younger patients.
The Journal of Bone and Joint Surgery claims that there will be a 670% increase in the total number of knee replacements by 2030.
While there have been numerous advances in the field of knee replacement surgery, this is still considered a major operation. Here are some steps that you can take to delay the need for this surgery:
1. Lose Excess Weight
The knee joints bear a significant amount of pressure from supporting our body weight.
Each pound of excess weight can exert up to four pounds of pressure on the knee, meaning a person who is 10 pounds overweight exerts 40 pounds of excess pressure on his knees with every step he takes.
The damage builds over time, leading to degenerative diseases such as osteoarthritis. Compliance to a diet and exercise plan may be the simplest way to avoid surgery later on.
2. Strengthen Your Joints
You can increase the stability of your knees by strengthening the muscles that support the joints. The quadriceps and hamstring muscles are of particular importance, as they absorb the shock and weight-bearing loads.
Building joint strength is done through exercises such as resistance training (squats and lunges), swimming, cycling and other activities.
Building strong leg muscles has been correlated with less risk of joint replacement surgery.
Physical therapy can help strengthen one’s knees and take pressure off the arthritic joint.
3. Wear a Brace
Some studies have shown that degenerative damage to the knee can be avoided by regularly wearing support. Braces and knee supports improve the alignment and stability of the knee joint, relieving pain and minimizing progressive damage.
The top braces to wear are called offloaders and shift pressure to the part of the knee joint that has less arthritis to relieve pain.
4. Hyaluronic Acid Injection
Hyaluronic acid is a naturally-occurring lubricant in the joints. It also regulates inflammation and provides a cushion between the knee cartilages. Hyaluronic acid injection has been shown to decrease pain and improve knee function in some people. It has also delayed the need for knee surgery in some patients.
5. Platelet-rich Plasma (PRP) injections and Stem Cell Injections
One novel treatment that has gained popularity because of its use by athletes such as Tiger Woods and Rafael Nadal is the injection of platelet-rich plasma (PRP). PRP contains a greater concentration of platelets and growth factors than normal blood.
The blood for PRP is drawn from the patient and run through processes that elevate the platelet concentration. The preparation is later injected to the site of injury to speed up healing.
This is a relatively new treatment, and may require further studies validating its effectiveness.
Stem Cell injections with amniotic derived stem cell material or bone marrow derived stem cells are being shown to help considerably with degenerative arthritis.
Learn About the Risks of Delaying Your Joint Replacement Surgery
Hero Images / Getty Images
Have you been told you need joint replacement surgery, but had hoped you could wait a little longer? Well, you're not alone. Many patients want to find relief from pain but are not ready to proceed with major surgery.
They may, therefore, choose to delay joint replacement and continue simpler treatments, including oral medications, cortisone injections, use of walking aids, and physical therapy.
But they may also worry if they are doing damage, or making surgery more difficult, by delaying a hip or knee replacement.
In the short term, the answer is no. Seldom does surgery get more complicated or more difficult because of a delay in joint replacement surgery.
Patients who are diagnosed with hip arthritis or knee arthritis should take time to determine the right course of treatment for their situation.
This may include trying more simple treatments, getting another opinion, or taking some time to consider their options.
While delaying joint replacement surgery for months, or even years, may not have significant consequences, a prolonged delay may complicate the situation.
There are some considerations patients should understand. Here are some of the concerns about delaying joint replacement surgery.
Most often arthritis progression is gradual and develops slowly over the course of months and years. Some people do have accelerated changes, but even in these situations, the changes don't occur overnight. As arthritis worsens, there can be increasing deformity of the joint.
In patients with knee arthritis, this most commonly becomes an increasing knock-kneed or bow-legged deformity. In hip arthritis, the leg length can shorten as cartilage and bone wear away. Joint replacement can become more complicated with increasing deformity of the joint.
This may require your surgeon to use specialized implants or to perform more extensive surgery to correct the deformity.
In the same light, as joint arthritis progresses, the joint moves less. With less movement, soft-tissues surrounding the joint—including muscle, ligaments, and joint capsule—may contract, causing stiffness. This is especially notable for patients having a knee replacement, where mobility before surgery is one of the best indicators of expected motion after surgery.
