Joint Pain

What is Hip Arthritis?

Hip arthritis, also known as hip osteoarthritis, is a pain generating condition of the hip joint resulting from “wear and tear”. The articular cartilage, over time, begins to thin and even disappear, resulting in bone on bone contact in the hip joint. This cartilage is responsible for providing a smooth, “gliding” surface for the joint to rotate upon. Therefore, as this joint surface wears out, pain results. This process can be exacerbated by things like a rigorous physical activity resulting from occupation or sport. Additionally, increased body weight significantly affects symptom presentation. For every pound of body weight gained or lost, that equals 4-7 lbs of distributed force through the hip in either direction. Therefore, a pound lost provides significant help and a pound gained is all the more painful. Lastly, hip osteoarthritis also may have a genetic component, meaning regardless of lifestyle, body weight, or activity habits, some people are predisposed to develop early and severe arthritis. 

Conservative Treatment

It should be known that hip osteoarthritis is typically a progressive problem, meaning it will worsen over time as the joint continues to “wear”. However, there is a list of non-surgical interventions that may be beneficial and significantly delay and even prevent the need for invasive surgical procedures. The conservative treatment package typically includes activity modification, ice and course of scheduled anti-inflammatory medication. Additionally, discussions will be had regarding weight loss and the resources available to assist in dieting and activity management. As stated before, the weight loss effect is magnified by the fact that the hip joint itself sees more weight than your body carries. In addition, local anesthetic and steroid injections can be very successful at limiting arthritis symptom presentation. These injections may be given as frequently as every 3 months and must be stopped well short of a scheduled operation. When you visit Dr. Davis for hip arthritis, these treatment interventions will be recommended and attempted prior to moving on to a discussion regarding surgical intervention. 

** Prior to taking a scheduled anti-inflammatory regimen, patients should alert Dr. Davis of any pre-existing acid reflux/GERD. Additionally, prior to anti-inflammatory medication in the setting of pre-existing heart conditions, please obtain cardiovascular clearance from a primary care physician or cardiologist. 

Surgical Intervention

Once all conservative intervention has been exhausted and quality of life is still suffering, Dr. Davis will move to discuss operative intervention. Hip arthritis is treated surgically with a procedure called a hip arthroplasty, or total hip replacement. In its simplest form, this involves removing the bone and cartilage from the hip joint that causes pain and replacing it with a ball and socket joint made from artificial implants. This procedure has years of evidence based backing to prove its effectiveness and safety. Preoperatively, Dr. Davis will inquire about your medical history to be sure your baseline health allows you to undergo the procedure. You will also obtain preoperative radiographs, or x-rays, to assess anatomy, deformity and leg length. Using this data, Dr. Davis will template your implants to obtain precise intraoperative anatomic accuracy. Your individual case will be discussed at length during your preoperative clinic visit and all questions may be answered at this time. Dr. Davis typically performs a total hip arthroplasty through an anterior approach, or from the “front”, allowing for a minimally invasive, muscle sparing technique that minimizes operative time, maximizes implant accuracy, and minimizes dislocation risk. Occasionally, however, body habitus or bony anatomy may prevent this option and a posterior approach will be used. This will be discussed preoperatively as well. The procedure is also not without risks. Risks of anesthesia, bleeding, infection and implant failure are present, although very rare. Due to their rarity, patients are very often happy with their decision to proceed. Schedule a visit today to start your journey to pain relief. 

Post Op

The post-operative journey following a hip replacement is fairly consistent. On the day of surgery, you will get out of bed and be able to bear weight on your hip replacement with physical therapy. Immediately, you will know that the pain you have been experiencing for years has been eliminated. The purpose of such early mobilization is to restore confidence in your new joint in addition to minimizing your risk of developing a blood clot. Typically, this operation is followed by a night in the hospital. This allows for monitoring of labs, vital signs and pain. Pain will be addressed in a multimodal fashion to aid in your recovery. Occasionally, you will be able to have your surgery on an outpatient basis, avoiding your hospital stay altogether. This allows for you to return to the comfort of your own homes as soon as possible, minimizing the risk of hospital associated bacterial exposure. This will be discussed with you during your preoperative visit. Be prepared to take a blood thinning medication for a period of 30 days after surgery to minimize blood clot risk. Subsequently, you will be seen at the 2 week mark to assess your wound healing, followed by 6 week and 3 month visits to monitor your return to function, guided by physical therapy. 

