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Causes of Joint Pain


Why joints hurt and what you can do about it

If you are experiencing joint pain it is important for you to discuss this with your doctor. A careful history and physical examination including X-rays of the affected joints are the main ways your doctor can help you make an accurate diagnosis. If the cause of your pain stems from osteoarthritis, treatment will be based on how far the disease has progressed and how bad and how long your joints have been hurting. It's important to understand that not all hip and knee pain is osteoarthritis and there are other diagnoses and treatment options depending on the underlying cause of your pain. Below you’ll find additional information and frequently asked questions to assist you on the path to a pain-free lifestyle:

Is it possible to alleviate hip and knee pain without surgery?

If your doctor is not recommending surgery for your hip or knee joints, there are other ways to alleviate pain and improve mobility:

Medications

Pain relievers are usually the first choice of therapy for osteoarthritis of the hip and knee. Simple pain relievers, such as acetaminophen (Tylenol), are available without a prescription and can be effective in reducing pain. Non-steroidal, anti-inflammatory medications include other over-the-counter medications such as aspirin, ibuprofen (Motrin or Advil), or naproxen (Aleve) to help reduce pain and swelling in the joint. More potent types of pain relievers are prescription-strength, non-steroidal, anti-inflammatory drugs (NSAIDs) that can be prescribed by your doctor.

Injections

Cortisone injections can provide you with pain relief and reduce inflammation. They can be very useful if there is significant swelling but are not very helpful if arthritis affects the movement of your joint. How long the injection works before it wears off is variable, and there is a limit to how many your doctor can give you per year.

Viscosupplementation is a treatment in which hyaluronic acid (HA) is injected into the joint. It can help joints to work properly by acting like a lubricant. There are several different types that your doctor will give in various treatment regimes. Due to anatomy around the hip joint, injections into the hip are more complicated and therefore less frequently prescribed. Examples of such medications include Synvisc, Orthovisc, Supartz, and Hyalgan.

Weight Loss

Many people with osteoarthritis are overweight. Simple weight loss can reduce stress on your weight-bearing joints, such as the hip or knee. Based on the physics of the hip and knee joints, you put three to five times your body weight on these joints throughout the day — especially during stair climbing and getting in and out of a chair.

Every ten pounds of extra weight that you carry can result in fifty pounds of weight-bearing pressure across your hips and knees. Losing weight can result in reduced pain and increased function, particularly in walking.

Exercise

An exercise routine can help increase your range of motion and flexibility as well as help strengthen the muscles in your legs. Exercise is often effective in reducing pain and improving function. Unfortunately, in the setting of advanced arthritis (bone-on-bone), exercise can sometimes increase pain in your hip and knee joints. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Braces and Splints

Braces may be especially helpful in knee arthritis if the arthritis is centered on one side or the other. A brace can assist with stability and function. Braces are not for everyone and they can be difficult to fit for certain people.

Physical Therapy

Physical therapy to strengthen the muscles around your joint may help absorb some of the shock imparted to the joint. Physical therapy can help to reduce the pain, swelling, and stiffness of osteoarthritis, and it can help improve joint function. It can also make it easier for you to walk, bend, kneel, squat, and sit.

Alternative Therapies

Examples of alternative therapies include the use of acupuncture and magnetic pulse therapy. Acupuncture uses fine needles to stimulate specific body areas to relieve pain or temporarily numb an area. It is used in many parts of the world, and evidence suggests that it can help ease the pain of arthritis. Magnetic pulse therapy is painless and works by applying a pulsed signal to the knee, which is placed in an electromagnetic field. Data on this is somewhat inconclusive.

Is a short-stay hip or knee replacement right for me?

Outpatient total joint arthroplasty (TJA) is now being performed in select centers on select patients who are healthy enough to be candidates for this pathway. These surgeries can be done at an ambulatory surgery center or an inpatient hospital. Orthopedic surgeons agree that outpatient TJA should only be done on patients who are healthy enough to have surgery in such setting and have the appropriate home setting/support to allow them to be discharged in this manner. This concept is new, and orthopedic surgeons are still clarifying how to maximize the benefits of this idea for patients. Here are a few considerations to keep in mind before making your decision:

Know your health care team

The entire health care team for an outpatient TJA must be adept at managing this type of surgical pathway. Your primary care provider will need to agree that you are medically able to tolerate the surgery. The orthopedic surgeon then must deem that you are a candidate for outpatient TJA and feel comfortable doing the surgery in this manner. The anesthesiologists should be skilled at multimodal pain management techniques to ensure your safety, pain management and quick recovery. The nursing team must be skilled at preoperative education, operating room workflow, rapid recovery, and be able to assess your readiness for discharge. Your family or friends must also be educated about what to expect at home and about recognizing potential postoperative complications.

Advantages and disadvantages

The advantages of outpatient TJA include a reduced hospital stay, a possible reduced chance for hospital-acquired infections, and the possibility of increased patient satisfaction. There is also the potential for reduced cost to the health care system. The disadvantages of the outpatient TJA include the chance of having a complication at home, having difficulty with pain management, and the chance for readmission to the hospital. Orthopedic surgeons agree that outpatient TJA is not for everyone, and actual peer-reviewed reports on the success of this approach are available and usually have demonstrated positive results.

Will my artificial joint set off airport security metal detectors?

Belt buckles, key chains, and smartphones may set off sensitive metal detectors at airport security checkpoints. Many commonly used orthopedic implants may also set off the metal detectors. Over 90% of implanted total hip arthroplasty (THA) and total knee arthroplasty (TKA) devices will set off airport metal detectors. Many THA and TKA implants now include ceramic and plastic materials in addition to metal, and the metal will still likely cause an alarm. A card from your physician is no longer needed for identification of these type of implants.

If you or a family member has a metal implant, he or she should inform a Transportation Security Officer before screening begins. Passengers can use TSA's notification card to communicate discreetly with security officers; however, showing this card or other medical documentation will not exempt a passenger from additional screening.

Many patients now prefer to be screened by imaging technology (X-ray) to reduce the likelihood of a pat-down being necessary. If a pat-down is selected by the TSA, it will be helpful to wear clothes that allow you to easily reveal your surgical scar.

The TSA offers more information on metal implants and the TSA notification card on their website.

If you have additional questions about joint pain or would like more information about treatment options please contact our office at 972-403-2843.