non operative treatment Arthritis patient guides for patients needing knee and hip surgery

Non-operative or conservative treatment for arthritis.

Arthritis is a very common condition. It is seen more frequently with advancing age and expresses itself with varying degrees of severity.

It may be associated with swelling and/or deformity of the joints. The patient may complain that the joint is “stiff” from the slow and restricted movement. Abnormal cracking or crunching noises can be heard on movement of the joint. Some weakness of the muscles associated with the joint can occur. Quite often, (but not always!) The arthritic joint will be painful. It is often the pain from arthritic joint that causes a patient to seek advice.

Not all arthritic joints need treatment! For many, the pain is manageable and a slight loss of function may have no noticeable effect on somebody’s day-to-day activities. For those who are symptomatic, there are a number of options short of surgery that are worth exploring:

Drugs

Physiotherapy

Splintage and support

Modification of activity

Joint injections

Drugs.

In the early stages of the disease, the symptoms can be held at bay by the use of certain drugs. In general we tend to use the mildest drug that will control the symptoms. Typically, paracetamol, non-steroidal anti-inflammatory drugs (NSAID) ibuprofen, and codeine-based drugs. There are other specialised drugs which are normally prescribed by a rheumatologist or other specialist practitioner. Some of these drugs do have hazardous side-effects and need to be monitored. Although the milder forms of NSAIDs, such as ibuprofen, are available over the counter, you should always discuss with your own GP whether these are suitable or not, particularly if you are taking other drugs with which they may interact.

Typical side effects of anti-inflammatory drugs are:

Indigestion, reflux, gastrointestinal ulceration and bleeding, damage to the kidneys in susceptible patients.

Typical side-effects of codeine-based drugs:

Constipation, drowsiness, unsteadiness

Paracetamol has a very low incidence of side-effects but it is highly toxic if it is taken in large doses.

It makes sense therefore very carefully follow the instructions given to you by your doctor or on the medication label to make sure you reduce the chance of side effects.

Physiotherapy

It was once believed that physiotherapy had no beneficial effect on the progress of symptoms of arthritis. Clinical studies have shown however that some patients gain very real benefits from the attentions of a physiotherapist.

Exercises to improve your muscle strength and to improve your balance are often associated with a significant reduction in symptoms. It is probably true that the arthritis itself does not diminish but the positive effects of physiotherapy in terms of symptoms can be achieved with virtually no side-effects. It also has the added benefit that should you come to surgery, you are actually in a better position to get over that surgery. It does however require some degree of discipline to continue with your exercises as you need to keep the muscle tone topped up

Splintage and support

There is a vast array of commercially available braces, supports and orthotics which seem to have some benefit in terms of pain relief. In order to be acceptable they cannot be too cumbersome, and the mechanism by which they relieve pain may be somewhat indirect. Again, these are treatments which have virtually no side-effects and are completely reversible (by taking them off!)

In the knee, orthotics or specially moulded insoles placed in the shoes can have quite a significant effect on the pain of arthritis.

In general, it does no harm to try these non surgical treatments before considering surgical treatment.

Modification of activity.

Most patients come to complain that the pain of the arthritis prevents them from achieving certain activities. For example walking long distances, certain types of sport and other recreational activities can be made very difficult. Although most patients are looking for advice and treatment that will help restore their function, not all are willing to take tablets, undergo physiotherapy or be burdened by Splintage and walking aids. If the symptoms are particularly mild, changing your activity may be enough to keep symptoms at bay. For example planning to walk short distances, changing your sport to something less aggressive, getting help from friends and relatives to do certain activities on your behalf. Everyone is individual and you should discuss your own personal needs with your doctor.

Steroid and other injections.

Steroid in general has a bad press and is often associated with major side-effects such as osteoporosis, weight gain and other generalised symptoms. Localised injection into a joint however is in general free of these complications as the drug stays limited to the knee joint.

In fact steroids (short for corticosteroids) are an extremely effective and very strong anti-inflammatory drug. Preparations are made with a carrier that will allow the drug to stay within the arthritic joint and be released slowly over time. This can give months of relief with very little side-effects.

Of course, to get into the joint they have to be injected. The injections themselves are like any other injection and are painful for a short period of time. Some people cannot bear the idea of a needle being inserted into the joint, but those who are brave enough to undergo this get profound dramatic relief that can substantially change the quality of life and function.

The major side-effect or complication of an injection is infection. The steroid is also very powerful at suppressing the local immunity response and encouraging infection. For that reason, they have to be given very carefully in a clean environment to avoid the transmission of any infection into the joint itself.

A steroid injection can provide relief for a few weeks to several months. Individual patients vary quite substantially in how they respond to these injections and sometimes the only way to find out is to try it.

Assessment.

“Measuring “ arthritis is not easy. X-rays can be assessed for degree and extent of damage, but surprisingly, these measurements do not always equate to the symptoms a patient may have. Indeed is well known that even severe arthritis on an x-ray may be associated with little or no symptoms.

Measuring how arthritis affects an individual is even more problematic. One man’s pain is another man’s ache and even if we could agree how to measure pain, a person’s individual circumstances may lead them to suffer more disability than another given an agreed measure if similar pain!

However we can get an idea of severity from some simple information, such as “Does the pain wake you up at Night”, “How far can you walk before you have to stop”.

There are more sophisticated analytical tools which assess many parameters of pain and disability, such as the Oxford Knee score and the Oxford Hip score; They can help us to get a rough idea of disability, but again , they are not foolproof tools to say whether someone should have a surgical operation, but they can help when put together with other information to give a patient the best guide to making a decision. Modern surgeons are trained to use these tools and using input from patients, can help you to come to the correct decision.

What if I need surgery?

If you and your surgeon have come to the conclusion that you need surgery, the pages on this website can help you understand what steps you can take to improve your problem, what to expect and how to achieve it.

See:-

Patient Guides Sports Injuries Arthritis Surgical Guides Anaesthetics Pre-Operative Guides Post Operative Guides