What is knee arthritis?

Knee arthritis, much like hip arthritis, is a degenerative condition of the cartilage surface in the knee. As the cartilage wears out, the bone of the knee joint begins rubbing together, causing significant discomfort and disability. Cartilage degeneration is largely due to age and overuse. However, a genetic component may predispose one person to developing arthritis earlier in his or her life than others. Unfortunately, once the degenerative process has begun, there isn’t much that can be done to “reverse” the process. Interventions such as “stem cell therapy” have not been proven in the literature to be beneficial and often come at a great expense to the patient. As the disease process progresses, patients will often experience stiffness, progressive deformity and difficulty with mobilization. In extreme cases, arthritis may lead to the continuous use of a cane, walker or even wheelchair. Dr. Davis’s goal will be to treat your pain and discomfort as conservatively as possible while still preserving your quality of life. 

Treatment

Initially, arthritis may be relatively mild, resulting in pain late in the day or at night that is responsive to medication. At this point, Dr. Davis will recommend ice, over the counter anti-inflammatory medications and activity modification to preserve your natural anatomy while improving your symptoms. As symptoms worsen, you may be a candidate for a steroid injection in the joint. This allows for focal administration of medication that decreases inflammation and can minimize the symptoms of an arthritic “flare”. Injections may be given every three months as long as they remain effective. However, it should be noted that a three month break will have to occur prior to any operative intervention. This is due to the slightly increased risk of infection associated with steroid injections just prior to an operation. Lastly, weight loss can be a very effective method to treating arthritic pain. Although difficult, weight loss provides a way to significantly offload the stress your knee joints see every step. It has been reported that 4-7 times your bodyweight travels through the knee joint during activity. Therefore, weight loss or weight gained has a significantly large effect on the knee joint. Weight loss, if possible, with the assistant of a nutritionist, will be pursued as well. These options and the treatment plan will all be discussed at your first visit with Dr. Davis.

Surgical Intervention

If non operative management has failed or is no longer effective and quality of life is dwindling, Dr. Davis will begin to discuss the operative options for knee arthritis. For young patients with pain on the inside, radiographic assessment will be utilized to determine of symptoms are arising from an angular deformity of the leg, causing increased pressure on the inside of the knee. These patients may be candidates for a procedure called a high tibial osteotomy (HTO). An HTO is a procedure that cuts the tibia bone and introduces some angular correction. The tibia bone is cut, corrected and fixed with a plate and screws. This indication is fairly rare and, if needed, may be discussed during your office visit. If no angular deformity is present and the arthritis is focused on a single side of the knee, a unicompartmental knee arthroplasty, or partial knee replacement may be an option. This procedure involves removing the arthritic bone/cartilage and replacing it with artificial parts consisting of highly polished medical metal and plastic. The benefits of the unicompartmental knee arthroplasty include a smaller incision, less blood loss, quicker recovery times, and a more native feeling knee due to minimal soft tissue insult. If the previous to surgical intervention options are not available, total knee arthroplasty, or a total knee replacement, is the gold standard treatment. This involves removing the arthritic bone/cartilage and replacing this with metal and plastic parts, with care to balance the soft tissues. This eliminates the pain generator and maintains range of motion, with the goal of returning the patient to work or activities of daily living that have been hindered by pain.

Post Op

Postoperative protocol will be tailored to the specific procedure that occurs. However, with knee replacement, motion and weight bearing will begin immediately with physical therapy. Your procedure may be done on an outpatient basis, preventing a night in the hospital. Or, commonly, one night in the hospital is required for anesthesia reversal, therapy and pain control. A blood thinning medication will be administered for 30 days postoperatively to prevent blood clots. Your initial 2 week postoperative visit will be utilized to assess your incision for healing and rule out the presence of any early complication such as infection. At the 6 week mark, range of motion and daily pain should be near normal and you should feel as if your life has been returned, pain free. Please call Dr. Davis’s office to schedule your knee arthritis consultation!

