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DEAR MAYO CLINIC: I am 50 years old and live an active lifestyle. Recently, I started having more aches and pains, especially in my knees and hips. I wonder if I have arthritis. What are my treatment options?
ANSWER: Osteoarthritis, also known as mechanical arthritis or "wear-and-tear" arthritis, is the most common joint disorder in the U.S. This condition occurs when the protective cartilage lining the joints is lost, resulting in pain and impaired function. An estimated 20%-30% of adults older than 45 have evidence of hip or knee osteoarthritis on X-rays.
As a first step, it is important to establish a diagnosis for hip and knee pain. Through an appointment with primary care, or with a specialist such as an orthopedic surgeon, your doctor can perform a careful history, physical examination and obtain X-rays to confirm if you have osteoarthritis. This needs to be differentiated from other potential sources of hip and knee pain, such as referred pain from the back; soft tissue pain, like tendinitis or bursitis; and other joint pathologies, including osteonecrosis or inflammatory arthritis, such as rheumatoid arthritis. Once your health care professional diagnoses osteoarthritis and confirms the degree of severity, you and your health care team can discuss an appropriate treatment plan.
Generally, it is best to treat painful osteoarthritis with the most conservative and least invasive measures first, and then escalate as necessary to achieve tolerable pain and function. A three-tier framework can be helpful to understand the treatment ladder orthopedic surgeons use to manage osteoarthritis
The American Academy of Orthopaedic Surgeons publishes clinical practice guidelines for hip and knee osteoarthritis, as well as many other conditions.
Many other conservative measures can be discussed and tried, but strong evidence of patient benefit has not been achieved. Narcotics should not be used for hip and knee osteoarthritis. While narcotics or opioids are helpful for some medical conditions, including managing pain after hip or knee surgery, they are inappropriate to use for osteoarthritis.
Injections are the second rung in the treatment ladder and may be considered when conservative measures fail.
The final option for treating hip and knee osteoarthritis is joint replacement surgery. These are the most common elective surgeries in the U.S. Although they are major procedures with risks to consider, they are also remarkably effective for most patients deemed candidates by their surgeon. Hip replacement and knee replacement are routinely rated as the first and second among all surgeries in medicine in a metric of health improvement known as quality added life years.
Not every patient is a candidate for hip or knee replacement, however. While joint replacement is effective for most patients, complications can occur. You should discuss risks with your surgeon to ensure an informed decision for surgery.
Also, patients need to be cleared for surgery based on lifestyle factors and health risks. For instance, many institutions have a cutoff for a body mass index of less than 40. Patients with diabetes need to demonstrate reasonable control with blood testing. If you are on immunosuppression or blood thinner medications, your surgeon and the doctor prescribing these medications will formulate a management plan.
If surgery is warranted, it is important to remember that recovery takes time.
Hip and knee osteoarthritis can be extremely debilitating, but fortunately, there are many treatment options. Seek out a certified and skilled orthopedic specialist to confirm your diagnosis and develop the best treatment plan. Health care organizations that offer collaborative care can assist you in all elements of therapy, whether that includes medication therapy, weight loss, exercise or surgery. — Dr. Cody Wyles, Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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