Treating Knee Arthritis Without Surgery

welcome to talking with Doc's if you haven't seen any of our videos before we have put together a new series of medical videos and we cover a lot of different orthopedic and other medical topics if you're wondering what it's all about you can check out our introduction video I am dr. Paul's Al's ow and I'm dr. Brad weenie and today's episode is concerning with managing knee osteoarthritis without a knee replacement really common problem well yes absolutely and I'm we're not saying don't ever replace your knee but if you are you know not bad enough for a knee replacement or too young to get into your place no just don't want to undergo surgery so employees can take the time off yeah like me yeah me then you these are some things you can do to try and manage your knee arthritis without replacing your knee so with with arthritis we progressively get atrophy of the muscles stiffness of the joints and associated inflammation and these all result in pain and reduced function and the goal of all of our treatments of the knee arthritis and hip arthritis for that matter are to reduce these yeah you might find many similarities to our video on managing hip arthritis without hip replacement here but there are some key differences so how can we go about managing those kind of symptoms so I like to employ a multi-modal approach where we do multiple different kinds of treatments at once yes I as I mentioned before I call that my shotgun approach but patients became nervous when I mentioned that so I use the term multimodal now as well so we try a bunch of treatments at once and this is sort of the trend in pain management what we've learned recently is that you it's difficult to manage pain with just one modality so often pain specialists anesthetists and other physicians that treat pain will use a multi-modal approach and just try different modalities at the same time to try and manage pain so what are some of the multimodal treatments we can just one of the thing Paul I think it's important to remember that all these treatments and even you could argue surgery are incomplete and not necessarily permanent so our goal is to get patients as close as possible to being pain-free but often that is not a realistic goal so pain reduction is our goal to get you back to doing more of your stuff with less pain um yeah so treatments include one of the first things I talk to patients about is activity modification physiotherapy embracing kind of as a group of treatment that are not related to medication I agree yeah activity modification that I mean that can be something that's very obvious like I enjoy jumping off the top of my desk onto a concrete floor five times an hour well stop doing that because that's probably going to hurt your knee my back unimodal piece can be something a lot more subtle perhaps it's you know the way you're riding your stationary bike have you got the seat too low so you're really putting your knee through a major range of motion if you put the seat up higher does that modifying your activity like that does that help your symptoms or it can be something like if exercising if you like to run maybe consider power walking or consider going to an elliptical or some other type of aerobic exercise yeah agreed now activity modification sometimes is challenging for example if in the activity that hurts you it happens to be a major part of your job if you're on your feet all day if you're working in construction or on an assembly line or a surgeon again you you're on your feet a lot and you can't really modify that activity so you're really gonna try and modify activities that are in your control to modify and as a surgeon I appreciate that it's easier for me to say hey if your job really hurts you just change your job I mean that's obviously not practical for a lot of people and certainly if you can change jobs that's worth thinking about but other activity modifications that I think we Paul our weight loss what are your thoughts on weight loss for knee arthritis I think weight loss for New Age certainly has a role it can really really help your knee pain for example I tell people who have an elevated BMI or an elevated body mass index which means they're over over their ideal weight if you walked around carrying a 50-pound weight all day on your knee hurts at the end of the day think how good how good it'll feel when you put down that 50-pound weight so that's in my opinion maybe not in other people's of pain but that's analogous to just losing losing weight and hopefully uni you would feel better or more than likely your knee would go better that's a great analogy I also use like a knapsack analogy you're carrying a knapsack and you can take it off you're gonna feel good yeah particularly going up and down the stairs when you're kneeling we're squatting when you're getting in and out of the car all the things that knee arthritis patients complain about yeah and certainly you know saying lose weight is easy but it's very very challenging to do and and you often need to get help in order to do so if you have the motivation in the means I totally agree employing a team of people if losing weight was easy people would lose weight it's very difficult and the other thing that that patients tell me is well I can't exercise so how much will lose weight my knee hurts ouch I can't exercise it is a bit of a vicious cycle Bentley and I certainly accept that people that have knee arthritis don't burn as many calories but but certainly consumption plays a very large part in weight gain and lack of weight loss yeah so I can appreciate that's difficult but it is something that can really help you so we've talked about acting modification or type of weight loss what about physiotherapy I think physiotherapy is a critical part of New York's rightist treatment like we talked about before when people have arthritic knees and other joints the muscles around that knee get weak so by strengthening them not only stabilize the knee which has been shown to reduce pain but also you can improve the range of motion that will progressively reduce the amount of inflammation reduce your pain and improve your function yes yeah I agree range of motion what I mentioned is important especially if you're going to be thinking about replacing your knee down the road because if you have a poor range of motion before you replace your knee that is the biggest risk factor for having a poor range of motion after you replace your knee so