What is shoulder arthritis?

Shoulder arthritis, much like hip and knee arthritis, is a degenerative condition of the cartilage surface in the knee. As the cartilage wears out, the bone of the shoulder joint begins rubbing together, causing significant discomfort and disability. Cartilage degeneration is largely due to age and overuse. However, a genetic component may predispose one person to developing arthritis earlier in his or her life than others. Unfortunately, once the degenerative process has begun, there isn’t much that can be done to “reverse” the process. Interventions such as “stem cell therapy” have not been proven in the literature to be beneficial and often come at a great personal expense. As the disease process progresses, patients will often experience stiffness, pain with range of motion, and decreased quality of life. At your initial visit, Dr. Davis will attempt to tease out the primary source of your shoulder discomfort. This will include a physical exam as well as radiographs of your shoulder to assess the bony anatomy and the status of the shoulder joint. Range of motion assessment will occur in an attempt to determine if stiffness is, perhaps, a primary source of your decreased shoulder function. Additionally, assessment of your rotator cuff musculature, either with physical exam or MRI is a critical step in your shoulder evaluation, contributing significantly to treatment decision making. This will be discussed at length during your visit.

Treatment

Initially, your evaluation will be performed to attempt to determine the severity of your shoulder arthritis. Conservative measures, including ice, anti-inflammatory medication, and physical therapy will initially be utilized to attempt to restore motion and minimize pain, allowing for maintenance of your native anatomy and maximization of functional results. These conservative measures may be supplemented with steroid injections in the shoulder, providing immediate pain relief as well as inflammation reduction. These injections may be used at 3 month intervals. However, once conservative measures have failed, operative intervention will be discussed to address your symptoms.

Surgical Intervention

Surgical intervention for shoulder osteoarthritis has been, over the years, divided into two separate categories. These categories include a standard, or anatomic, shoulder replacement and a reverse, or non-anatomic shoulder replacement. This decision will require assessment of your age, functional status and, very importantly, the status of your rotator cuff muscles. Your rotator cuff muscles are responsible for maintaining certain critical motions in the shoulder joint and also are responsible for maintenance of the “ball” portion of the shoulder joint in the “socket” portion of the shoulder joint. If these muscles are present and functional, an anatomic shoulder replacement may be performed. This involves replacing the “socket portion” with a prosthetic “socket” and the ball portion with a prosthetic “ball”, restoring motion and eliminating the painful, degenerated joint surface. 

If, however, the rotator cuff musculature is not functional, or if deformity in the shoulder joint eliminates the possibility for an anatomic reconstruction, a “reverse total shoulder” arthroplasty will be utilized. This is a procedure that replaces the “socket” portion of your shoulder with a “ball” and the “ball” portion of your shoulder with a “socket”. This, in actuality, bypasses the need for a functional rotator cuff muscles, allowing for restoration of painless motion to the shoulder. Much improved outcomes can be expected following either selected procedure and your options will be discussed and questions answered at your clinic visit.

Post Op

Immediately postoperatively, you will likely be admitted to the hospital for a single night. This will allow for vital sign monitoring and appropriate pain control. Physical therapy will evaluate you, ensure you are able to mobilize, and clear you for return home. After discharge from the hospital, initial rehabilitation will focus on healing the soft tissues around your shoulder arthroplasty and allowing your arthroplasty components to grow into the shoulder bony anatomy. For the first 6 weeks, this will involve remaining in the sling for the majority of the time. Therapy will be focused on gentle shoulder passive range of motion. Also, goals to improve/maintain elbow/wrist/finger range of motion will occur at this time. Additionally, therapy will focus on firing some of your deltoid and periscapular musculature without moving the shoulder joint itself. This is called “isometric” contraction. From weeks 6-12, gradual range of motion progression will occur both actively and passively. A weight bearing restriction, less than two pounds, will still remain at this point. However, you should begin to feel during this phase as if your range of motion is significantly improving and you are on the road to recovery. From weeks 12-16, therapy may transition to a home regimen, continuing to focus on strengthening and range of motion with overhead lifting remaining <10 lbs. Return to work may be discussed in a graduated fashion. The details of your recovery plan will be discussed in your preoperative visit.