Why Surgery Isn't Always the First Choice for Knee or Hip Pain

If you're feeling pain in your knee or hips, you may be putting off a trip to the doctor for fear that you'll have to have joint replacement surgery. But fear not.

Only about one of every five patients with arthritis of the knee or hip are treated with surgery, says orthopedic surgeon William Petersilge, MD.

Depending on the extent of your pain and the impact on your daily function, you're most likely to be treated with oral pain medications, then with injections, before surgical options are considered, Dr. Petersilge says.

How Joint Pain Happens

Arthritis is a broad term that includes a variety of painful conditions that may be treated with a replacement joint, Dr. Petersilge says. Osteoarthritis is a condition caused by the breakdown of joint cartilage and underlying bone in a joint. The breakdown can take years with no or little pain. But once the cartilage wears through, the pain can be sudden and severe.

“The cartilage covering doesn’t have nerves, so as the knee starts to wear a person doesn’t feel pain symptoms,” he says. “As the cartilage wears through, the bones, which do have nerves, can rub together and cause intense pain.”

Initially, an orthopedic surgeon may suggest exercises to strengthen the joint, weight loss, when appropriate, to reduce the load on a patient’s joints, and prescribe medication or other pain relief methods.

“Subsequent treatment could include injecting medications, such as corticosteroids, into the joint to reduce pain and swelling or, alternatively, using a series of lubricant or gel injections to increase lubrication and reduce pain,” Dr. Petersilge says. “Patients who are not adequately responding to that second tier of management may be candidates to consider surgical treatment.”

Injections are typically done three to four times a year, and if successful, may be used to control symptoms for several years.

“Unfortunately, it's not a cure, but rather a way to manage pain,” he says. “Eventually as the arthritis gets worse, these treatments become less effective.”

When Joint Replacement Surgery Make Sense

Surgical options for people older than age 65 usually involve joint replacements, since their condition is more likely to result from osteoarthritis. Younger patients, he says, may suffer from a variety of other conditions that can be managed without replacing a joint.

However, Dr. Petersilge says, younger patients are opting for artificial joints with increasing frequency.

“One reason is that the life span of the replacement joints has improved so much since we started to use them,” he says. “Thirty years ago, they were expected to last eight to 10 years, so replacing a joint in somebody at age 50 made no sense at all, because they would be back multiple times. They are now lasting 25 to 30 years, so it is more reasonable to consider.”

Dr. Petersilge says maintaining an appropriate weight and doing plenty of exercise during one’s younger years can help to reduce the risks of developing knee or hip arthritis.

“If you keep your muscles strong, you have a better chance to prevent joint injuries,” he says.

William Petersilge, MD, is an orthopedic surgeon and division chief of orthopedic surgery at University Hospitals Ahuja Medical Center. You can request an appointment with Dr. Petersilge or any other University Hospitals doctor online.

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