Hip/Knee Pain: 10 Steps to Take Before Considering Surgery

Not all pain in your joints is arthritis. Here are ten tips for dealing with pain.

1. Get a proper diagnosis

Many causes of joint pain are not related to arthritis including fractures, nerve damage, a torn meniscus, cancer or one of the other “ITIS’ such as bursitis, synovitis, tendonitis, myositis. ALWAYS GET A PROPER DIAGNOSIS FIRST.

2. Start an Exercise Program

Moderate exercise is an integral part of treating arthritis. Although exercise may sometimes cause discomfort, proper exercise helps nourish the cartilage, strengthen the muscles and help prolong the life of your joints. Please check with your physician before starting an exercise program to obtain permission, precautions or guidelines.

3. Modify Your Activities

Proper body mechanics can lead to a more effective use of your body and put less strain on your joints. These activity guidelines may prove helpful.

• Avoid slouching.
• Practice good posture by sitting and standing up straight
• Avoid sitting in low chairs to reduce stress on your knees when sitting and rising
• Get up and move around every hour or so to avoid stiff joints
• Avoid impact-loading activities (running, etc.)

4. Nutritional Supplements

Recently nutritional supplements have become popular with patients who have arthritis. Glucosamine and Chondroitin have been most widely used. 

Glucosamine: A natural building block found in cartilage, may also be labeled as a hydrochloride or sulfate. Studies have shown Glucosamine to be useful in strengthening, repairing, and revitalizing cartilage, and in reducing pain. 

Chondroitin Sulfate: This supplement is commonly taken in conjunction with glucosomine. It is found in cartilage and makes the cartilage more elastic and spongy. Chondroitin may also help prevent the breakdown of cartilage. 

*Glucosamine and Chondroitin Sulfate are most effective when used together daily. The daily dose of Glucosamine is 1500 mg and Chondroitin Sulfate is 1200 mg. You will need to use these nutrients daily for three months before you notice an improvement.

5. Apply Heat and Cold

Heat and/or cold may be used to decrease pain and increase flexibility. Cold decreases blood flow and helps relieve joint pain and swelling. Heat increases blood flow and helps relax the muscles.

6. Use Orthotics/Bracing/Self-Help Devices/Support

Simple everyday tasks may be hard to accomplish when your joints hurt. Ask your physician or physical therapist about self-help devices for the feet, knee, hands/wrist or back-hip-knee.

Support: Support devices such as canes, walkers or crutches may also help with pain and discomfort and help your balance. Talk to your doctor if you feel these might help you.

7. Investigate Over-the-Counter Medications

Medications are important in the treatment of arthritis. Many over-the-counter (OTC) medications have few side effects and are effective in patients with arthritis. 

Pain relievers such as Tylenol are generally safe and effective in relieving minor pain and discomfort however, they do not reduce the inflammation caused by arthritis. Nonsteroidal anti-inflammatory drugs such as Motrin, Advil, and Aleve help relieve joint swelling and inflammation. The American College of Rheumatology recommends capsaicin as part of the treatment plan. Other creams may be useful as well. Always check with your physician before starting any medications or supplements.

8. Ask About Prescription Medications

When OTC medications are ineffective in reducing pain, swelling, and stiffness from arthritis, then prescription medications may be helpful. There are four general classes of prescription medications. 

NSAIDS: These medications reduce the productions of prostaglandins, which is a major cause of pain and swelling in arthritis patients. They do this by blocking the COX enzyme, which exists in two forms: COX1 (good) and COX2 (bad). Traditional NSAIDS such as Motrin block both of these enzymes. NSAIDS that selectively block only the COX2 have been developed and used. 

Narcotics: Usually reserved for severe pain of a short duration, these medications include Percocet, Lortab and Demeral. These work by reducing brain recognition of pain but have significant side effects such as drowsiness, nausea, constipation and addiction. As most arthritis pain is chronic (longstanding), they are generally not used in people with arthritis. 

Rheumatoid, Lupus medications: There are many excellent medications today for patients with rheumatoid arthritis and other inflammatory diseases, such as Methotrexate, Plaquenil, Remicade, Arava and others. They are generally prescribed by rheumatologists, internists, and family physicians.

9. Consider Injections

Cortisone injections: Cortisone injections are injected directly into joints and help relieve swelling and pain. Cortisone is a naturally occurring hormone produced by the adrenal gland that can help for several months. The effect usually occurs within a few days following the injection.

The long term use of cortisone injections is controversial. However, cortisone may play a role in weakening tendons or cartilage if used too often. Therefore, most physicians limit its use to every three months depending on the circumstances. 

Hyaluronate Injections: Approved for arthritis in the knee, hyaluronate may help relieve osteoarthritis pain and restore joint function. It is a naturally occurring substance in joint fluid that provides lubrication and cushioning in the joint. Several synthetic forms of hyaluronate have been developed for use in the knee joint. To be effective, you must receive three to five injections weekly. The effectiveness is usually not noted for a month or so. 

Studies have shown that the more severe the arthritis, the less effective the injections. When effective, however, the relief may last for six months to a year. Injections may be repeated in six months

10. See a Surgeon Who Specializes in Arthritis

Surgeons who specialize in arthritis can provide you with all the options and expertise to decide whether surgery is right for you. 

Knee Surgery Options 

Arthroscopy: Arthroscopy is a form of surgery where surgeons place a small instrument through punctures into your knee joint. Damaged tissue can be removed or repaired within the joint providing relief from both pain and swelling, while possibly preventing further damage to the knee. This procedure is usually not helpful if you are suffering from severe arthritis. 

Total Knee Replacement: For patients with significant arthritis, your surgeon may recommend knee replacement surgery. Knee replacement involves replacing the worn out surfaces of the knee with metal and plastic components. 

Hip Surgery Options 

Hip Replacement: Total hip replacement replaces the ball on the upper end of the femur (thigh bone) and resurfaces the acetabulum (socket). These implants are designed to restore function and eliminate as much discomfort as possible, while allowing you to return to a more active lifestyle.

To talk to a surgeon in our Joint Replacement Center, or to schedule an appointment, call MoBap at 314-996-3627.