Manage hip, knee osteoarthritis
Q: I am 50 years old and live an active lifestyle. Recently, I started having more aches and pains, especially in my knees and hips. I wonder if I have arthritis. What are my treatment options?
A:
Osteoarthritis, also known as mechanical arthritis or “wear-andtear” arthritis, is the most common joint disorder in the U.S. It occurs when the protective cartilage lining the joints is lost, resulting in pain and impaired function. An estimated 20% to 30% of adults older than age 45 have evidence of hip or knee osteoarthritis.
It is important to establish a diagnosis for hip and knee pain. Your doctor can perform a physical exam and obtain X-rays to confirm if you have osteoarthritis. This needs to be differentiated from other potential sources of hip and knee pain, such as referred pain from the back; soft tissue pain, like tendinitis or bursitis; and other joint problems, including osteonecrosis or inflammatory arthritis.
Generally, it is best to treat painful osteoarthritis with the most conservative and least invasive measures first, and then escalate as necessary. A three-tier framework can be helpful to understand the treatment ladder to manage osteoarthritis.
The first-tier conservative regimens with the strongest evidence include the following.
Shift to activities that cause less pain and avoid activities that are aggravating.
Modifying activities:
Exercise: It’s one of the most effective interventions for hip and knee pain, but it may require you to change routines and find lower-impact activities.
Manage weight: Under the guidance of your doctor, lose weight if you need to.
Gait aids and braces:
Offloading pressure from the joint with gait aids such as canes, crutches or walkers, or with braces for the knee, can ease pain, especially for long walks or when on uneven surfaces.
Over-the-counter pain medication:
Acetaminophen or nonsteroidal anti-inflammatory drugs, or NSAIDs, can be effective first-line therapies for pain. Topical NSAIDs can be rubbed over the joint. While narcotics or opioids are helpful for some conditions, they are inappropriate for osteoarthritis.
Injections are the second rung in the treatment ladder and are considered when the above strategies fail to work. Options include the following.
Steroids: Steroids are highly beneficial for pain relief and may be used in conjunction with local anesthetics. Note that steroids do not work for everyone, only provide temporary relief and typically have decreased effectiveness with repeated use.
Hyaluronic acid: Injections use components of knee joint lubricating fluid to replenish it. This option is useful for patients who do not respond to steroids.
Regenerative medicine:
Some injections are marketed as regenerative medicine, including stem cells, platelet-rich plasma and acellular biologics. These are costly, not covered by insurance and not recommended for hip and knee osteoarthritis.
The last option is joint replacement surgery. These are the most common elective surgeries in the U.S. Although they are major procedures, they are also remarkably effective. Not every patient is a candidate for surgery, however. Complications can occur, so discuss risks with your surgeon.
Patients need to be cleared for surgery based on lifestyle factors and health risks. For instance, many institutions have a cutoff for a body mass index of less than 40. Patients with diabetes must demonstrate reasonable control with blood testing. If you are on blood thinners, your health care team will formulate a management plan.