“You don’t have to have surgery.”
Six words you might not expect to hear from an orthopaedic surgeon! But it’s true: when it comes to serious knee problems, surgery isn’t always the answer.
In fact you might be surprised to learn that it’s usually not the answer. Of all the patients we see here at Chris Bailey Orthopaedics, roughly 60 to 70% will end up being treated conservatively – that is, without surgical intervention.
Why would we avoid surgery? There are several reasons. Firstly, it’s invasive. It takes time for your body to recover from it. So it follows that surgery shouldn’t be undertaken lightly. Sometimes the surgery is right but the timing’s wrong – if you’re struggling with a serious illness, for example. And sometimes we can achieve a similar, or even a better, outcome by using other options.
So what are the alternatives to knee surgery? Here are five.
With pain medication, we’re aiming to relieve the symptoms of a knee problem. If that problem is reversible – an injury, say – it can buy time. We can use it to let the body heal itself naturally, or wait to see how the injury develops before moving to treatment. If the problem is arthritis, it’s more about managing those symptoms to make life more comfortable. Pain relief comes in a kind of ‘ladder’, starting with over-the-counter medicines like ibuprofen (which is also an anti-inflammatory) and paracetamol, before progressing to more powerful codeine-based drugs, and finally opiate medications or analgesics for nerve pain.
We can also treat knee pain with injections into the joint. There are two main types. Corticosteroids reduce inflammation, targeting the swelling and friction that worsen pain. This can be a big help with arthritis, particularly if you are prone to acute flare-ups. The effects generally last from six to 12 months. Hyaluronic acid injections aim to supplement the level of this naturally-occurring molecule in your joint. Think of it as a gel rather than an acid. Its chief function is to provide lubrication – and injecting it may therefore help to reduce pain and inflammation.
Some knee problems are best treated with supports. Here the idea is to help the healing process by easing pressure away from the problem area. If you’ve had a ligament injury, for example, we might recommend a brace to provide extra stability to your knee; there are various types depending on the instability involved. If you have a malalignment problem, an ‘offloader’ type brace can encourage the joint to move differently, shifting your bodyweight away from the damaged area.
Physical therapy can be particularly helpful if your knee pain is related to a muscle issue. Weakened muscles provide less support to the joint which, naturally, increases pressure on the knee. A good physiotherapist will show you build up leg muscles – like the quadriceps, for example – in just the right way. Over time, this can help to increase stability and reduce stiffness.
Our osteoarthritis patients often ask us about supplements. They are usually thinking about things like glucosamine and chondroitin sulphate, both of which are naturally present in knee cartilage. Adding them to your diet sounds logical, but the science is inconclusive. Studies have tended to show limited or no effectiveness in improving pain relief or joint damage. Having said that, around one in five patients who take a supplement tend to report some benefit. For that reason you may feel it’s worth a try. If you see no benefit after six weeks, it’s probably not worth continuing.
Keen to find out more about non-surgical options for your knee treatment? This blog is just a small part of the picture. If you’d like to discuss the alternatives in more detail, we would be very happy to help.