When Medication and PT Aren’t Enough
July 18, 2023

When Medication and PT Aren’t Enough

Texas Health Center for Diagnostics and Surgery

Learn the crucial difference between minor aches and severe pain that requires medical attention. Dr. Donald Hohman, a joint replacement specialist, explains the stages of joint pain and how to discern when treatments like therapy, injections, or even joint replacement surgery become necessary.

Categories:   Hip Pain Joint Pain Joint replacement Knee Pain

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When should I see a doctor for joint pain?

Imagine that you can’t run, walk or even stand without experiencing pain in your knees. Maybe your hips hurt so bad it takes everything within you to get out of bed in the morning. Millions of Americans are living with joint pain due to arthritis or injury. If you’re one of them, it doesn’t mean you have to sit out life on the sidelines. Know that treatment options are available.

Everyone experiences aches and pains from time to time, especially as we age. Many of those aches and pains will resolve on their own. Mild soreness after a bout of vigorous exercise, for example, can usually be managed at home with over-the-counter medications. But joint pain that is sudden, or joint pain that is new or worsening, may need medical attention.

It’s not always easy to tell the difference between a minor ache or pain and more severe pain that requires treatment. If you’re not sure when you should you see a doctor for joint pain, here are some tips. In general, it’s a good idea to make an appointment with your doctor if experience worsening joint pain, joint pain for more than a few days, or three or more episodes of joint symptoms that occur within a month. Your physician can guide you on the best treatment options for joint pain.


What’s the difference between joint pain caused by injury and arthritis?

Donald Hohman, M.D., a joint replacement specialist on the medical staff at Texas Health Center for Diagnostics and Surgery, said he sees patients whose joint pain is caused by injury or overuse, as well as those whose pain is related to arthritis. In general, patients fall into one of four basic stages of joint pain, from those with occasional flare-ups to those needing total joint replacement surgery.

“Most commonly we see people in their 40s or 50s who are experiencing pain, usually due to strenuous exercise like CrossFit,” Hohman said. “They might have some pain and swelling but can generally get back to normal by modifying their activities, taking over-the-counter pain relievers and resting.

“The next group is made up of those with more wear and tear on their X-rays, who experience pain on and off. Something might flare up or they might have a torn meniscus that just gets worse. Generally, we direct them to pain relievers and physical therapy, which helps keep the muscles strong around the knee.”


What are the treatment options for prolonged joint pain?

In addition to the weekend warriors, Hohman said the third category of patients experiences more severe arthritis and significant pain, but a combination of therapy, braces and injections can usually get them through their discomfort.

“Sometimes the pain gets so bad it wakes them up at night and it may be unbearable when their knees touch together or they make any twisting motion,” he said. “These people have more impressive arthritis on their X-rays and are beyond just physical therapy, so we try injections, either steroid injections with numbing medication or lubricating-like injections that act like putting grease in the gears."

The final category of patients that Hohman and his colleagues see includes those who need partial or total replacement surgery due to pain that has become unbearable.

“These are the people who have tried everything and say they just can’t live like this anymore,” Hohman said. “When joints start to wear out, there just aren’t a lot of good options. We see both young and older people with severe rheumatoid arthritis or psoriatic arthritis, which can cause horrific knee problems. The medications for these autoimmune diseases are improving, but surgery is still often necessary.”

According to the American Academy of Orthopaedic Surgeons, close to 1 million Americans received total joint replacements in 2011. And while hip and knee replacements are the most common, other joints such as the wrist, elbow, shoulder and ankle can be replaced as well.

Joint replacement surgery involves removing the damaged cartilage and bone before replacing them with metal, plastic or ceramic prosthetic components, which replicate a healthy joint. And while a large majority of patients who undergo joint replacement report a significant improvement, maintaining realistic expectations is important.

“It’s challenging to see a person in their 40s or 50s who is really active and the replacement doesn’t work the way they want it to because they aren’t designed for high performance,” Hohman explains. “I recently saw an avid weightlifter who had someone else do his knee replacement but he’s not happy because it’s not allowing him to do the things he did before.”

