Non-operative Treatments for Hip and Knee
Hip and knee joints are the common weight-bearing joints and are also the most commonly affected joints by disease conditions such as arthritis, traumatic injuries or sports injuries. These conditions may affect the joints and impair the mobility as well the quality of life of the patients. All these conditions require appropriate treatment, may be surgical or non-surgical to restore the normal activities. The Non-operative care for the hip and knee includes the use of both non-pharmacological and pharmacological interventions. They are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to certain condition or to decrease pain as well promoting functioning and quality of life after the surgical treatment.
Non-pharmacological interventions may range from simple lifestyle modification or the physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:
- Weight reduction and physical exercise – The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of the hip and knee conditions.
The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered over weight and BMI over 30 is considered as obese.
Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore rigorous exercises is not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.
It should not be used by patients having pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
- Thermotherapy – Thermotherapy involves application of hot or cold packs at the affected area. There is some evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.
- Massage therapy – It is one of the oldest methods of treatment and reduces pain by increasing the circulation of blood and lymph as well by reduction of muscle tension or because of the therapeutic effect of the touch.
Pharmacological interventions include management of pain using medicinal preparations such as pain relieving capsules or injections.
- Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the hip and the knee. Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with kidney diseases must have extreme care while using them. They cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
- Weak and strong opioids – Opioids are prescribed when use of analgesic medications or NSAIDs does not offer symptomatic pain relief, if other treatments have intolerable side effects or in whom the surgery is delayed or contraindicated. Though they offer better pain relief they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise cause withdrawal effects. They are also known for addiction.
- Intra-articular corticosteroid injection – These injections should be given using appropriate imaging technique and only by an appropriately trained and experienced clinician. Corticosteroids are injected into the joints to offer pain relief however they are not approved for use more than 3 or 4 times a year because of risk of cartilage damage.
- Viscosupplementation – Viscosupplementation is the treatment modality where hyaluronic acid or hylan derivatives are administered by intra-articular injection in the knee or hip. It improves mobility and reduces pain. Hyaluronic acid is naturally present in the joints and gives elasticity and lubrication of synovial and cartilage in the joints. It is not found to be very effective in hip problems.
- Glucosamine hydrochloride and glucosamine sulphate – Preparations containing these compounds are available as dietary supplements. It should not be taken by patients with shellfish allergy as these compounds contain shellfish extract. Improvement is seen with minimum one month of treatment with these products. However these are associated with certain side effects such as gastrointestinal problems, drowsiness, headache, and skin reactions.
- Other treatments – Your physician may recommend the use of braces and orthoses .
Though there is little scientific evidence for various non-operative techniques in offering symptomatic pain relief they were found to be effective in certain cases and are considered to possess minimal side effects. Discuss with your physician about these therapeutic options before initiating the treatment.
Can Stem Cell Therapy Help My Joint Pain?
Osteoarthritis is a chronic disease that may impact multiple joints with varying degrees of severity. It impacts over 25 million people with nearly $90 billion spent annually for treatment in the United States.
Modern medicine offers the ability to treat the associated symptoms of osteoarthritis – like pain and stiffness – without impacting the progression of the underlying disease. Recently, there has been an increase in the number of “injection centers” around the country offering alternative injections including viscosupplementation, platelet-rich protein (PRP) and stem cell therapy.
While it often sounds appealing, stem cell therapy is a new treatment that is poorly understood. There are many websites and advertisements for “curing” osteoarthritis; however, there are no proven uses of pain medications or therapies that can delay or reverse the progressive joint destruction that occurs with osteoarthritis. These are temporary fixes.