Last week we began our discussion of joint pain and cartilage care with things you can do at home. When you have been treating your knee or hip pain yourself and getting no relief it is time to see medical care. You must be careful, however, that your sports doc understands that your goal is to stay active, vital, healthy and joyful and does not simply tell you to act your age. Many docs are as behind in their expectations of aging athletes (recreational and elite) as those people you meet who think you are crazy for pushing yourself so hard to be your best. If you can’t get your doctor to take your desire to remain active, even with arthritis…look around. This sounds harsh but as one of the only sports docs focusing both research and clinical time on the care of the masters athlete I know it is true.
Two main types of joint injections are given for arthritis pain and swelling. These are steroid injections and joint lubrication. Steroid injections have been around a long time and consist of injecting the joint with a mixture of numbing medicine, such as lidocaine or marcaine, and steroids. The point of this injection is to decrease the pain and inflammation of arthritis. Although used commonly these injections usually last an average of three weeks and most physicians will give only three a year to any joint. I tend not to use steroids unless my patients have acute excruciating pain.
I prefer to use joint lubrication with a class of injection called hyaluronic acid. There are currently 5 of these on the market. Four are purified from the comb of roosters and the fifth is grown in bacteria and then purified for injection. The hyaluronic acid works to decrease inflammation and lubricate the joint. It causes the joint lining to secrete substances that feed the remaining cartilage. Hyaluronic acid injections, or the chicken “stuff,” as it is referred to by many of my patients, works best in early arthritis and can be effective up to 6 months or longer. They are given once a week for three to five weeks and can be repeated every six months if patients receive significant relief.
Using hyaluronic acid injections and quad strengthening I have returned many athletes to their sports including a ultra-marathon and skiing in Vail.
As the cartilage and then bone wears down inside the knee your leg will often change from straight to bowed or knock kneed. Braces can unload the affected side of the joint by pushing on the opposite side and effectively straightening the leg again. For instance, if you have arthritis on the inside or medial side of your knee and develop bow legs the brace will unload that side by pushing against the outside or lateral side of the knee. The problem with knee braces are that they only work if they are worn daily and many people simply put them in the closet. These braces are custom braces made especially for you and must be ordered by your physician. The stretchy knee sleeves you by in a pharmacy are not effective in unloading the knee and are not what I am describing here. Some of my patients like the sleeves because it makes them more aware of their knees and they feel more stable. For many sports docs the jury is out on the use of knee braces for arthritis. Many of you may not want to admit that you need them. The fact is that for many people they unload the joint sufficiently to allow less painful activity and increased stability.
Arthroscopic joint debridement
“Washing the joint out” by surgically removing loose tissue or debris in the joint with small camera and instruments through tiny incisions has not been found to be effective for long-term treatment of arthritis pain. The only true indication for arthroscopic surgery with arthritis is if the person has mechanical catching or locking (feels like popping, snapping or sharp pain) due to a torn meniscus. Arthroscopic surgery is useful if loose bodies (pieces of cartilage or bone that break off ) are getting caught in the joint. The surgery will eliminate the mechanical symptoms but will not touch the aching pain of arthritis. I always make this distinction to my patients.
Next time: Surgical interventions for cartilage gone bad: microfracture