As arthritis progresses, muscles surrounding the joint are ly to weaken. People use the joint less and limit their physical exertion as a result of their pain. As the muscles weaken, rehabilitation after surgery may become more difficult, and perhaps the muscles may never regain their full strength.
This is probably the most controversial complication of delaying surgery, as there is a debate about the extent to which the body develops this type of compensatory problem.
But it's reasonable to believe that people who favor one joint may place more of a burden on other parts of the body.
People with severe hip arthritis often experience back pain, and people with knee arthritis often complain of pain in their opposite knee.
Your surgeon can usually overcome the technical difficulty of performing a joint replacement on someone who has delayed her surgery, but there can be patients who develop medical problems as a result of aging and decreased physical activity. Weight gain, decreased endurance, cardiac and pulmonary conditions are all concerns for people who put off joint replacement for too long.
These are some of the reasons that you may want to proceed with joint replacement surgery. As stated, seldom are any of these issues acute emergencies—meaning you certainly have time to make a decision that works for you.
I often hear doctors say, “you'll know when the time is right to proceed with surgery.
” I don't think this is a terribly helpful thing to say; rather, I would encourage you to think about the signs you're ready for knee replacement or hip replacement and use these as your guide for determining when to proceed with surgery.
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lizaur-utrilla A, Gonzalez-navarro B, Vizcaya-moreno MF, Miralles muñoz FA, Gonzalez-parreño S, Lopez-prats FA. Reasons for delaying surgery following hip fractures and its impact on one year mortality. Int Orthop. 2019;43(2):441-448. doi:10.1007/s00264-018-3936-5
American Academy of Orthopedic Surgeons. Total Knee Replacement – OrthoInfo – AAOS.
The Reasons Why Patients Delay or Decline Knee Replacement Surgery
ER Productions Limited / Getty Images
It's not uncommon for patients to initially postpone but eventually undergo knee replacement surgery. Certainly, many patients have the procedure done.
Every year in the United States alone, more than 600,000 knee replacements are performed.
So why the apprehension about something that is supposed to improve a patient's physical function and relieve pain that interferes with daily living activities?
Patients' pre-op and post-op experiences with knee replacement surgery were analyzed in a study from Kent State University. The researchers identified four stages that patients went through on their way to accepting that they needed knee replacement surgery. The four stages are:
- putting up and putting off
- waiting and worrying
- letting go and letting in
- hurting and hoping
Putting up and putting off is the first stage a patient goes through once they are informed they need knee replacement surgery.
Patients initially hope that knee replacement surgery isn't really needed — something else will work or it will get better on its own. With this line of thinking, the patient chooses to put up with the bad knee and put off the surgery.
They view surgery as a last resort treatment option, but they don't believe they have reached that last resort.
The second stage, waiting and worrying, begins once a patient decides to have knee replacement surgery. Typically, patients going through stage two had put off having the surgery for years and have reached the point of wanting to get it done and over with.
But there tends to be some worry involved with this stage. Although patients realize they must have the surgery, they worry that something will go wrong or won't turn out right.
It's a bit of obsessive thinking or a level of anxiety that might be expected.
Stage three may be the most important of all.
Patients evolve to this stage by realizing they must give up some independence, relinquish some control (that's the letting go part) and accept help and encouragement from others (that's the letting in part).
A patient must be inspired to reach for the goal – a successful knee replacement – and understand how it will improve and enhance their life. There is no better way than learning from those who have done it and can guide you through the process.
The fourth stage could also have been called “No Pain, No Gain”. There is pain before surgery and there is pain during the recuperative period after surgery. Psychologically, the patient must get beyond the hurt, and focus completely on getting better. The ultimate goal is to return to activities they love and had to give up – and to just feel normal again.
Knee replacement surgery is needed if a patient is in pain that cannot be relieved by other more conservative treatments and if the pain and other symptoms interfere with daily living activities. Once that is the case the patient needs to move beyond stage one and stop putting off the inevitable.
