The effective treatment of arthritis starts without surgery. The process begins with listening to the patient and asking very specific questions. The answers to those questions serve as clues that will help Dr. Grimsley determine what is causing your pain and how it is affecting your life. Often, relatively simple and low-risk interventions can make a big difference. These include:
- Easing the load on your joint. Avoiding excess stress on your joints can help protect them. When lifting and carrying items, for example, let your bigger muscles and joints support the weight. Weight control also helps ease pain by reducing the load on your joints.
- Ice or heat. Heat may help you loosen up your joints before an activity. Ice is a good pain reliever after activity or exercise.
- Exercise. Exercise helps because it makes your muscles stronger, which lowers the stress on your joints. But be sure to talk to your doctor about what kind of activity is best for you.
- Walking aids. There are many devices you can use to take some of the stress off of your joint. These include crutches, walkers, braces, and tape.
- Physical therapy or occupational therapy. Research shows that individuals who receive regular physical therapy treatment experience greater improvement in function and decreased pain intensity.
- Medicine. If your pain is mild, you may need nothing more than over-the-counter pain medication (analgesics) such as Tylenol. Anti-inflammatory medications such as Advil, Aleve, and aspirin also can provide relief. Stronger medications that are used to treat osteoarthritis include Tramadol and narcotics.
- Injections. Corticosteroid (cortisone) injections provide strong anti-inflammatory medication directly into the joint. Vicosupplementation—the injection of so-called joint gels made from hyaluronic acid—provides lubrication and nutritional support for the joint. Such injections can offer significant pain relief with only minimal discomfort.
If you’re still in pain after all conservative treatment options have been exhausted, your condition may warrant surgery, There are several common surgical procedures that Dr. Grimsley may recommend. These include:
Arthroscopy. This minimally invasive procedure utilizes specialized instruments and a tiny camera to fix tears in soft tissues, repair damaged cartilage, and remove loose bodies. Arthroscopic surgery is performed as outpatient surgery and typically entails a short recovery time. Although arthroscopy can offer reduced joint pain and improved range of motion, there are no long-term studies to support the notion that the procedure prevents further joint deterioration or cartilage loss.
Partial Joint Replacement: Also referred to as joint resurfacing, this surgery replaces only the diseased or damaged surfaces of the joint while preserving as much of the natural joint as possible. Patients having this procedure generally experience a quicker recovery and less pain after surgery, but may need further joint surgery in the future if arthritis develops in the parts of the joint that have not been replaced.
In knees, this procedure is also known as unicompartmental knee replacement, and is appropriate when advanced osteoarthritis is limited to a single joint compartment. In hips, the procedure is known as hip hemiarthroplasty; the head of the femur is removed or covered with a protective plate, while the pelvic portion of the hip (the acetabulum) is left in place. Partial joint replacement is more common and appropriate in the knee, but is seldom an optimal choice for the hip.
Total Joint Replacement (TJR): During this procedure, the damaged joint is replaced with a prosthetic implant that mimics the motion of the natural joint. All surfaces of the joint are replaced. TJR has a strong, proven track record for safety and success; patients having the procedure typically report significantly reduced pain, improved mobility and function, and dramatic gains in quality of life. Minimally invasive total joint replacement uses shorter incisions than traditional TJR and spares more muscle, but the procedure can have a higher complication rate and the best candidates are active, normal-weight individuals younger than 50 years old.
Joint Revision: Implants can last 20 years or longer, but there are specific instances when a prosthetic must be replaced. Joint revision surgery is performed to remove a failed, infected, or worn-out implant and replace it with a new one. Because of the alterations surgeons must make to bones during a joint replacement, revision surgery is more complicated and typically less successful than the initial joint replacement operation; such cases should ideally be performed by surgeons like Dr. Grimsley who have advanced specialty training in this procedure.