Arthritis is one of the most common degenerative disorders that patients see a physician about. It’s caused by a loss of cartilage, and it affects many different joints. Up to one in four adults in the United States are impacted by significant arthritis.
The main symptoms people experience are pain, swelling, and stiffness. As more cartilage is lost in the joint, the bones can rub against each other. Bone-on-bone arthritis is severe arthritis.
There are many causes of arthritis. Genetics can play a role. Older age, prior trauma or injuries to a joint, instability in a joint, and obesity can all predispose people to arthritis.
The most common type of arthritis is osteoarthritis, which is the degenerative wear-and-tear arthritis. Other types of arthritis, such as rheumatoid arthritis and inflammatory arthritis such as gout, also exist.
Relieving Hip & Knee Pain Without Surgery
Arthritis cannot currently be cured, but we can manage symptoms and pain. We start with non-operative management.
- Activity modification. Trying to avoid those things that flare symptoms. For example, replacing high-impact activity such as running, jumping, pivoting, and cutting sports with lower impact activities such as cycling, elliptical, walking or swimming can reduce pain and symptoms.
- Medications. You can start with over-the-counter pain relievers like Tylenol and non-steroidal anti-inflammatories (NSAIDs), including ibuprofen, Advil, Motrin, or naproxen (Aleve). If the over-the-counter versions are not providing enough pain relief, there are prescription versions your doctor can prescribe. If you have medical conditions that mean you can’t take the oral (pill) forms of pain reliever, there are topical medications your doctor can prescribe.
- Injections. There are multiple types of injections available for arthritis pain relief, but the two main ones are cortisone injections and hyaluronic acid (gel) injections.
- Exercise. Exercise is a major component of managing arthritis. Keeping the muscles around the joint strong can help to offload some of the pain. As arthritis gets worse, people tend to lose range of motion. Exercise is important to try to maintain the range of motion. People who are sedentary have worse arthritis symptoms than people who are active.
- Weight loss. Even small changes in weight can make dramatic improvements in arthritis pain, especially for arthritis pain of the lower body. A three-to-five-pound weight loss is 20-25 pounds or more of force that goes through the knee or the hip.
- Physical therapy. Physical therapy can be very effective at strengthening the muscles around the joint and maintaining range of motion. Physical therapy can be done without surgery or before surgery, not just after surgery.
- Braces and splints. Braces and splints can be helpful for people, especially for knee arthritis.
- Alternative and biologic therapies. Talk to your doctor about alternative therapies such as acupuncture or biologic therapy such as stem cells or PRP.
Comparing Surgical Options for Hip Arthritis
Hip Arthroscopy
Hip arthroscopy is a minimally invasive surgery that is generally reserved for younger patients, under 40 or 50 years old, who have not had significant arthritis on x-rays or advanced imaging. These patients may have femoroacetabular impingement or labral tears.
Osteotomy
Osteotomy means to cut bone. Osteotomies are extensive surgeries that are often performed in young patients who have dysplastic hip anatomy, and they are not useful surgeries for advanced hip arthritis.
Hip resurfacing
Hip resurfacing is a surgery that has historically been offered to younger, very active patients with strong bones but is less popular in recent years. Total hip replacement has become more popular, and with hip resurfacing the components have metal-on-metal bearings that may cause complications.
Total hip replacement
Total hip replacement is the gold standard for treating disabling hip pain in people over 40, as well as some younger patients who have particular conditions that mandate an operation.
Comparing Surgical Options for Knee Arthritis
Knee arthroscopy
Knee arthroscopy, or “clean out” of the knee, does not have consistent results and should be avoided for patients with moderate to severe arthritis.
Osteotomy
Osteotomies around the knee can be helpful for patients in their 20s or 30s, but do not have good results in older patients when compared with knee replacements.
Cartilage procedures
Cartilage procedures harvest cartilage cells and transplant them into a specific area, particularly around the knee. The place where the cartilage is lost must be very defined for the procedure to be effective. If the arthritis is affecting multiple portions of the joint, the cartilage transplant procedures won’t be helpful.
Partial knee replacement
If arthritis is isolated to one compartment of the knee, a partial knee replacement may be useful.
Total knee replacement
If the arthritis affects more than one part of the knee, a total knee replacement is the most successful surgical procedure for advanced knee arthritis.
When is the time right for surgery?
- You have bone-on-bone degenerative joint disease (due to osteoarthritis, rheumatoid arthritis, avascular necrosis of the hip, or other similar condition).
- You have pain that is impacting daily activities and desired recreational activities.
- Non-operative treatments, like medications, injections, exercise, weight loss and physical therapy, have failed to provide sustained relief.
In the vast majority of cases, joint replacement is an elective surgery where the patient and their surgeon make a decision together.
Frequently asked questions
What can I do to keep knee arthritis from getting worse? Are there specific exercises I should do or avoid?
My general advice is to try to avoid high-impact activities such as running, jumping, pivoting and cutting sports. I do know that those sports are what some people do for their mental and physical well-being, and it’s difficult for example to tell a runner not to run. Specifically for knee arthritis, doing anything you can to maintain range of motion and strengthen the quadriceps muscle is helpful, either with a home exercise program or with formal physical therapy. For hip arthritis, maintaining range of motion and strengthening some of the muscles around the hip joints is encouraged.
How can you tell if hip pain comes from arthritis, or if it is nerve pain from your lower back?
When you come in for a visit, you’ll explain your symptoms to your doctor. Your doctor will perform a physical exam and look at imaging of the hip or the lower back. Your doctor is familiar with evaluating this question and will make a diagnosis.
Can yoga help prevent later hip and knee issues?
I don’t know that yoga can help prevent the development of arthritis, but it’s a very low impact exercise that helps to maintain a tremendous range of motion. As a low-impact exercise it’s encouraged.
Is too much walking bad for your knees?
No, not in my opinion. My advice is to let pain be your guide. Walking is a low-impact exercise that can be beneficial not only for your joints but also for your cardiovascular system. If you’re walking several miles a day and having to ice your knees all evening, you may be walking too much in that case.
What is the gel injection and how is it different from cortisone injections?
Gel injections are hyaluronic acid injections. Cortisone injections are anti-inflammatory injections. A cortisone injection is putting anti-inflammatory medication directly into the joint to decrease inflammation. Hyaluronic acid (gel) injections are more of a lubricant type of injections and can be beneficial in earlier stages of arthritis. Cortisone injections have stronger data in the published literature, but many patients do receive relief from gel injections. However, hyaluronic acid injections are more expensive and insurance companies often require pre-authorization. I recommend you talk with your doctor about the type of injection that is right for you.