Making an appointment with an orthopedic surgeon to discuss joint pain doesn’t always lead to surgery. That’s the message Dr. Slade Moore of Novant Health Orthopedics & Sports Medicine in Greensboro, North Carolina, wants you to know. In fact, he hopes to keep you from having surgery.
More than 32.5 million American adults have osteoarthritis, according to the Centers for Disease Control and Prevention. That’s also the condition Moore treats most often. There’s a lot you can do to treat arthritis pain before resorting to surgery.
Let’s start with the basics. Moore addressed several questions about joint pain to help us better understand this condition.
There's no reason to live with pain...
How does someone know its arthritis? What does arthritis pain feel like?
Let’s first make clear that we’re talking about osteoarthritis, which is deterioration of joint cartilage and bone, particularly in the hips, knees and thumb joints. That’s what I treat. Rheumatoid arthritis is different and something you’d see a rheumatologist for.
The big difference between the two is the cause behind the pain. Osteoarthritis, which is more common, is caused by wear and tear on your joints. Rheumatoid arthritis is an autoimmune disease.
Osteoarthritis pain can vary, but it’s rarely a sharp pain. It’s more of a deep ache that can radiate from where it originates, but it doesn’t radiate far. People with osteoarthritis can feel a change in their condition when there’s a change in the weather. That isn’t just an old wives’ tale. When there’s a change in barometric pressure, they may find their joints feel more stiff.
Osteoarthritis, in the early stages, also feels better once you move around a bit.
Where do people feel the pain?
If the problem is in the hip joint, they may feel it in the front of their leg or the groin area. Or sometimes the buttocks. Knee arthritis can vary, but the pain is usually felt in the front of the knee. I don’t see a lot of hand osteoarthritis, but when I do, it usually affects the first two joints – those at the end of the fingers.
At what age might it first come on?
It varies widely. It can happen to people in their 30s and even 20s. But it’s more common in people who are in their 60s and 70s.
What are the risk factors? Is it hereditary?
There is likely a hereditary component. Also, previous injury can lead to osteoarthritis. Symptoms are made worse by relative inactivity and by being overweight.
What are the first non-surgical options you might take before surgery?
That depends on the severity. Low-impact aerobics is a good place to start. And weight loss if your BMI is over 25. Every pound you lose helps you feel better. Every pound gained increases the stress on the hip or knee by 4 to 6 pounds. Because there’s so much obesity in America, we’ve seen a significant uptick in the number of people needing hip and knee replacements.
And exercise. It’s good for mental stress. Too many people have let their exercise habits go since we’ve been home so much during the COVID-19 pandemic. Those with osteoarthritis have had flare-ups because they’re less active and may have put on weight. The best and simplest thing you can do is get out and walk.
Anti-inflammatories can help, too – ibuprofen, Aleve, Celebrex. But they can have side effects. People with high blood pressure, kidney disease or a history of ulcers should be careful. Tylenol is not an anti-inflammatory, but it can help. There’s also a topical anti-inflammatory called Voltaren, available over the counter, that can help – especially with joints closer to the skin.
We can also try cortisone injections, but they need to be used judiciously. You can’t get them too frequently, and they should not be given if your symptoms are mild. Studies show that cortisone injections can actually worsen your arthritis if you get them when your condition is mild.
How infrequently should someone get a cortisone injection?
Again, it depends on the severity of their condition, but one every two years would be about right in many cases.
What's your advice about supplements? There are so many advertised - Bi-Flex, glucosamine, turmeric ...
Turmeric is a good adjunct and has little to no side effects. Same with fish oil. Studies haven’t shown glucosamine to be effective relief for osteoarthritis. Our academy – the American Academy of Orthopaedic Surgeons – says glucosamine is not supported by the literature as effective.
When is surgery appropriate?
When the pain or the deformity is impacting your quality of life. When your bad days outnumber your good days. Surgery is not intended for mild or moderate cases.
Whether or not you choose surgery also depends on your age and goals. If you’re in your 80s and mostly sedentary, you may not want to have knee surgery. There are risks associated with it, as with any surgery. You should discuss the pros and cons with your doctor.
The decision about surgery also depends on what joint needs to be replaced. It’s counterintuitive, but a hip replacement is much easier than a knee replacement. Most people can walk with a cane two weeks after having a hip replaced.
But there’s a longer recovery with a knee replacement. Knees are still healing up to 18 months after surgery. People get back to their daily routines two to three times as fast with a hip replacement than with a knee replacement. There’s more rehab involved with a knee, and it’s more intense.
Most people are surprised by the pain associated with a knee replacement. But the payoff is big: After the rehab, your knee pain is gone, and you can get back to doing the things you love to do.
Do people ever get both knees or both hips replaced at the same time?
Rarely. There’s a big surgical stress with both operations, so it’s better to be done in a staged fashion.
These surgeries are done in a hospital and involve an overnight stay, right?
Some are done outpatient, but I’m not doing them. Most people spend one night in the hospital and can go home the next day if they have good social support at home.
Anything else you want to say?
Don’t give in to inactivity and assume weight gain is inevitable during the pandemic. I’ve seen it. You feel trapped in the house, and it’s an excuse to put on 10 or 20 pounds. Take charge of your life. Help yourself. Get out and get moving.