“I try to be honest with people so they can make an informed decision with the right expectations. Knee replacement is a pain-relieving operation, but it’s good for walking around the grocery store, not for climbing Mt. Everest.”


What would make someone a good candidate for joint replacement surgery?

Typically, surgery is recommended only after more conservative treatments – such as medications, injections or physical therapy – have failed to provide lasting relief.

Joint replacement surgery is usually recommended for patients who have:

• Conditions such as osteoarthritis and rheumatoid arthritis of the joints.

• Severe joint pain that limits daily activities such as walking, getting up from a chair, or climbing stairs.

• Moderate-to-severe pain that occurs during rest or awakens the patient at night.

• Chronic joint inflammation and swelling that is not relieved with rest or medications.

• Weakness and/or loss of joint motion.

• Severe joint fracture or trauma.

The most important thing for patients to understand before moving forward with joint replacement surgery is that while the surgery will relieve their pain, their bodies won’t feel or perform the same as before.

“These replacements are mechanical parts, so you’re not going to get the same feedback,” Hohman said. “You lose ligaments in surgery and since they’re no longer communicating to your brain, the joint isn’t going to work the same as it did when you were younger. If we can do a partial knee replacement and keep all of the ligaments inside the knee, it gives more stability and better maintains that ‘normal’ feeling because you have more of your own parts.”

Hohman said patients should be in the best physical and mental shape possible before heading into surgery to limit potential complications, such as blood clots and infections, and to limit extended recovery periods. Overweight patients should try to reach a body mass index of less than 40, and those with diabetes should aim to control their blood sugar levels for at least six months. Finally, patients should ask their doctors any questions about potential limitations and not expect more than the surgery can reasonably deliver.

“Sometimes we can help people get relief with braces, injections or physical therapy and that’s what we want,” he said. “I never want to perform surgery unless we have to, so we try to bridge the gaps in other ways if possible. When the pain gets too bad though, we’ll be ready to do surgery to improve their quality of life.”


Are there any minimally invasive options for joint replacement I should consider?

For those patients who do require surgery, many minimally invasive surgical options are available. For example, Texas Health Center for Diagnostics and Surgery offers the Mako robotic-assisted total knee replacement system. By selectively pinpointing the portion of the patient’s knee damaged by osteoarthritis, the surgeon can resurface the knee while sparing the surrounding tissue.

Both Mako robotic surgery and conventional joint replacement follow the same basic approach, but the Mako system gives the surgeon a more detailed view of the joint before and during surgery, enabling more control and consistency. By using a computed tomography (CT) scan, the surgeon can map the placement of the implant precisely. The CT scan creates a 3D virtual model of each patient’s knee’s unique anatomy, creating an image of the shape and motion of the knee. This detailed view enables the surgeon to create a surgery plan that may be adjusted, if necessary, during the surgery. The model also helps the surgeon visualize the joint in motion for the optimal placement of the implant. When the surgeon prepares the bone for the implant, the robotic arm guides the surgeon within the predefined area, allowing for a more accurate and better-aligned knee replacement.



How do you know if joint pain is inflammatory?

Inflammatory arthritis includes a group of arthritis accompanied by joint pain, swelling, warmth, tenderness in the joints, and morning stiffness that lasts for an hour. Some types of arthritis require prompt action because they can cause permanent joint damage. Getting treatment quickly can help preserve joint function and prevent other serious health problems.

How do you know if joint pain is arthritis?

Watch for these potential signs and symptoms of arthritis: Pain, swelling, or stiffness in one or more joints. Joints that are red or warm to the touch. Joint tenderness or stiffness. Difficulty moving a joint or doing daily activities. Other signs that may suggest the presence of arthritis but which may not directly affect the joints include fatigue; itchy, dry or flaky skin; changes in the fingernails and/or toenails; rashes; weight loss; hair loss. Discuss any symptoms that cause you concern with your doctor.


If you’re struggling with joint pain, contact Texas Health Center for Diagnostics and Surgery to find a physician who can help. Visit this page for more information on why your joints hurt, and what you can do about it. Click here for more information about joint replacement surgery at THCDS and here to learn more about robotic knee replacement.