Five non-surgical alternatives for knee arthritis
Knee arthritis is the most common form of arthritis. Our knee joint is arguably the most prime joint in our skeletal system as it majorly contributes to the balance and movement of our body from one point to another. Despite all the wear-and-tear it undergoes, there is no other element that can allow the extreme mobility and flexibility provided by our natural knee joint.
Hence, when you suffer from knee pain and disorders like arthritis, and if knee replacement surgery is suggested, you might not feel ready to give up on it just yet. Although no surgeon would suggest a replacement surgery at the initial stages, you need to be aware of every other treatment option that has proven to be effective in preserving and improving knee conditions.
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 tears 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 the 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.
Management for both hip and knee arthritis is fairly similar. It is important to offer the entire spectrum of treatment options for 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.
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 knee arthritis, you may have more options than you realize.
Based on the severity of the problem with your knee, alternative treatments that are either short-term or long-term can be prescribed to preserve your knee joint in the long run. Here are the most essential treatment options which you can discuss with your orthopedist to treat your knee instead of replacing it:
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) and prescription forms such as 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.
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.
It is recommended that patients use a body mass index calculator to learn if they are overweight or obese. 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 Total Orthocare, 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
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. 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 multipotent 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 donor tissues. I typically use fat from my patients’ own bodies 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). Surgery should be the last resort. The goal of replacement surgery is to decrease pain and stiffness, therefore allowing patients to return to an active lifestyle.
When non-surgical options fail, it is important to have an open discussion with patients and their families about what surgery entails with a detailed plan for all patients undergoing hip and knee replacements. It is part of a team approach.
Please let us know if you have any questions and do leave a comment
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