Minimizing the Effects of Hip and Knee Arthritis, with Eugene Eila, M.D., Orthopedic Surgeon, Delaware County Memorial Hospital and Stuart Gordon, M.D., co-chief of the Section of Orthopedic Surgery at Taylor Hospital. Both physicians are members of the Crozer-Keystone Human Motion Institute.
If you are age 50 or older, there’s a pretty good chance you’ve felt the pain of arthritis. That’s because more than 50 million Americans – more than 1 in 6 – suffer from one of the various forms of treatable arthritis. Fortunately, there are options for people who deal with daily pain in their knees and hips. Eugene Elia, M.D., an orthopedic surgeon at Delaware County Memorial Hospital and a member of the Crozer-Keystone Human Motion Institute, and Stuart Gordon, M.D., co-chief of the Section of Orthopedic Surgery at Taylor Hospital and a member of the Crozer-Keystone Human Motion Institute, recently spoke about ways you can relieve hip and knee pain – from medication to exercise, surgery and rehabilitation – to prevent arthritis from taking over your life.
As we age, there are certain things we can look forward to – retirement, grandchildren, maybe even a cruise to a tropical destination. Unfortunately, for about 50 million Americans, these happy events come with an unhappy sidekick – the pain and discomfort of various forms of arthritis, often located in the hips and knees.
“The reason you get arthritis is that you take a lot of steps during the course of your life,” says Eugene Elia, M.D., an orthopedic surgeon at Delaware County Memorial Hospital and a member of the Crozer-Keystone Human Motion Institute. “By the time you are age 75, you would circle the globe four times. It’s an amazing amount of distance. Every year, you are actually moving your hip back and forth, and your knee back and forth, between 1 and 2 million times. That’s why you need to take care of your joints – because there are very few things in life that last longer.”
The hip joint, explains Stuart Gordon, M.D., co-chief of the Section of Orthopedic Surgery at Taylor Hospital and a member of the Crozer-Keystone Human Motion Institute, is an acetabulum, or “ball-and-socket,” joint. This joint allows the hip to move in three directions, and makes it one of the few areas in the body where rotation occurs. The knee, on the other hand, acts more like a hinge, with a back-and-forth motion. In both the hip and the knee, the area between the joints is cushioned by a substance called cartilage, which keeps the bones of the joint from rubbing together. For many people, the constant movement of the hip and knee joints results in the wearing away of cartilage, which allows one bone to rub on another and can cause significant pain.
“Cartilage continually wears away over the course of your life, starting at age 1,” Dr. Elia says. “It doesn’t become symptomatic until usually about age 50, unless you’ve experienced trauma from a car accident or fall, for example. When it becomes symptomatic and starts to hurt, you’ll usually go to the doctor, who will diagnose osteoarthritis.”
“Osteoarthritis is ‘wear-and-tear arthritis,’” Dr. Gordon says. “It is slow-developing joint arthritis. It causes joint pain, achiness and stiffness. The joints become inflamed and filled with fluid, which eventually causes joint destruction. The cartilage is no longer smooth and pristine – it’s roughened, and it catches sometimes, which causes your pain.”
The onset of osteoarthritis can usually be staved off for a few years through a combination of several different techniques.
“We recommend a program called SAVE, which stands for situating your environment, avoiding further wear and tear on your joints, varying your positions frequently, and exercising faithfully,” Dr. Elia says. In order to situate your environment, Dr. Elia and Dr. Gordon recommend checking your house for safety hazards and items that could contribute to cartilage degradation.
“Living on one floor is best,” Dr. Elia says. “If you have the money to add a bathroom, put some rails in, or install a chair lift, do it. Also, you can do some common-sense things, such as putting in higher-wattage light bulbs, getting rid of scattered throw rugs and moving clunky furniture that gets in your way.”
“In your kitchen, move objects that you use frequently from the bottom shelves to shelves and cabinets that are at a higher level, so you don’t have to bend,” Dr. Gordon says.
