Been told you need a hip or knee replacement? Here’s what you need to know…

 

We see a number of individuals coming in complaining of knee and hip pain and stiffness, told by a specialist they’re fighting the inevitable of getting that joint replaced. That might just be the case. However with the huge body of research showing the ability to avoid hip and knee replacements through conservative management (non-operative) measures, isn’t it worth at the very least giving non-operative treatment a real shot? 

The purpose of this blog post is to provide you with the facts and dispel some of the myths around hip and knee replacement, so you have the information you need to make a decision that’s best for you. 

 

Can exercise help my hip or knee arthritis? The statistics…

 

Research for individuals with osteoarthritic changes of the hip or knee, who were identified to be in need of joint replacement shows that for those who undertook 2 x 1 hour exercise sessions per week for a minimum of 6 weeks, incorporating neuromuscular exercise to improve joint stability, confidence in one’s knee and movement quality and strength can achieve the following optimal outcomes:

  • Reduced sick leave due to hip or knee pain
  • 1 in 3 stopped paracetamol, non-steroidal anti-inflammatory medications and opioids
  • 25% pain reduction on average
  • Improved function, quality of life and physical activity.
  • 2 out of 3 people delayed a hip or knee replacement by 2 years 

FACTS: These are the things we know to be true! 

  • Scans are poorly related to pain and disability. If you’ve been told your joint is “bone on bone” or “there’s no cartilage left”, it doesn’t condemn you.  Scans on healthy people with no hip or knee pain can also display these same findings on investigative scans. 
  • Rest and avoidance of activity makes pain worse 
  • Graded exercise is safe and helps 
  • 20% of people do not get any pain relief from knee joint replacement
  • Pain does not equal damage

 

MYTHS: The things you may have been told, but aren’t true. 

  • The degree of arthritis on a scan predicts your pain and disability levels
  • Rest is helpful
  • Only surgery will fix it
  • Exercise is dangerous
  • Pain equals damage (we know pain is multifactorial, and is not representative of the damage at a tissue level) .

 

What’s the best treatment for my osteoarthritic hip or knee? 

 

A holistic approach to OA treatment is considered optimal. Best treatment includes the following: 

  • Therapeutic exercise (relieves pain and does not harm knee cartilage nor trigger inflammation. In fact therapeutic exercise is safe for articular cartilage and if anything has been shown to improve articular cartilage health.) 
  • Weight control (1kg weight loss results in 2.2kg peak force reduction at the knee) 
  • Patient Education (understanding that movement and exercise in the right dosage and form is good for you!) 
  • Surgical review following a 6-12 week block of therapeutic exercise if you are still unhappy with your pain, function and quality of life. 

 

Our take:

As Physiotherapists, perhaps we’re a little bias. We know there will always be people who undertake conservative management and still need a hip or knee replacement at some point. However, with the benefits of exercise as a treatment for osteoarthritis of the hip and knee of exercise well researched, we think it’s a no brainer. Coupled with the global benefits of exercise on the mind and the body, and the fact that getting strong prior to a knee replacement results in better outcomes following replacement…you’d be silly not to give exercise a trial for a 6-12 week period prior to locking in your surgery date). Worst case, you get your replacement, recover quicker than you would have without exercise, and continue on your merry way. 

Leave a comment and let us know what you think! For more information, or to speak to a Physiotherapist about your hip or knee pain, call 8490 0777. Alternatively if you’re keen to get started on the path to avoiding or postponing a hip or knee replacement, book a time here. Thanks for reading. 

 

References: 

Bricca et al. 2018, BJSM; Bricca et al. 2018, ACR: Skou et al 2018. JosPT