Alternative Treatments for Joint Replacement

by Brett Whitfield, M.D., FAAOS

Alternative Treatments for Joint Replacement

There are more than a hundred types of arthritis, and 70 million Americans, or about one in three people, suffer from arthritic pain. Of these variations, osteoarthritis is the most common. It affects roughly 20 million Americans and is what we call a "wear and tear" arthritis. Osteoarthritis in your joints is like wearing the tread off your tires.

What are the treatment options for osteoarthritis?

There are three categories of treatment options: physical modifications, medications, and injection treatments.

Physical modifications

One of the most important things you can do to better manage your arthritis is physical therapy. You can do formal physical therapy in one of our clinics or you can regularly perform therapy exercises at home.

As you develop arthritis, your joints will become stiff and you won’t want to move them as much. Not moving stiff joints is the worst way to treat them. You want to stay active and keep moving your joints.

When it comes to exercising, do low weight workouts with high repetitions. Another great exercise for arthritic joints is pool therapy, also known as aqua therapy or aqua aerobics. Being in the water lessens the weight-bearing burden on your joints, making it easier to move and work out.

Maintaining a healthy weight is also incredibly important for managing arthritic pain.

The best thing you can do to help an arthritic joint is to reduce the weight load on that joint. For example, for every pound you lose, you reduce the pressure on the knee joint by four pounds. Weight loss is not easy. A nutritionist can guide you through the dietary options that are right for you.

Bracing is the final type of physical modification. Arthritic joints are often also unstable. A brace can stabilize the joint. For the right kind of brace, talk to your orthopedist.

A brace also provides pressure around the joint and to the skin. Your brain can only handle so many sensations at once, and many times the pressure sensation will override the pain sensation so your joint hurts less.&

The final thing a brace can do is provide warmth, especially in the winter. Arthritis often feels worse in the winter, and a brace can warm the joint and soothe pain.

Medications

There are various types of medications people can take for arthritis. The most common are NSAIDs or non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen. If you have other medical issues besides arthritis, you should consult your doctor before taking any medication.

I encourage my patients to consistently take anti-inflammatories for a short course (a week or two), similarly to how they would take antibiotics. Taking anti-inflammatories in this manner will build up a level of anti-inflammatory in your system, and there is a greater chance of the medication working to reduce the pain.

The second medication option is acetaminophen. If you're on a blood thinner or otherwise can’t take an NSAID, acetaminophen can help with pain. However, it only helps when it’s actively in your system, so it doesn’t have the build-up advantage that anti-inflammatories have.

There are also some topical medical creams and ointments such as Voltaren cream. These do not provide as much medicine to the area but are still helpful. Your physician can also write a prescription for more powerful topical medical creams if needed. This type of treatment doesn’t affect the kidneys and is a little bit safer if you have a history of gastric ulcers.

If you're interested in herbal remedies, I suggest looking into are curcumin and turmeric. They are spices that have anti-inflammatory properties. There isn’t any scientific data on them, but they are safe to try if you don’t want to try other medications.

One thing I must stress in terms of medications is in regard to narcotic medications. In my opinion, there is no role for narcotics in treating arthritis.

Injections

Injections are a slightly more aggressive treatment option than pills. They allow us to administer medicine directly to the area of arthritis.

When you take a pill, it is absorbed through the stomach. Some of the pill is broken down; some gets to one joint; some gets to a different joint. A pill follows an indirect route to the area of pain.

The two types of injections we usually use are corticosteroids and viscosupplementation shots, which people often recognize as lubricant shots. Steroid injections act like we injected an NSAID directly into the joint. Viscosupplementation shots don’t reduce inflammation but make it easier to move the joint.

There are some more progressive treatments available to patients, including a PRP (platelet-rich-plasma) injection. For a PRP injection, we take a sample of your blood and spin it in a machine. We take the anti-inflammatory components created in the blood from the spinning process, and we inject it into your joint.

This treatment is fairly new for arthritis, although it’s been used for other purposes for over a decade. While we are still looking at the effectiveness of this treatment, the injections are completely safe. Many studies show that PRP injections can be beneficial in reducing pain and inflammation.

The newest type of injection treatment uses stem cells. These stem cell injections are taken from bone marrow, adipose tissue, or umbilical blood. The philosophy is that if injected into a joint, stem cells can help reduce inflammation. Again, research is being done to see how effective the treatments are.

Tip summary

Keep those joints moving. If we don't move, our joints become stiff, so do your exercises. Walk on cushioned surfaces. Avoid asphalt if possible. Make sure you have the proper shoes to work out in.

Watch your diet. Weight has such a significant impact on our joints in terms of deterioration as well as causing pain when you already have arthritis. Stay away from pasta, breads, and very carb-heavy foods. Shop around the outside of the grocery store to avoid more processed foods and don’t shop hungry.

Start treatments early. Don’t wait until you can’t move due to pain to go see your orthopedist.

Frequently asked questions

What are your thoughts on CBD products?

There are a lot of supplements on the market, and the problem with them are that they only have to be proven safe. They don’t have to be proven to be effective.

The only experience I have with CBD is that some patients have told me it has helped. I think I's safe, and if you want to try it out, there’s no harm in doing so.

What are some treatments for arthritic pain in feet?

The foot is difficult because the structure is made up of a lot of different joints. Topical creams for the feet are helpful, and I often prescribe a cream that has lidocaine as well as an anti-inflammatory. If it’s neurogenic pain (from diabetes or nerve pain), there are also medicines your physician can prescribe to help.

Make sure your footwear is not too tight. I often see patients come in wearing sandals that are too tight which increases the pressure on their feet.

Do cryotherapy or ice packs help joint pain?

I don’t think it helps with joints. We use cryotherapy and ice treatments with athletes after training sessions. The cold constricts the blood vessels, decreasing the generation of lactic acid so an athlete can recover faster.

Cold therapy can help with swelling, however. If you have a swollen joint, then ice will be very beneficial.

Can you have hip arthritis after a hip replacement?

No, you cannot have hip arthritis after a hip replacement.

You no longer have any cartilage in your hip, so therefore you cannot have arthritis. You can have pain after a hip replacement from soft tissue impingements, loosening, or any multitude of things.

However, if you’ve had a partial hip replacement, you can develop arthritis on the other side of that hip that was not replaced.