As the weather warms and spring approaches, it’s important we make time to get outside to take advantage of nature’s beauty. This can optimize both our physical and mental health. Unfortunately, for some, this is easier said than done due to debilitating knee or hip pain. One of the primary causes for this discomfort is osteoarthritis. This diagnosis can sometimes be confusing as no two people have the exact same symptoms, severity or progression. Working with your doctor to develop an individualized treatment plan that is specifically tailored for you is essential for recovery. It is also vital you gain an understanding of what the disease is, how it’s diagnosed and the multiple treatment options.
What is Osteoarthritis?
Osteoarthritis is a joint disease that mostly affects cartilage. A joint is the connection between bones, while cartilage is the tissue that covers the ends of a bone. I often describe cartilage to my patients as being similar to the soft, gristly material on the end of a chicken bone. Normally, healthy cartilage allows bones to glide over each other and absorb the shock of movement. When this layer breaks down, thins out or wears away the bones will eventually rub against each other, which can lead to pain, swelling and loss of motion.
What are some symptoms of Osteoarthritis?
• Joint Pain; Stiffness; Pain with movement that improves with rest
• Muscle weakness; Poor Balance
• Hip arthritis typically causes pain over the front of the groin which is worsened when rising from a seated position and during the initiation of walking
How is Osteoarthritis Diagnosed?
• A detailed medical and family history in conjunction with a physical exam performed by your doctor is crucial
• Clinical signs and symptoms that aid in diagnosis:
• Morning stiffness that lasts less than 30 minutes
• Persistent joint pain in one or more joints
• Age over 45
• X-ray, however this type of imaging has limitations with picking up early stages of arthritis
• MRI can be used but is usually not needed
Once you receive the diagnosis of hip or knee osteoarthritis it’s important you discuss with your doctor all available treatment options. Your active life does not have to end and it is essential to not let this pain create a negative health image. Becoming proactive with your healthcare is the best first step. Treatment is focused on improving joint function, keeping a healthy body weight and controlling pain. Initially, many non-surgical measures are all that’s needed. These include:
Although moderate physical activity such as brisk walking is safe for most people, please talk to your doctor before you start any exercise regimen.
The focus is on strengthening the muscles that surround the hip/knee, which in turn can reduce the stress being placed on that joint. You can easily strain muscles that surround an arthritic joint as they can be overworked trying to protect you from painful movements.
Maintaining a healthy weight and positive attitude:
Although our food is delicious (Dolma is my favorite!) there are steps you can take to ensure you are maintaining a healthy, well balanced diet. You can start by implementing small changes such as: decreasing portion sizes, limiting soda intake and avoiding consumption of fried or processed foods.
Knee and hip pain can limit your ability to comfortably perform exercises or work out, however this does not have to lead to weight gain. Adhering to a healthy diet can prevent a vicious cycle from occurring where lack of mobility leads to poor eating habits, which in turn can lead to negative thinking.
Adjust your approach to daily activities:
Instead of focusing on how difficult tasks are now, such as sweeping the kitchen, taking out the trash or mowing the lawn, make small changes with your approach. Break the tasks down into smaller jobs and understand it’s okay to ask for help. Figuring out ways to work smarter is not a form of laziness and can help preserve your joints.
For example, mow the lawn in stages instead of trying to get it done all in one setting. Clean one room at a time with breaks instead of the whole house in a day. Although this can lengthen the time it takes to get things done, you are protecting your joints from the rigors of prolonged activity, which will improve your pain in the long run.
Prior to taking any medication you should always check with your doctor to ensure if it’s safe and right for you. This is especially important for anyone that has underlying medical problems requiring daily treatment such as high blood pressure, diabetes, heart disease, etc.
Pain relievers such as acetaminophen (Tylenol) and Anti-inflammatory medication such as ibuprofen (Motrin) may help. Your doctor may also prescribe topical creams that you apply to the skin as they can have a more favorable side effect profile.
Unfortunately, studies are limited on the effectiveness of herbs/supplements, however a combination of glucosamine and chondroitin may be beneficial.
Certain knee braces can help to reduce the pressure on a specific part of the joint and provide added stability. It’s important to talk with your orthopedic doctor to ensure you obtain the appropriate size and fit.
Steroid Injection: These injections can help reduce inflammation or swelling and provide short-term relief. Again, it’s important to discuss with your doctor if you are a candidate for these injections as certain medical conditions can preclude their use.
Visco-supplementation: You may have heard these referred to as “gel injections”. Normally, our joints have a thick lubricating fluid that over time will decrease as your arthritis progresses. We can now inject a gel like fluid called hyaluronic acid into the knee joint, which may provide longer lasting relief.
Biologic Injections such as Platelet Rich Plasma (PRP) and Stem Cells: These injections use our body’s own natural reparative processes to aid in healing. Unfortunately, most of these injections are not covered by insurance.
Knee/Hip Arthroscopy: These are minimally invasive procedures that can further identify the extent of your arthritis and repair damaged tissue or remove loose pieces of cartilage/bone that could be floating in your joint.
Knee/Hip Replacement: There have been many new advances with knee and hip replacements, which has lead to variations in length of recovery and lifespan of the implant. MAKOplasty Partial Knee Resurfacing: At the Detroit Medical Center, we use a robotic arm assisted partial knee surfacing procedure that is designed to relieve pain by specifically targeting the part of your knee that is damaged by arthritis. The goal is to resurface the knee while sparring healthy bone and surrounding ligaments.
Ultimately, the most important step when dealing with arthritis or any medical problem in general, is education. Learning what the disease is and how you can treat it are vital to optimal recovery. Know that you are not alone and that your orthopedic doctor can help walk you through this overwhelming amount of information. I recommend writing down questions in advance of your appointment and taking notes during your visit so you can make the most informed treatment decision. Being proactive with your healthcare is the best advice I can give.
I hope to see you all this spring and summer enjoying the many activities that enrich your body, mind and spirit.
Brandon Kakos, MD is a sports medicine physician in Troy.