How to treat "osteoarthritis"? Does it really have to end with surgery?

Phyathai 3

6 Min

11/04/2022

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How to treat "osteoarthritis"? Does it really have to end with surgery?

Currently, “osteoarthritis treatment” can be done in various ways depending on the severity of the disease, ranging from lifestyle modifications to knee replacement surgery. In all treatment methods, care should be under the supervision of a specialized physician to assess and plan appropriate osteoarthritis treatment. We have compiled details on which treatment methods are suitable for different symptoms.

 

Osteoarthritis Treatment Methods

When treating osteoarthritis patients, doctors consider symptoms, severity caused by cartilage degeneration and wear, pain, impact on daily life, and other health aspects of the patient. There are several treatment options depending on suitability as follows:

 

1. Lifestyle modification (non-pharmacological therapy)

This is an important treatment method. When knee pain begins, patients need to understand self-care, know how to manage or adjust their lifestyle to address the causes of the disease, such as:

  • Weight loss: If overweight or obese, weight reduction is recommended. Avoid fatty foods, sweets, and alcohol consumption.
  • Avoid lifting heavy objects because it increases stress on the knee joint. For every 1 kilogram of weight carried or lifted, the knee bears about 3 times more weight, accelerating knee degeneration.
  • Knee exercises: Proper joint use and care, appropriate muscle strengthening exercises around the knee to help support the joint and slow degeneration.
  • Adjusting improper sitting postures such as squatting, sitting on heels, kneeling, and cross-legged sitting. These postures increase compressive forces on the joint structure, and frequent or prolonged use can accelerate knee degeneration and cause inflammation.
  • Resting the joint occasionally, especially for those with occupations requiring prolonged standing, such as vendors or cooks, who should take breaks to sit down.

Another important point is to understand that osteoarthritis can occur at any age and that the condition can be managed to improve symptoms. Therefore, it should not be ignored until symptoms worsen. It is better to see a doctor promptly.

 

2. Rehabilitation medicine and physical therapy

Physical therapy in rehabilitation medicine can help reduce pain, stiffness, and muscle spasms around the joint. It also strengthens the muscles surrounding the joint to better support it. Treatment should be supervised by a specialized physical therapist to ensure correct and safe therapy, such as:

    • Massage to relax tight muscles, reduce pain, decrease muscle tension, and improve joint mobility.
    • Use of heat and cold (thermal modalities) to reduce joint stiffness, pain, muscle spasms, and prevent muscle and tendon shortening. Heat therapy includes superficial and deep heat.
    • Superficial heat, such as using a hot water bag.
    • Deep heat, such as ultrasound therapy, often used for large and deep joints.
    • Use of support devices, such as knee braces to reduce pain and stabilize the knee area, or walkers and canes to assist knee function.

3. Exercise

Appropriate exercise helps increase strength and endurance of muscles around the knee, improve muscle tone and flexibility, enhance joint mobility, reduce fat in obese individuals, and relieve knee pain. However, the type of exercise should be chosen according to the symptoms.

 

4. Medication therapy (pharmacological therapy)

Medications may be oral, injectable, or topical, depending on the doctor’s judgment, to relieve pain and improve joint function and mobility.

    • Injections to improve osteoarthritis symptoms must be closely supervised by a doctor due to the risk of chemical accumulation.
    • Pain relievers for knee pain include non-anti-inflammatory analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) that help reduce knee pain and inflammation.
    • Topical medications to relax muscles and relieve pain.

 

5. Knee replacement surgery (Knee Arthroplasty)

Knee replacement surgery involves removing only the damaged surface of the knee joint without removing all the original bone. The bone is shaped to fit the surface of the prosthetic joint, which is then placed over it. The prosthetic knee replaces the damaged cartilage inside the knee joint.

 

Knee replacement surgery can be done with or without cement. Cemented prostheses provide more stability and strength, often requiring coating the prosthetic surface with special substances such as Hydroxyapatite to help the patient’s bone grow and bond better with the prosthetic surface.

 

Currently, there are various types of knee prostheses available depending on the doctor’s judgment, patient preference, and budget, such as:

    • Partial knee replacement (Unicompartmental Knee Arthroplasty: UKA) replaces only one compartment of the knee that is worn out, preserving the healthy parts. The knee is generally divided into three main compartments: the medial (inner) compartment, the lateral (outer) compartment, and the patellar compartment, differing from total knee replacement.
    • Total knee replacement (Total Knee Arthroplasty: TKA) is used for severe osteoarthritis. The damaged joint surfaces are removed and replaced with prosthetic surfaces for the femur, tibia, and patella.

 

Total knee replacement involves cutting away the damaged joint surfaces of the distal femur and proximal tibia, both medial and lateral compartments. This surgery addresses the problem comprehensively, is popular due to quick results, and allows patients to return to normal life without pain.

 

6. Alternative treatments

    • Subchondroplasty injection involves injecting a calcium phosphate bone substitute into the knee joint. The injected material flows into porous bone inside and hardens like bone tissue, helping the joint bear weight better.
    • Platelet Rich Plasma (PRP) injection uses a concentrated platelet extract from the patient’s own blood to help heal injuries to joints, ligaments, and muscles.
    • Hyaluronic acid injection is a lubricant that increases joint lubrication and stimulates cartilage precursors. This method is suitable for patients with osteoarthritis who do not respond to medication, helping relieve pain and reduce joint stiffness.

 

Is surgery necessary to cure osteoarthritis?

If osteoarthritis is managed early when symptoms are mild, it is better because not all cases require surgery. However, if the condition progresses and surgery is necessary, it is usually the last resort. Nowadays, knee replacement surgery is not as frightening as before due to advances in medical knowledge and technology, including computer-assisted surgery, which increases precision and speeds recovery. Most patients can walk with assistive devices within one day after surgery if there are no complications, reducing hospital stay duration.

 

There are many treatment options for osteoarthritis, and the appropriate method depends on the patient’s symptoms and severity. A detailed history and physical examination, along with imaging diagnosis, help determine disease severity. Doctors will evaluate symptoms and plan suitable treatment for each patient to restore the best quality of life.


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