Non operative techniques
Non operative techniques are useful in the earlier stages of arthritis, and there are multiple techniques which work together to help alleviate some of the discomfort. Below are a few examples, and combined together can be effective for mild and moderate arthritis.
As arthritis progresses, non operative techniques become less useful but still have a role. Its best to discuss how you are managing with your GP or specialist, and together they can help you determine the best way forwards.
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Physio
A structured exercise programme can help many patients with early arthritis. Maintaining strength, stability and movement helps how a joint feels and functions. As arthritis progresses, these techniques become less effective and other methods to help the pain should be consideredÂ
Tablets
Simple painkillers are a good adjunct for arthritis pain. Paracetamol is a good place to start, and short term use of anti inflammatories are helpful if you don’t have stomach, kidney or cardiac issues. If the pain needs stronger opiates, then its worth considering operative management to give you longer lasting pain relief than relying on strong medication with their associated side effectsÂ
Diet & Supplements
A diet or supplements aiming at reducing inflammation has some merit, but there is no strong evidence that it will make a prolonged difference. Nonetheless some people do find that a low salt mediterranean diet, or supplements such as cod liver oil, glucosamine or turmeric may help.  Â
Weight Management
We all have different body shapes, and when we have joint pain it’s very easy to put on a bit of weight. Extra weight increases the forces through the joints, and it’s suggested that an extra 1kg on the body is equivalent to an extra 4-5kg through the hips and knees! What we also know is that if our height to weight ratio, or Body Mass index (BMI) is higher than we have an increased risk of infection when having a joint replacement. From baseline a BMI >35 has 2 times, and a BMI >40 has a 3 times increased risk of infection. It’s important that our BMI is ideally less 40 prior to surgery, and hopefully less than 35 to minimise risks. That’s not always easy, so you may need help from your GP, or a weight reduction clinic we can refer you to.
Activity Modification
It makes sense that higher impact activities on your joints will cause more pain, so substituting sports from running to swimming or cycling can help with the pain. Aerobic low impact exercises are good for your general health, mental health and muscle strength, all of which help your joint pain.Â
Injections
There are 3 main types of injections that are useful for mild and moderate arthritis. As arthritis becomes more advanced the injections become less effective and don’t last as long. There are broadly 3 types of injections:
1. Cortisone
These are cost effective injections, and whilst they act quickly, they wear off quickly as well, with most injections lasting around 3 months. They act by suppressing the body’s response to inflammation, so if injected within a few months of surgery can increase the infection rate of a joint replacement.
2. Hyaluronic Acid
These injections aim to reproduce the lubrication fluid in the joint. they have various names such as Synvisc, monovisc, durolane, cingal to name a few.  Following an injection most patients get around 4 months of reduced pain, with a small risk of an allergic reaction.
3. PRP Injections
In this technique your own blood is taken and is then centrifuged, with the healing proteins preferentially removed and injected back into the joint. There is a low risk of any adverse effects, and the pain is reduced for 6 months on average. For arthritis the evidence supports 3 low volume injections, or a single higher dose injection.
Radiofrequency Ablation
This relatively new technique aims to block some of the nerve fibres that transmit pain sensation from the knee. The procedure is often done under a light general anaesthetic or sedation, takes 10 minutes, and involves inserting small needles at specific locations around the knee. The procedure can provide up to 12 months of reduced discomfort, and so is a temporary solution.  Â
It’s a useful technique with a quick recovery. We generally use it on patients that are having a knee arthroscopy who have established arthritis, or patients who aren’t quite ready for a knee replacement for now.Â
This guide is for general information only and does not replace medical advice. Please consult your healthcare professional before starting any new treatment or therapy.Â