During the process, a certain amount of anxiety is expected, but patients should recognize anxiety and apprehension for what it is and try to temper it. Patients can seek out others who have had successful knee replacement surgery and become empowered by their positive experience.
Most importantly, never lose sight of why you need a knee replacement and the expectation that life will improve after the surgery and recovery period.
Positive thinking plays a big part in arthritis treatment, including joint replacement surgery.
Once you learn all you can about knee replacement surgery and what to expect, engage in positive thinking, and draw inspiration and encouragement from others — you're where you need to be. No need to further delay or decline the surgery.
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Scheduling vs. Postponing Knee Replacement Surgery
Knee Replacement Surgery Video
When is the right time to get a knee replacement, and when can it be postponed? While there are no universally accepted medical guidelines to follow, there are several factors that doctors and patients can consider when deciding when to schedule or postpone surgery.
Delaying Surgery Because of Potential Risks
Everyone who elects to have knee replacement surgery must weigh the potential benefits against the potential risks. Smoking, obesity, poor circulation, and certain other pre-existing medical conditions can increase the risk of postsurgical complications, such as infection.
Total Knee Replacement Risks and Complications
People with serious concerns about their potential risks may postpone surgery indefinitely or until they can take steps to reduce their risks.
Many people decide to schedule knee replacement surgery after they have quit smoking, after they have lost a certain amount of weight or improved other modifiable risk factors such as diabetes control.
How to Prepare for Total Knee Replacement
Knee replacement is a major surgery, and a full recovery can take 6 months or longer. For most people, it does not make sense to schedule a knee replacement right before a big life event, a move, family wedding, or an active vacation.
Total Knee Replacement Surgery Recovery
Commitment to physical therapy
A successful recovery typically requires a patient to attend physical therapy appointments. Physical therapy may be prescribed a couple of times per week for 6 to 12 weeks. The patient will also be expected to do knee and hip stretches and strengthening exercises at home.
Knee Replacement Surgery Rehabilitation Exercises
Potential patients should consider whether they have the time to commit to physical therapy before electing to have surgery. People who know they do not have time for recovery and rehabilitation may decide to postpone knee replacement surgery until a time that they do.
Scheduling Surgery to Lower Costs
How much will the surgery cost? How much will be covered by insurance? Some people who are uninsured or underinsured decide to postpone surgery until they get better insurance. For example, people who do not have insurance may wait until they are eligible for Medicare before scheduling knee replacement surgery.
Lowering indirect costs
In addition to medical bills, there can be indirect costs related to knee replacement recovery.
Purchasing pet care, home cleaning services, taxi rides, and prepared meals are all examples of indirect costs.
To limit indirect costs, some people schedule their surgery around relatives’ or close friends’ vacation schedules, ensuring at-home help will be available.
Lowering opportunity costs
Taking several weeks off of work to have knee replacement surgery can result in lost wages, making the surgery less attractive.
Alternatively, knee arthritis pain may prevent some people from working to their fullest potential. In these cases, knee replacement surgery may be an economically wise choice.
It is up to the patient to evaluate opportunity costs.
Coping with Knee Pain Until Surgery
If a patient decides to postpone knee replacement surgery, a doctor can recommend options to temporarily relieve arthritic knee pain.
For example, a person who wants to postpone surgery for 6 to 12 months may be able to get one or more cortisone or hyaluronic acid injections to reduce his or her knee pain.
See Therapeutic Injections for Knee Arthritis
Other people may choose to take prescription strength nonsteroidal anti-inflammatories (NSAIDs), such as ibuprofen and naproxen. NSAIDs can have negative effects on the stomach and liver if taken long-term, but they may be an acceptable temporary solution.
See Knee Osteoarthritis Treatment
There is no right or wrong answer when it comes to scheduling knee replacement. Some people may decide they want to avoid surgery indefinitely and reduce knee pain using a combination of nonsurgical treatments.
Other patients may use nonsurgical treatments just to get them through another year or so of working, after which they can retire and devote time to postsurgical recovery.
Still, other people may decide they need to have knee replacement surgery as soon as possible in order to work effectively or get more enjoyment day-to-day living.