To avoid further wear and tear on your hip and knee joints, try to do your normal activities from a standing or seated position.
“If you have a dishwasher, stack everything on the top so you don’t have to bend over,” Dr. Elia says. “When you cook, use the top shelf in the oven, and keep your pots and pans in a cabinet with sliding shelves. Don’t kneel down to scrub the floors – use a mop or a vacuum. And use a little stool when you’re out gardening to avoid spending too much time on your knees.”
Using crutches or a cane, even on a temporary basis, can also help avoid wear and tear on the hip and knee joints.
“Don’t be embarrassed to use a cane or crutches,” Dr. Elia says. “They can keep you independent and would definitely take a lot of stress off your joints.”
The physicians also recommend varying your positions frequently.
“Keep your joints moving,” Dr. Elia says. “Stiffness can creep in after about an hour. When you are sitting, move your knees around and avoid keeping them straight. Sit with your knees and hips in a relaxed position and keep them bent a little bit. Cross your knees and switch your legs back and forth, unless you’ve had a hip replacement. And when you are laying down, use a pillow between your knees, especially if you have difficulty laying on your side.”
Finally, Dr. Elia recommends daily exercise to ward off painful arthritic flare-ups.
“Again, exercising prevents stiffness,” he says. “Also, by exercising, you can strengthen the muscles around your joints, which helps support the joints and reduces the rate of wear and tear on the cartilage.” If you suspect the onset of osteoarthritis, Dr. Gordon recommends visiting your family physician.
“Your family doctor is the first person you should see for treating arthritis,” Dr. Gordon says. “It’s very important that he or she starts with something simple. Make sure that your treatment plan starts slowly – don’t rush toward surgery. Surgery is the last thing we should do, because surgery is aggressive.” However, Dr. Gordon adds, patients who do not respond well to conservative therapy may need surgical intervention.
Dr. Elia agrees.
“If you have severe osteoarthritis, nine times out of 10, your doctor is going to suggest the inevitable, which is surgery,” Dr. Elia says. “In the past, artificial joints were made of metal, and the scars left by replacement surgery were about 12 inches long. Today, with new technology and new instruments, we are able to put artificial joints in through an incision between 3 and 4 inches, which results in less pain and less recovery time. In addition, the joint surfaces are made of ceramic, metal or plastic, which gives the joint a nice frictionless type of motion, similar to the natural movement of the body.”
“Hip and knee replacements are great operations – hundreds of thousands are done each year in America alone,” Dr. Gordon says. “It is one of the greatest technological advances of the past century. Today, 95 percent of all hip and knee replacement surgeries get great results.”
Post-surgery, you can expect your pain to subside after just a few days, and will probably be able to walk the day after surgery. Your physician will probably restrict certain positions and movements, such as sitting with your legs crossed or kneeling for extended periods of time, but you will be able to resume most normal activities within a few weeks.
“We will have you up and moving the day after your surgery,” Dr. Gordon says. “You’ll work with a team of doctors, nurses, and physical and occupational therapists who will help you feel more comfortable about your pain level, movement and weight-bearing capabilities, and can even help you with your discharge to make you safe and comfortable at home. For the first six to eight weeks after surgery, you should remain pretty calm, but after that, you can start driving, and after a few months, you can play golf and walk.”
“You will eventually be able to walk as far as you want after hip or knee replacement surgery,” Dr. Elia adds. “Swimming and biking are wonderful ways of exercising. Golfing and dancing are no problem. Of course, certain activities are out. Jumping is out of the question, so you’ll have to cut out the skydiving. Running is also restricted, as is playing singles tennis. Doubles tennis is fine, though.”
In addition to surgery, pain relief options include medication and injections, such as cortisone, and activity modification.
For more information about the Crozer-Keystone Human Motion Institute, or to find a Crozer-Keystone physician who’s right for you, call 1-800-CK-HEALTH (1-800-254-3258).