According to the Arthritis Foundation, arthritis afflicts 54 million U.S. adults and is the leading cause of disability among Americans over the age of 55. Although total joint replacements are very successful and can be life-changing, patients should not rush into surgery if they don’t have to.
Total joint replacements are meant for older patients whose pain is limiting their daily activity. All too often, younger and younger patients are requesting and having their joints replaced. This can lead to severe problems for them in the future.
Why you should delay surgery for arthritis
The artificial knee consists of metal moving on plastic. Like the heel of your shoe, the plastic will wear down over time. In patients over 65, we know replacements last around 15 years. However, the more active you are, the faster the plastic will wear down.
The problem is the plastic debris. Plastic doesn’t break down – as you may know with our world’s environmental problem of plastic accumulation from our garbage. Over time, the plastic debris accumulates in the knee joint.
The more active you are, and the more you weigh, the more plastic debris. The white cells in your body recognize that plastic debris as foreign invaders and try to break it down. The more debris, the greater the number of white cells. Since the white cells can’t break down the plastic, they instead will attack the surrounding bone.
Therefore, when it becomes time to replace the plastic joint, we will also have to replace the bone. That is a significant surgery I don’t enjoy, and I guarantee you won’t either.
The best approach for arthritis of the knee is to wait as long as possible before joint replacement surgery.
8 steps to take before opting for surgery for arthritis
There are several steps you can take to deal with your pain before selecting the surgical option. These measures, some of which you can perform without the aid of a medical professional, often significantly lessen the pain and improve your quality of life.
I recommend trying these 8 steps before opting for surgery:
- Wear good shoes with arch supports. With weight bearing and time, the arches in feet tend to fail. Good shoes with arch support improve the alignment of the feet and ultimately improve the alignment of the knees.
- Have a daily exercise and balance program. Studies show that arthritic patients who exercise do much better than those who don’t. Patients with arthritis should exercise at least a 20-minutes a day. Exercise should include stretching, aerobic activity, and strength training. Remember to “listen” to your knees. If running hurts and causes your knees to swell, STOP! Try using the elliptical machine instead or try biking or swimming.
- Use a hinged knee brace, as needed, for support. Wear the smallest brace that makes you the most comfortable. Do not wear the brace for everyday activities, but for extra activities such as golfing, shopping or exercise. It unloads the arthritic area and allows you to pursue more pain-free activities, which you may not have been able to do otherwise.
- Try over-the-counter pain medications. These come in a number of different forms.
- Non-steroidal Anti-Inflammatory medications (NSAID) such as Advil (ibuprofen) or Aleve (naproxen) can relieve some of your pain. However, remember do not mix NSAIDs. Also, remember to take them with food. Patients should also be aware of possible side effects, including an upset stomach and bloody or dark, tarry stools. If you have these symptoms, stop taking the NSAID immediately and contact your physician. On other note, if you are taking NSAIDs for an extended period, consider taking Pepcid or an over-the-counter proton-pump inhibitor to protect your stomach from ulcers
- Tylenol (acetaminophen) also works for many. However, patients should not exceed a total of 3000 mg per day. Since NSAIDs are metabolized in the kidney and acetaminophen is metabolized in the liver, you may combine both medications – taking a lower dosage of each thereby reducing their risks.
- Topical pain-relieving creams with cortisone, aspirin or arnica (a plant-derived natural anti-inflammatory) can also be helpful. When applied directly on the skin over the knee joint, they may stop the swelling and relieve the pain without getting into the bloodstream, thus, limiting their side-effects. Mixing lidocaine cream with the above can potentiate the pain relief.
- Try dietary supplements. There are several on the market that have been promoted as reducing inflammation. Although the results of studies of their effectiveness are conflicting, these products are generally safe and so may be worth a try.
- Glucosamine sulfate and chondroitin sulfate are two key components found in cartilage. These amino acids aid in rebuilding and repairing worn cartilage. I recommend buying a two-month supply of glucosamine sulfate—not glucosamine HCL (read the label carefully)—and chondroitin sulfate. If it yields positive results after two months, great—continue taking them. If not, stop. If you are a long-distance runner or have had meniscus surgery, take glucosamine as a preventive measure. It can’t hurt.
- Omega 3 & fish oil. Omega 3 has been shown to help your heart, brain, and joints. It’s a three-for-one deal. Why not take it?
- Turmeric is a member of the ginger family and has some anti-inflammatory properties. Although studies are inconclusive as to its effectiveness, some patients swear by it. You may want to try it to see if it works for you.
- Eat nutritious foods and keep your weight under control. Weight loss reduces the stress on your knees and increases mobility. Sugar and processed foods may also cause inflammation of your joints. Eat lean meats and fish, along with more fruits and vegetables.
- Improve your bone health. Although studies of effectiveness are not been conclusive, I believe that it is worth trying to improve your bone health with increased calcium intake, daily vitamin D, and weight-bearing exercises. It is possible that these interventions may lessen the pain of arthritis. Should you eventually need a total joint replacement, having an increased bone density can improve your chances of having a long-lasting joint replacement.
- Try injections. Although injections are not a cure, they can “buy time” so you may resume your normal activities in comfort while delaying the need for surgical intervention. Injections can last three months up to a year. There are different types, however, and I don’t recommend them all for every patient.
- Cortisone is a steroid that stops the inflammation in the joint and relieves pain. I do not like to give it to younger patients or to patients with modest arthritis because it may contribute to the further breakdown of cartilage. Steroids given frequently may be necessary for some patients with specific diseases, but in the long term can make you retain water, weaken your bones, raise your blood sugar, cause cataracts, and have many other side effects. However, steroids in your knee joint, given four times a year, are usually safe.
- Hyaluronic acid is the naturally occurring gel that lubricates the knee joint. Coincidentally, it is also found in the coxcombs of roosters. Hyaluronic acid is deficient in arthritic knees. Injecting it into your knee can give you up to one year of relief. Because these injections are very expensive, Medicare and most insurance companies regulate their use. They only allow injections if cortisone injections have failed, and injections can be given no more than every six months. Injections can be given all at one time or spread out over several weeks. I have found that a series of five injections, spaced one week apart, will improve your pain better than a single injection. Receiving injections in six-month intervals manages your pain better than waiting until your pain is unbearable. Therefore, if the hyaluronic acid shots help, I recommend scheduling your next series of injections six months and one day after your last injection.
- Platelet-rich plasma (PRP) and stem cells are harvested from your blood and bone marrow, respectively and amniotic tissue is derived from the placenta and umbilical cord. They can be injected into your joint to stimulate cartilage regrowth. Although insurance companies refuse to pay for these injections because they consider them experimental since studies on these are inconclusive, they can be given in special situations when surgical correction is not a good option.
When you’ve tried all of these non-surgical measures and they don’t seem to work any longer, and you are not ready for a rocking chair and shawl, then surgery may be your best option. If surgery is necessary, rapid and successful recovery is possible by having optimized your physical and nutritional health beforehand.
Victor Romano MD
Dr. Victor Romano (www.romanomd.com) is an orthopedic surgeon in Oak Park, Ill. and the author of Finding The Source: Maximizing Your Results--With and Without Orthopaedic Surgery. He is board-certified in orthopedics and sports medicine with over 25 years of experience in the field. He graduated cum laude from the University of Notre Dame and completed medical school at the University of Loyola-Chicago.