Joint Preservation Strategies to Delay the Need for Hip or Knee Replacement Surgery – The Leone Center for Orthopedic Care
In the first of several blog posts about hip and knee joint preservation, I will discuss the mechanics of these amazing joints that help keep us moving and the conservative treatments that can delay and possibly prevent the eventual need for partial or total joint replacement.
As we continue to live longer and lead more active lives, the wear and tear on both our hip and knee joints has become a focus of the medical community. According to The Journal of the American Medical Association (JAMA), total knee replacements in Medicare patients have risen by 162 percent over the past 20 years.
In December 2012, The JAMA Forum — comprised of a team of journalists who provide daily news about developments in medicine — noted that the number of total knee and hip replacement surgeries is predicted to quadruple, reaching 4 million a year by 2040.
And, these surgeries, especially knee replacements, are becoming more prevalent in younger patients, not just the elderly.
There are conservative and even preventative measures everyone can take to manage pain and delay hip or knee replacement surgery. To understand prevention, you must first understand the way these joints work.
Hyaline cartilage is the tissue that covers the bones that come together in both hips and knees to form a joint.
This highly specialized cartilage has unique wear characteristics that both help remove friction and distribute forces more uniformly throughout the bone. Unfortunately, when injured, hyaline cartilage heals poorly if at all.
This is partially because cartilage does not have its own blood supply. The loss of hyaline cartilage results in arthritis.
Arthritis can be caused by a multitude of conditions, but the common result is the same: hyaline cartilage is lost. As more and more cartilage is lost, bones that make up the joint rub together, resulting in pain and joint inflammation and swelling.
With time, the destructive process progresses until the pain and disability become so damaging that it impedes everyday movement and quality of life. At some point, the arthritic process becomes so advanced that less-invasive and more conservative treatment options no longer are not effective.
That’s when join replacement surgery becomes a reasonable treatment option. Fortunately, joint replacement surgery has a wonderful track record of relieving pain and allowing individuals to become active again.
However, everyone wants to cure or at least minimize discomfort and disability with alternative methods, while gracefully delaying the need for joint replacement.
At the Leone Center for Orthopedic Care, I see all types of complex hip and knee problems and my first advice to anyone is to learn about and understand the condition that is causing the pain.
If an arthritic joint has developed, then it’s important to understand the condition or mechanics that lead to the arthritis.
No matter what the cause, the next step is to develop a strategy to treat and if possible cure the condition, while preserving the joint with the least-invasive but most-effective method possible. I encourage my patients to “listen to and know their own bodies” to help preserve their joints.
If you are experiencing continual or repeated intermittent pain, if knee or hip pain keeps you awake at night, or you experience pain when bending or rising from a sitting position, don’t ignore these signs. Seek advice from your doctor for a diagnosis and a treatment protocol that is right for you.
Some of the most common preventative and conservative treatments include:
- Exercise and physical therapy often are the first line of defense because damaged joints actually can worsen without movement. Although it’s difficult to move when you are in pain, a regimen with specific exercises tailored to your condition can help restore function and ease pain. In addition, physical therapy can increase a joint’s range of motion and strength. Pay attention to activities that seem to make the condition worse, as well as those that don’t. Consciously avoid those positions or activities that aggravate or cause pain. The mantra “no pain, no gain” simply doesn’t apply when trying to nurse and prolong arthritic joints. wise, if the physical therapy is aggravating and making the condition worse, stop. Many of my patients benefit from exercising in a pool, walking or swimming to maintain mobility and strength without “beating up” their joints.
- NSAIDs, anti-inflammatory drugs such as ibuprofen and naproxen, can help reduce pain and swelling caused by arthritis. Your doctor may prescribe a particular NSAID that delivers a larger dose or is taken less frequently. Long-term use of these drugs sometimes can cause undesired side effects, so it is extremely important that your doctor monitors this usage.
- Use of ice, massage, deep heat and occasionally nerve stimulation or ultrasound also helps.
- Glucosamine and chondroitin occur naturally in the body, but also are available as OTC supplements. Glucosamine aids in the repair of joint cartilage, while chondroitin helps to prevent other enzymes from breaking down joint cartilage.
