Relieving Hip and Knee Pain without Surgery
Relieving Hip and Knee Pain without Surgery
Hip and Knee pain are common complaints orthopedic surgeons encounter. An individual can develop pain in the hips and knees and the incidence increases with age. The average incidence of developing Hip and Knee pain is around 10% in the general population. Older individuals have hip and knee pain while performing simple activities like walking, climbing stairs, getting in and out of chairs, moving from a seated to standing position, etc. This may be because of osteoarthritis, which is age-related degeneration of the joint surface. Young people with a high level of athletic activities may be more prone to developing pain in the hips and knees. Non-operative treatment modalities are typically first line treatment of Hip and Knee pain with an overall satisfactory outcome. Some patients not responding to non-surgical methods become a surgical candidate.
Non-Operative Treatment
● Over the counter analgesics:
Medications like Naproxen, Ibuprofen, and other medicines from the non-steroidal anti-inflammatory group are easily available and effective in reducing inflammation and pain. However, a long-term requirement of analgesics, pain not relieved with these medications, or increasing pain needs consultation with your doctor.
- Weight loss.
Excess body weight increases the load on the lower extremity causing increased pain of the hip and knee. Weight loss through dietary modifications and physical activities like swimming is an important measure to reduce hip and knee pain.
- Lifestyle modification:
This includes weight loss, diet modification, strengthening, exercise, and avoiding high impact activities. An anti-inflammatory diet is recommended for weight loss and overall reduction in inflammation which consists of fruits, vegetables, protein, low carbs, and avoidance of processed food. Activity and strengthening is encouraged especially strengthening the muscles surrounding the hip and knee. High impact activities may be avoided such as running as this may increase symptoms.
- Physical Therapy.
Physical therapy works by neuromuscular training, regaining range of motion of the joint, and maintaining muscle tone and power. With these measures symptoms may improve allowing for normal activities of daily living. Other physical therapy modalities like TENS therapy, heat therapy, etc. modulate the nerve fibers for pain and increase the pain threshold as well ultimately decreasing the pain sensation to the acceptable limit of the patient.
- Durable Medical Equipment
DME are accessories designed to provide added support. This includes walkers, canes, knee braces, shoe lifts, etc. These devices help in offloading the weight and redirecting the stress from a joint surface.
- Corticosteroid injections.
Corticosteroids are a group of medicines that reduce inflammation. Pain around the hip and knee joint is because of the inflammatory mediators. Injections containing steroids are injected directly into the joint space or around the pain site. Medicine is released slowly into the surrounding tissue decreasing the inflammation and the pain. The pain-free duration, the effect, number of times the injection can be provided is variable from person-to-person.
- Alternative therapies.
Acupuncture, Yoga, Magnetic pulse therapies, Platelet-rich plasma (PRP) injection, Hyaluronic acid injection into the joint, etc. Acupuncture involves the insertion of fine needles into the joint and modulation of nerve fibers for pain. Platelet-rich plasma (PRP) injection into the joint is believed to help reduce inflammation. The hyaluronic acid injection is a lubricant injection that helps to provide increased fluid in the joint space. These treatment methods though claimed to be effective the results are inconclusive in many.
References:
Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. Jama. 2021 Feb 9;325(6):568-78.
Pradelli L, Sinigaglia T, Migliore A, Checchia GA, Franceschi F, Frediani B, Iannone F, Romanini E. Non-Surgical Treatment of Knee Osteoarthritis: Multidisciplinary Italian Consensus on Best Practice. Therapeutics and Clinical Risk Management. 2021;17:507.
[Internet]. Pennmedicine.org. 2021 [cited 30 December 2021]. Available from: https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/orthopaedics/hip-pain/non-surgical-hip-treatment