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Manage hip, knee osteoarthr­itis

- Mayo Clinic — Cody Wyles, M.D., Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota Mayo Clinic Q&A is an educationa­l resource and doesn’t replace regular medical care. Email a question to MayoClinic­Q&A@mayo. edu.

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?


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.


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