physiotherapy is key and that can really help you maintain your range of motion now like any treatment some treatments were great for some people and they don't brother so yeah don't feel bad if you tried physiotherapy nah didn't work that a lot of that happens a lot of people but you might want to try a different physiotherapist or a different type of physiotherapy treatment the other thing for me about physiotherapy is I think it's critical to do the physiotherapy not just go to the physiotherapy you're going to a therapist that is is is not engaging you in the exercises and maybe teaching you our program so you can change your lifestyle outside and work on a daily basis just having someone massage you or put machines on you is not enough for me yeah that's a good point I've had people say oh yeah I did pick up therapy nicely well how many times did you go I said once yeah well it didn't work yeah I drove by I just like to apply the therapist oh yeah so certainly you've got to give it a good shot and really give it a good try and don't reward yourself with going out afterward that's pretty something deserty hey that that takes us back to weight loss okay No so we talked about a cake modification is your therapy weight loss do you ever prescribe braces well yes that's a good one - so what's the role of a brace for an arthritic knee well how do you approach that so some people say should I wear a brace and what I tell them is is I have two goals of bracing for me one is if people have a sensation of instability not necessarily because their knee is actually unstable because the ligaments aren't working properly but maybe because of pain and - if we can unload the part of their knee that is the main source of their pain right so so when when you sit when you think of a knee brace it ranges from something you buy from the local drug store for $20 and that's like a sleeve you pull on to any custom fitted knee brace that can cost you know anywhere from $1,500 or $2,000 or anywhere around there where it's actually custom fitted to your leg and it's trying to unload the part of your knee that that has the most arthritis they work in different ways and sometimes we don't even know how they work but they still seem to work for some people so in in arts in the knee arthritis the braids the kind of braces that we prescribe most commonly are unloader braces so it's a carbon fiber or some sort of rigid material brace that actually tries to change the alignment of your leg and certainly we have seen success in embracing arthritic knees and people say to me law I have to wear this brace all the time when I tell them no you should wear it as much as you can tolerate and you want to wear it during if you like wearing it during sports reduce your pain at that time but I also tell people if they're gonna wear it during the day often they'll have less pain at the end of the day and they'll be able to walk farther 20 minutes instead of 10 minutes yeah but the bottom line is if you're not willing to wear a brace don't get a brace yeah some people just don't like truth yeah and you know what if you tried one of those pull-on sleeve tight braces or the less expensive braces and you get relief you're not alone a lot of people do get relief with those types of braces as well so we've talked about in we've talked about physiotherapy activity modification bracing medications that's it okay so now you've tried a lot of these less invasive things and another treatment option is actually taking a pill to help manage your arthritic knee what client what class of medications can we so usually the first the first couple types of pills that I talked about are a payment in case still acetaminophen is something that I talked to a lot of patients about I like it because it does have a relatively safe side-effect profile acetaminophen is processed by the liver so if you had liver disease or something that makes you prone to liver disease you would have to be careful and certainly any medication that you ever takes you should talk to your doctor about but that's I think a not unreasonable place to start also because it's cost effective and then the second one would be anti-inflammatories so whether they're steroidal or non-steroidal anti-inflammatories that you're taking by mouth things like ibuprofen aspirin those have been shown to reduce the inflammation around your joints and certainly have significant success in reducing your pain but they do come at a cost all treatments whether it's a brace a pill a needle have pros and cons and for me in my practice Paul I find that as people get older and they're taking more and more pills for other reasons I'm a little more concerned about interactions and they're kind of combined effect I would agree with that and certainly if you're thinking of going on a medication check with your family doctor first to make sure it doesn't interfere with any of your other medications or to make sure you're healthy enough to take a medication for your knee arthritis but yeah I agree there there there are you know risks and concerns with unlike any treatment we've mentioned this before there's risks and there's benefits usually as the risks go up the benefits go up too but it's finding that treatment that works for you or part a multi-modal approach where you've managed minimize your risk and maximize your benefit so every treatment we talk about has risks and benefits now you you mentioned something you said needles you talked about needles a second ago yes I'm afraid of new agree agree but you administer a lot I do I'm not afraid when they're in my hand I'm afraid when they're in my knee but yes injecting someone's knee I think is a very very practical and effective approach for reducing the amount of pain people have from arthritis are there specific things that you inject into people's knees Paul yeah so in me injections for the management of arthritis there's two main classes there's corticosteroids which are powerful anti-inflammatories and there are viscosupplementation injections so these are things like hyaluronic acid you might have heard them referred to as gel injections or visco injections and they are thought to maybe lubricate the knee and how they also actually do are thought to take down a bit of inflammation but those are the two main sort of classes of injections that we use for me arthritis and certainly in my experience I think they are effective I think with all these treatments it's it's important to recognize that the benefit is