Early or mild arthritis of the knees or hips can generally be managed with exercise, braces or simple over-the-counter medications like Tylenol or anti-inflammatories. Physical therapy exercises, either formal or at home, also can help with maintaining good muscle strength and balance.
As the arthritis progresses, treatment consists of modalities which quiet down the symptoms of pain or stiffness. Injections of corticosteroids like cortisone can be helpful, but the positive effects usually are temporary. Hyaluronic acid injections (also called viscosupplementation) are quite popular, but they don't always give the long-term outcome many patients are looking for. Assistive devices such as canes are useful to take some of the pressure off the affected leg when walking.
When the symptoms of arthritis become more severe, many patients seek medical attention. X-rays may reveal significant narrowing of the spaces in the joints. The white cartilage covering of the bones in the knee or hip joints essentially wears down, almost like brake pads in a car. When the cartilage is fully worn away, the spacing between the joints is gone and the "bone-on-bone" situation occurs.
Options for severe arthritis are more limited. Active, healthy patients may decide with their surgeons that replacing the joint makes sense. Several scenarios may make this decision easier: pain at night that wakes a patient; pain severe enough to prevent activities of walking or exercising; and finally pain that is severe enough that stronger pain medications such as narcotics are contemplated or currently used. Balance issues or lack of motion secondary to arthritis also may play in decision making.
All in all, the decision to perform a knee replacement should be made when:
• The arthritis has reached a severe stage by x-ray and symptoms.
• The non-surgical options fail to work.
• The benefits of the surgery outweighs the risks.
• The health of the patient would allow for a safe surgery and rehabilitation.
Knee and hip replacements are wonderful tools when the situation is right - a good discussion is essential between the surgeon and patient to ensure the best possible outcome.