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Alternatives to Surgery for Osteoarthritis
February 15, 2005
By: Steve Siwy for Knee1
With advances coming seemingly every day, it’s no wonder that so much attention is paid to the new and better ways doctors have developed to perform successful knee surgeries on patients suffering from osteoarthritis. The fact is, though, that only one in four people with osteoarthritis of the knee will require surgery, according to the American Academy of Orthopaedic Surgeons (AAOS). Most patients end up being able to manage their arthritis with one of a variety of non-surgical, “conservative” treatments, without having to resort to surgery.
For instance, a doctor may recommend modifications in health or behavior. Movements that exacerbate the trauma to the joint should be avoided, and proper amounts of exercise and rest pursued. A physical therapy program designed to accommodate the patient’s lifestyle and the ways in which her osteoarthritis has manifested might be prescribed. If the patient is overweight or obese, as many who suffer from osteoarthritis are, the doctor will recommend a program of weight loss to reduce stress on the joint.
If drugs are called for, usually the first choice will be simple analgesics to dull the pain, like acetaminophen, according to the AAOS. Other drugs, called nonsteroidal anti-inflammatory drugs or NSAIDs (like naproxen or ibuprophen), work by stopping the inflammation that causes the pain, and may be recommended by a doctor as a more potent solution. If knee pain is moderate to severe, NSAIDs called cox-2 inhibitors may be prescribed. These stop pain and inflammation with fewer gastrointestinal side-effects than other NSAIDs, though they have other side-effects that a doctor will take into account if prescribing them (the recently recalled Vioxx is a cox-2 inhibitor). The AAOS takes care to note that all drugs, including pain relievers and anti-inflammatory drugs, have side effects that should be considered when planning treatment.
Taking supplements of Glucosamine and chondroitin sulfate, which are large molecules found in the cartilage, can also help with pain and inflammation in the joints. According to the AAOS, two months of continuous use of the supplements is usually necessary for them to be fully effective. As with pain relievers, the AAOS notes that these supplements, though sold over the counter, have side effects and can interact with other medications, so as always, one’s doctor should be consulted if they are to be used.
Another way doctors have to bring down a patient’s swelling is by injecting corticosteroids into the knee. This is a short-term measure, however, and according to the National Institutes of Health (NIH) should not be performed more than two or three times a year.
A procedure known as viscosupplementation is also sometimes used on patients with knee osteoarthritis. Hyaluronic acid, a substance found in the knee, is injected to help lubricate the joint. The pain relief from viscosupplementation is not permanent, advises the AAOS, but it can last for weeks or months.
Alternative methods may be recommended, as well. Acupuncture has been shown to help relieve the pain of osteoarthritis. If the patient turns out to be one of the 25 percent for whom none of the above treatments prove unsatisfactory, surgery, including total knee replacement, may then be deemed appropriate as a last resort. For the remaining majority, however, a plan of conservative treatments arrived at with the guidance of one’s physician will be enough to alleviate, and even relieve the symptoms of osteoarthritis.
1. Physical Therapy
2. Weight Loss
3. Medications or Supplements
4. Alternative Treatments including Acupuncture
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