When to Consider Surgery for Joint Pain

Andrew M. Pepper, MD July 23rd, 2021

Many times, when patients experience hip and/or knee pain, they don’t know where to turn. I have heard patients express reluctance to seek care because they are worried that a provider will only recommend surgery to address their problem. While many surgical treatments of hip and knee pain have been proven to be safe, effective, and long lasting, surgery is not the only option and often is the last resort after trying more conservative treatments first. The goal of this blog post is to discuss the common causes of hip and knee pain, the common process by which Rothman providers treat patients with these problems, and finally guidance on when to consider surgery to treat hip and/or knee pain. 

Osteoarthritis Hip and Knee Pain

One of the most common causes of hip and knee pain in patients 50 years of age and older is osteoarthritis (or “degenerative arthritis”). Osteoarthritis is the degeneration of our joints over a lifetime of activity. Thankfully, there are a variety of non-surgical treatments that provide relief and allow patients with hip or knee arthritis to remain active and retain their desired quality of life. 

Orthopaedic providers are well trained in caring for patients with knee and hip pain and are committed to offering patients a variety of treatments that follow evidence-based medicine and are proven to be safe and effective. 

Modification and Physical Therapy for Osteoarthritis

Patients with osteoarthritis clearly benefit from initial simple treatment measures, such as altering their activities to accommodate their level of pain and function as well as evaluating their body weight and its effect on hip/knee arthritis. Commonly, patients can see improvements in pain and increased ability to be active by a combination of activity modification and weight loss. Even small decreases in body weight can cause significant reduction of stress on an arthritic joint and allow patients to reduce their pain and remain active. 

Formal physical therapy can help strengthen weak muscles and loosen up stiff joints, both improving performance of arthritic joints. Next, simple medications have been found to improve the quality of life for patients with osteoarthritis and the most common type of prescribed medications are anti-inflammatories. For most patients, these medications: decrease pain and swelling, improve motion and ability to be active, and are typically safe. Your doctor will guide you on appropriate medications that take into account your personal medical history and overall health. 

Joint Injections for Osteoarthritis

After these initial steps, some patients are candidates for joint injections that include steroid injections and viscosupplementation. Depending on where you are experience pain, injections of steroid medications or possible viscosupplementation (a thick fluid the decreases inflammation and attempts to support the normal lubricating fluid naturally found inside of our joints) may be simple treatments that can lead to periods of improvement in pain/swelling and improve quality of life and activity levels for most patients. Your orthopedic provider will discuss with you if and which injections are appropriate for your specific situation. Thankfully, common injections are typically well tolerated with very low risk of side effects. The downside of injections is that while they can provide relief of pain, they do not ultimately change the underlying problem of joint degeneration. These are typically thought of as “symptomatic” treatment, as it will not ultimately change the amount of degeneration in the affected joint. 

Every patient is different, and while those treatments noted above are the most common, there may be more non-surgical treatments depending on the underlying cause of your joint pain. Forming a trusting relationship with your orthopaedic provider is important in evaluating your specific problem and determining a treatment plan that works for you. 

When Should I Turn to Surgery?

As a joint replacement surgeon, one of the most common questions I am asked is “when should I consider surgery.” Answering this question for patients is one of the best parts of my job, as it allows me to educate patients about their health, discuss all of the options specific to their problem, and many times I can recommend a surgical procedure that will drastically improve their life for decades. Ultimately, when discussing hip and knee pain caused by osteoarthritis, the answer to “when is surgery right for me?” is different for every patient. Common to almost all patients is that a standard attempt at conservative, non-surgical therapies should be attempted first. Many times, a combination of non-surgical treatments can provide patients the pain relief and quality of life that allows them live a happy and healthy life. 

But when non-surgical treatments don’t provide the desired pain relief or activity level, or when they stop being as effective as they used to be, this is typically when surgical treatments become appropriate treatment options. After reasonable attempts at non-surgical treatment, many patients are candidates for hip or knee replacement surgery. Both hip and knee replacements are surgical procedures that reliably result in pain relief and improved quality of life. My most common answer to patients’ questions about when to consider surgery is this: when intial treatments have been attempted and don’t provide the desired outcome, surgery is a good option when your level of pain and function are significant enough to affect your daily quality of life. I also counsel patients on the risks and benefits of surgical treatments, allow them to ask questions and provide answers, and ultimately let patients make the right decision for them at the right time of their life. 

It is completely natural to want to avoid surgery or to be anxious about undergoing a surgical procedure. But I hope that the information that I have provided here answers many of the questions/hesitancies that keeps patients from seeking care for their hip and knee pain. While surgery can be an exceptional treatment, it is not the only treatment. Forming a trusting relationship with your orthopedic provider will allow you to explore the treatment options that are right for you. 

Dr. Andrew Pepper is a joint replacement surgeon and sees patients in Winter Park, FL. To schedule an appointment with Dr. Pepper, please visit RothmanFL.com or call 844-407-4070.

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