Many options for dealing with painful joints

Getting older can be a pain - literally.

Many people develop arthritic pain in their knees, hips or other joints as they get older. But local experts say there are lots of things you can do to alleviate pain and be more active.

The key is to talk to your regular doctor about your joints on an ongoing basis if you're feeling pain, stiffness or a loss of motion.

“Just like reporting any of their other problems at their annual visit, they should be reporting those to their doctor,” says Dr. John Callaghan, the Lawrence & Marilyn Dorr Chair in Hip Reconstruction and Research and a professor of orthopaedics and rehabilitation and biomedical engineering at the University of Iowa.

And don't assume that joint replacement surgery is the only treatment available.

“We can counsel about conservative, non-surgical things they can do to benefit their joint,” says Dr. Christopher Scott, an orthopedic surgeon at Steindler Orthopedic Clinic and Mercy Iowa City.

A LOOK INSIDE AN ARTHRITIC JOINT

Most joint problems are caused by osteoarthritis, which is the wearing away of the cartilage within a joint, or post-traumatic arthritis that follows an old injury.

Your primary care physician and an orthopedic specialist can help you determine the extent of your arthritis. For many people, the goal will be to live with a mildly arthritic joint and postpone surgery as long as possible.

FIRST LINE OF ATTACK: WEIGHT CONTROL

In dealing with an arthritic joint, “the first thing we usually talk about is weight control,” says Dr. Scott. “That's a huge issue because so many people are overweight and losing weight can make a good difference to the symptoms they have.”

Doctors say that with each step you take, your knee and hip joints withstand five to six times your body weight in compression force. That means that for every single pound you're able to lose, you will take five to six pounds of pressure off your joints.

Both doctors realize that it can seem even harder to lose weight if you are already dealing with a painful joint, but they strongly encourage their patients to not use that as an excuse, and to really try to lose weight. “There's some great data on weight reduction being very independent of activity level,” Dr. Callaghan says.

SECOND LINE OF ATTACK: ACTIVITY

“A lot of people have the idea that they should rest (a sore joint) so that they don't wear it out, that's the absolute wrong thing to do,” Dr. Scott says. “We want to keep people active and moving so that they will be able to keep their muscles strong, keep their weight under control and keep their joint limber.”

Consider working with a physical therapist, even for a short time, to learn stretching and strengthening exercises that can help a painful joint. These exercises can do a great deal to alleviate pain and help a joint function more normally. For example, if you're experiencing knee problems, stretching your quadriceps, calves and hamstrings can be very beneficial.

OTHER NON-SURGICAL TREATMENTS

Physical therapists also can provide a variety of non-surgical treatments. Ultrasound can be used to carry heat deep within the muscle of a painful joint. Iontophoresis treatment uses an electrical current to drive cortisone into the tissue. Electrical stimulation to the affected area is another technique that can bring relief.

Your doctor or orthopedic specialist can perform an injection, putting medicine deep into the affected joint. “In the knee joint, the two main medications we use would be a steroid- or cortisone-type medication to reduce pain and swelling,” Dr. Scott says. He also mentions viscous supplementation or lubricating-type shots that some patients find very beneficial.

PAIN MEDICATIONS AND SUPPLEMENTS

Doctors can recommend several types of medication for pain relief, including acetaminophen (Tylenol), anti-inflammatory medications like ibuprofen (Advil) and naproxen (Aleve), or other analgesics or corticosteroids.

When asked about supplements, Dr. Scott says, “Glucosamine, chondroitin and fish oil are not showing as much promise as they had in earlier studies.” He adds, “I certainly have patients who feel that they're beneficial and there's a lot of anecdotal evidence that they can be beneficial.”

UNDERSTAND THE RISKS OF SURGERY

Knee and hip replacements have come a long way, but that doesn't mean surgery doesn't carry some level of risk.

“If a patient talks to a doctor (about joint replacement surgery) and they don't hear what can go wrong, they should probably find another physician,” Dr. Scott advises. “While, in general, people have very good results, complications can occur and you should be aware of what you're getting into.”

Although rare, it is possible that the components can loosen or wear out. Patients also can suffer nerve damage or get an infection within the artificial joint, which, if serious enough, can require more surgery.

Patients also need to understand that joint replacement surgery doesn't guarantee a complete relief of pain or return of function. Dr. Scott explains, “Joint replacement is perceived like changing a tire. Instead, you need to understand it's more like tire retreading; the bone that's worn-out is resurfaced.”

Even with the risks, there is no denying that joint replacement surgery has improved the day-to-day lives of millions of Americans.

“It's incredible how many people with end-stage hip and knee arthritis have been really given new lives, as far as decreasing pain and increasing function, and how long-lasting that relief has been,” Dr. Callaghan says.

This article originally appeared in the “Getting Older? Get Healthy” special section in The Gazette on Oct. 20.