James P. Jamison, M.D.
Osteoarthritis of the hip and knee is a problem that affects over 27 million people in the US alone. The resulting pain, loss of motion and mobility, and negative impact on daily life and productivity can be substantial. This disease may eventually lead to joint replacement surgery, but treatment should always start with evaluating conservative, non-surgical options.
Medications that are often used to manage pain from osteoarthritis include non-steroidal anti-inflammatory drugs (or NSAIDs) and acetaminophen. NSAIDs include over-the-counter (OTC) options like ibuprofen (Advil or Motrin) and naproxen (Aleve). These examples can be helpful, but some patients can’t take NSAIDs due to medical problems. Common medical concerns are high blood pressure, stomach problems or use of a blood thinner. Acetaminophen (Tylenol) has fewer side effects but may be less effective.
Regular exercise is always encouraged. Keeping your joints moving is important to maintain muscle strength and joint lubrication, and to prevent stiffness. Exercise can be done at home by anyone with just a little bit of instruction. Many patients choose to participate in exercise classes at local facilities such as the Y, health clubs or other facilities. Instruction can also be gathered on-line (have a look at www.AAHKS.org) or through a couple of visits to formal physical therapy. No matter how it is done, maintaining activity is key.
Injections are often used to help with joint pain from osteoarthritis. Knees are injected much more commonly than hips. Hips typically require imaging, such as fluoroscopy (live x-ray) because the joint is surrounded by layers of soft tissues and important nerves and blood vessels. Imaging usually is not needed for knee injections, as the knee joint is readily accessible in the majority of patients. Patients typically see more predictable, lasting relief from knee injections than from hip injections. Cortisone is used most often, but the same joint should not be injected more frequently than every 4 months. Visco supplementation, also called “gel” injections, are highly advertised but have less predictable results.
Bracing for knee arthritis can be helpful. An elastic knee sleeve provides compression and a feeling of stability to some patients. More complex braces are designed to relieve the stress on the most worn part of the knee joint and can be of benefit (but may also be uncomfortable to wear). Patients with swelling or a history of blood clots in the legs should not use braces or knee sleeves as they may make swelling more of a problem and may increase the risk of another clot.
Use of a cane can make it easier to walk by taking some of the load off of the involved hip or knee. Normal walking occurs by stepping forward with one foot while swinging the opposite arm forward at the same time, then alternating. The cane should be used in the hand opposite the side of the most pain, allowing a normal pattern of walking. For example, if your right knee is painful, use the cane in the left hand so that when you step forward with the right foot, weight is also shared through the cane in the left hand. A cane also helps to improve balance, preventing falls.
Dietary supplements to help with joint pain are also highly advertised. Examples include glucosamine and chondroitin sulfate, turmeric, curcumin, tart cherry, and raisins soaked in gin, just to name a few. There is little to no scientific evidence to support claims of regrowth of cartilage, but some patients do say that they feel better after using supplements. Remember that these examples are dietary supplements, not drugs, so there are no recommended doses or specific controls by the Food & Drug Administration.
Rest, elevation of the extremity, ice and moist heat are also options to consider for pain in the hip or knee from osteoarthritis. A warm shower can help, also. Care should be taken to be sure that heat or cold is not directly applied to bare skin to prevent burns or frost bite.
In conclusion, when considering hip and knee osteoarthritis, the conservative treatment options of NSAIDs, injections, exercise and bracing should always be considered. Not only is this the appropriate approach, it is also becoming more of a requirement with many health insurance providers. If your pain persists or progresses despite these efforts, the next step is to consider if you are ready for joint replacement surgery. If you would like to talk about it, make an appointment to come in for an evaluation.
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Dr. James P. Jamison, M.D., is an orthopedic specialist with a focus on hip and knee joint replacement and reconstruction surgery. Referrals to Dr. Jamison by your primary care physician can be made by calling (330) 758-0577, Ext. 1102.