- Weight loss: our joints carry the weight of our bodies and the more weight, the harder our joints have to work. Even small changes in weight make a significant difference in the forces on both our hip and knee joints.
- Some patients with knee arthritis obtain relief or an increased sense of stability by using an external knee brace or sleeve. Also, using a cane, walker or crutches can lessen the pain associated with walking or weight bearing from an arthritic knee or hip. For some, these devices also can minimize the risk of falling.
Intra-articular joint injections also are considered to be part of the arsenal of conservative treatments:
- Research indicates that some osteoarthritic joints have lower levels of hyaluronic acid, a naturally occurring acid found in the synovial fluid that acts as a joint lubricant. Some patients find relief from pain and stiffness with injections of hyaluronic acid that can last several months. However, it is not effective in all cases and does not stall the progression of arthritis
- Corticosteroids have long been used for symptomatic treatment for osteoarthritis. Corticosteroids, usually given by injection, provide joint pain relief by stimulating prostaglandin (hormone- compounds) synthesis and decreasing the activity of collagenase and other destructive enzymes. Prostaglandins, un hormones, are not produced in a specific site but are found in many locations throughout the body. They act on target cells in the immediate vicinity of their secretion.
There is no evidence that intra-articular steroid injections slow the disease progression and their ability to treat symptoms typically weakens over a three-month period.
Long-term use is not recommended because they can cause further joint destruction, as well as other side effects, including suppression of the immune system, elevated blood sugar and loss of bone calcium.
Typically injections are limited to two to three a year and many surgeons discourage injections into a joint scheduled for surgery six to 12 weeks after the last injection.
Hylauronic acid injections also been used since the 1960s in an effort to restore the viscosity of synovial fluid in degenerating joints.
Most of the common commercially available formulations are purified from the combs of chickens, and undergo chemical crosslinking to increase their viscosity and prolong their half-life.
Typically, 2 ml are injected into the knee once a week for three to five weeks.
Once again, any realized effects are palliative in nature and if effective, the series of injections often is repeated.
Because many formulations are derived from chicken combs, some individuals develop a sensitivity or allergy with repeat injections. Most common local symptoms include increased knee pain, swelling, redness and pain at the injection site.
Occasionally, patients develop more systemic symptoms including fever, nausea, itching and headache which can mimic an infection.
There has been a wide range of reported outcomes.
Recent clinical trials using meta-analysis, which combines the results from multiple studies in an effort to improve their accuracy, have demonstrated either no significant effect or significant improvement in pain and function. That taken into account, some patients report significant relief and request a repeat series when their symptoms return.
Patients need to be aware that it’s contraindicated to inject a steroid into a joint more than two or three time a year. Also, the therapeutic effects are almost always temporary.
I have had patients refer to these injections as “band aids.
” A steroid injection may not be appropriate for someone who has diabetes, advanced arthritis or has surgery planned within 6 to 12 weeks after the injection, due to increased risks of infection and tissue compromise.
Injections to the knee joint tend to be simpler and less painful than those to the hip. An intra-articular hip injection requires the assistance of fluoroscopy (which is a moving X-Ray) or Ultrasound. Both methods allow for the visualization of the joint space to aid in more precise placement of the needle.
It is not always easy, even with the aid of a fluoroscopy or ultrasound, to place the medicines into the hip intra-articular space because the hip joint space tends to be tight and there is significantly more tissue overlying a hip joint than the knee. In general, when a procedure has a greater degree of difficulty it carries more risk.
If the initial injection of a local anesthetic combined with a steroid produces significant pain relief and increases joint function for three to four months, I think it’s reasonable to have it repeated, especially in the knee. I have further reservations with regard to repeating hip injections.
Unfortunately, subsequent injections frequently will be less effective both in terms of pain relief and how long they provide beneficial results.
In my next blog, I will discuss treatments that specifically focus on treating joint osteoarthritis.
We thank you for your readership. If you would a personal consultation, please contact our office at 954-489-4575 or by email at LeoneCenter@Holy-cross.com.