is often incomplete and not permanent but significant and varying I've had a wide experience some people get weeks of relief some people get years and everything in between I agree yeah and like we said some treatments work for some people and they don't further so don't feel bad if you tried something it didn't work for you or if you tried something worked for you and it didn't work for your friend when people ask you what the risks of injections are Paul what you tell them well there are there are risks whenever now we're getting a little more invasive that then putting a brace on but it risks with even braces so the risks of injections usually there's a theoretical risk so you can get an infection whenever you reach the skin you could get an infection into the knee and that's called a septic arthritis and that that needs a surgical treatment and with anytime you inject something into a knee there's a risk of an adverse reaction or a swelling and some pain that evening or it could even last a few days yeah and that's usually not that's not as severe as a septic arthritis but it it is still quite bothersome buddy it does usually settle on its own and Paul you'd say septic arthritis after a needle injection is very very uncommon I've I don't know if maybe I've seen that once happen but I have heard of it happening but it's it's very rare but it you should be aware that it can happen absolutely yeah so you mentioned the infection you mentioned the local reaction this can be done in an office setting sometimes is augmented with an ultrasound or some other type of device I know just on a side note a lot of people ask me when I'm injecting they they say why are you injecting there and what I tell them is that your knee is surrounded almost by a by a bag that goes all around it called your synovial lining so I tell them it's like injecting a balloon so whether I inject on the inside of the outside of the top or the bottom it doesn't really matter as long as I'm inside of that bag and then the medication could go all around the knee to work yeah and and relatively speaking to inject into the knee is relatively easy if you've done it a lot of times don't try it at home don't do it to yourself I dare myself but I'm saying compared to like a hip injection which is which you need some sort of imaging or some sort of image guidance to get the injection into the hip it's not the case with the knee it's relatively easy to get the needle into the knee yeah it's close to the skin yeah so speaking of skin and reaching it to get into the knee what about topical treatments or a treatment that you apply it outside the area of pain I think topical agents and creams I think are a great idea they're very very common they're available both by prescription and non-prescription one of the things I like about them the best is that the amount of whatever medication or effective agent is inside the topical is typically absorbed at a very very low rate systemically so the risk is very low and I tell you if you can rub something on your knee that reduces your pain and doesn't cause any other problems I think that's definitely worth something so definitely they play a role what about magnet have you had patients come in and say oh I have magnets laser a blue light acupuncture yeah yeah lots of other thing you name it people have tried it and saw in three out of ten of those people it's gonna work what do you tell people in between something that in your mind there's not a lot of scientific evidence for like say a magnet so I work hard to not be judgey so with a smile on my face I would very honestly look them in the face and say as long as it doesn't hurt you I don't care and as long as it doesn't hurt you financially in a way that you can't before someone's not taking advantage you then I really don't have a problem with it but I'll say that I am not aware of any scientific evidence of that I agree I mean I've the same serve approach maybe a little different I mean I tell people that if if it works for you then go for it yeah if you've tried something and there may not be a ton of science supporting it then go for it and you know and it might work for you there's can we tell them about the placebo factor should people not know about that I think three of the ten people know about it I mean there's a placebo effect to any treatment right so a placebo effect is basically a perceived relief that you're getting that may not that may not be coming from the treatment itself yeah and no it's very real and it's very significant in some cases so you know if you're getting relief if I'm getting a pie of nitration I'm getting relief I don't care if it's a placebo effect if I feel better I'll take it who cares I totally agree with you okay so we went a little off topic there but yeah I think so and it's same with foods because some people talk IPAs become and swear that that tumeric or cumin you're the whole wide variety of yeah oral supplements potentially can change the way that their knee feels and again scientific evidence Barry's right across the board for commercial and non-commercial products so just proceed with caution beware there's someone selling you something there there there's other motivations but it hurts you if it helps your knee and other in other ways there are some food-related are our three entities that you know are real like gout certainly there's certain foods that will precipitate a Goudy inflammatory arthritis so definitely food food does play a role and agree with that so we talked about anti-inflammatories physiotherapy activity modification injections a lot of other you know less conventional multimodal things topical treatments with again the goal being just to get you older and kind of worse off for your knee replacement it's not because orthopedic surgeons are sadist I tell my patients because the worse you are before surgery the higher the chances you're going to be happy after surgery so we have to balance your suffering with getting you ready for surgery I would agree with that yeah definitely I refer to our knee replacement video for more information but you don't want to rush into new your place so not everybody loves their total knee replacement that's right I'll leave that for the other video

Channel: Talking With Docs

Views: 1,127,147

Keywords: Arthritis, surgery, treatment options, Talking with Docs, Doctors, Medical Care, Knee, Information, Helping you

Id: mL28XdniyyA

Length: 18min 19sec (1099 seconds)

Published: Fri Jun 10 2016