Joint Replacement Archive

Physical therapy may be an effective alternative to surgery in relieving joint and back pain.

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Exercising may be the last thing you want to do when you have a sore knee or aching back, but it might be the first thing you should do. Physical therapy has long been recommended following surgery. But for some, trying physical therapy before opting for surgery may be the better choice.

"You may be able to spare yourself the expense, pain, and recovery time of surgery," says physical therapist Karen Weber, clinical supervisor at Harvard-affiliated Spaulding Rehabilitation Outpatient Centers in Braintree and Quincy, Mass.

In the journals

Corticosteroid injections are used to ease short-term knee osteoarthritis pain, but a new study in the May 16, 2017, Journal of the American Medical Association suggests the treatment may not help in the long term.

Researchers recruited two groups of 70 people, average age 58, with knee osteoarthritis. One group received 40 milligrams of the steroid triamcinolone (Kenacort, Kenalog, Artistocort) every three months for two years, while the other group got placebo injections. By the end, pain scores — measured on a scale from zero for no pain to 20 for extreme pain — had dropped by only 1.2 points among the steroid group, while the placebo group's score dropped by 1.9 points, neither of which was clinically significant.

Aches or numbness may keep you from doing the things you love. Find out what's behind your pain, and do something about it.

Hand pain becomes common as we get older. Tingling and numbness, aching or locking joints, and difficulty grasping objects are frequent complaints. But don't make your own diagnosis and suffer in silence. "It's difficult to discern between different types of hand pain. Some have overlapping symptoms," says Dr. Sang-Gil Lee, a hand surgeon at Harvard-affiliated Massachusetts General Hospital.

Dr. Lee advises that you seek treatment as soon as possible for persistent hand pain, before it gets so advanced that it's tough to use your hands for even the simplest jobs, like brushing your teeth or buttoning a shirt.

Men considering surgery for back pain relief may benefit from more conventional treatment methods.

Back pain remains one of the top reasons people seek medical care for pain. For many older men, the source of their pain is spinal osteoarthritis.

Finding relief is an ongoing struggle, but men should think hard before turning to surgery without first trying less invasive treatments. "No one ever goes from initial back pain to needing surgery, unless the pain is due to something like cancer or an infection," says Dr. Steven Atlas, an internist with Harvard-affiliated Massachusetts General Hospital. "You can't fix arthritis. Surgery may help control the pain in some cases, so you can function better, but it won't cure your pain — no matter what doctors may promise."

In the journals

A study published online March 14, 2017, by The Journal of the American Medical Association suggests that when it comes to speed of recovery after a total knee replacement, a home-based rehabilitation program is as good as rehab that starts with a stay in the hospital.

Researchers randomly assigned people with osteoarthritis undergoing total knee replacement into two groups for 10 weeks of therapy. Those in one group received 10 days of hospital inpatient rehabilitation followed by a clinician-monitored program that they attended two to three times a week for eight weeks. Those in the other group skipped the hospital rehab and went straight into the clinician-monitored program but then progressed to at-home exercises.

News briefs

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Many older adults have pain from knee osteoarthritis, a condition in which cartilage in the joints wears away. But when is it time for joint replacement? An observational study published March 28, 2017, in The BMJ suggests that a new knee improves quality of life only in certain cases. The study included over 7,400 middle-age and older adults who already had knee arthritis or were at high risk for the condition. Compared with people who didn't have knee replacement, those who had the surgery during the 26-year study period appeared to have a better quality of life afterward. However, the improvements were minimal, except in people who were less physically functional before the surgery because of more severe arthritis symptoms. The authors suggest that the high costs of knee replacement may be justified only in those who are severely affected by arthritis. What if your symptoms aren't severe? As we reported last month, it may be possible to delay or avoid knee surgery by strengthening your leg and core muscles, losing weight, and improving range of motion.

This common type of arthritis can show up suddenly and cause debilitating pain.

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The great artists Ludwig van Beethoven, Luciano Pavarotti, and Leonardo da Vinci had more than extraordinary talent in common; they were also sufferers of a type of inflammatory arthritis called gout. You may be at risk of joining their ranks if you have any potential triggers for the condition. "Most people are surprised by their initial gout diagnosis, unless they have a strong family history," says Dr. Mark Fisher, a rheumatologist at Harvard-affiliated Massachusetts General Hospital.

About gout

Gout is mostly a man's condition, although women can experience it, too. It's caused by a buildup of uric acid — a waste product from the breakdown of natural chemicals called purines (an essential part of DNA).

In the journals

Studies have shown that regular activity can help older adults with arthritis stay independent. How much is enough? Research published online Dec. 28, 2016, by Arthritis Care & Research suggests you may need as little as 45 minutes per week.

Federal guidelines recommend 150 minutes of moderate activity per week to prevent premature death and serious illness. However, reaching that number is tough to reach for people with arthritis; in fact, only one in eight men with knee arthritis meet this standard. In this study, researchers tracked several years of fitness activity for 1,629 adults (44% of whom were men), ages 49 to 83, with osteoarthritis in the hip, knee, foot, or some combination. Specific exercises or activities were not recorded, only the time invested per week.

How to distinguish the symptoms from other conditions, and what to do about treatment.

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When your joints ache, you may chalk it up to an old injury or to osteoarthritis — the wearing away of cartilage that's common in older age. But for two million people in the United States, aching joints are caused by rheumatoid arthritis (RA) — when the immune system mistakenly attacks the tissues lining the joints.

"People commonly assume RA pain is due to aging, overuse, or even the flu," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center, and medical editor of the Harvard Special Health Report Rheumatoid Arthritis (health.harvard.edu/RA).