Arthritis Pain – Do I Need Surgery?

Osteoarthritis, or degenerative joint disease, is a very common ailment affecting many Americans.  As our population ages, especially our baby-boomers, the number of people seeking treatment for their arthritic pain will be on the rise.  While the increase in the number of joint replacements projected over the next few decades is a hot topic in media these days, not all patients need surgery, nor should all patients have surgery.  Treatment is a continuum, much as the disease process itself.

Osteoarthritis is essentially the wearing out of the cartilage at the end of bones in joints.  With time, activity, trauma, or injury, the cartilage gradually thins out, cracks, crumbles and erodes.  I often compare this process to a newly paved road.  At first, your car travels over the road smoothly.  Then with time, cracks and potholes start developing.  Your tires may start catching on these defects, much like arthritis.  As the road continues to crumble, the drive becomes bumpier and rougher.  Similarly, in arthritis, you start having more pain and stiffness.

Since your body cannot regenerative new cartilage, it often tries to maintain stability by growing extra bone called osteophytes, or bone spurs.  These spurs can limit your range of motion.   Some people develop excess swelling, called effusions, in the joints.  Others do not.

Initial treatment is non-operative.  Surgery is reserved for those with advanced arthritis who have failed non-operative treatment.  Initial treatments include activity modification, stretching, strengthening, and exercising.  Some patients benefit from formal physical therapy.  A well-exercised, strong joint is often less painful and more functional.

Another first line treatment is over-the-counter medications like acetaminophen, glucosamine, topical analgesics, fish oil, and non-steroidal anti-inflammatory drugs (NSAIDs).  Some of these medications like ibuprofen and naproxen should be taken with caution due to potential side effects.  Your physician may prescribe narcotic pain medicines in certain cases.

Braces, increased cushioning in shoes, and assistive devices like canes and walkers are other treatment options that may benefit select patients.

Injections are a more invasive treatment option that many patients will pursue prior to a surgery. Steroid injections and viscosupplementation injections of hyaluronic acid have varying benefits, but minimal risks.

If you continue to have pain despite these non-operative treatments, you may be a surgical candidate.  Find an orthopedic surgeon to help you navigate your treatment options, whether surgical or non-operative.

Written by Dr. Sean Brimacombe


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