As we age, the cartilage in our joints begin to deteriorate. Years of use will gradually wear down the cushion provided by cartilage and can lead to inflammation, swelling and, finally, arthritis. While joint replacement may be required eventually, Daryl Dykes, MD, of Alabama Bone and Joint Clinic offers several non-surgical options for patients to help them avoid surgery for as long as possible.
"Osteoarthritis is the most common cause of joint pain, and trauma and obesity tend to accelerate that process," he says. "If you have a history of those issues, your joints tend to wear out at 60 to 70 years of age."
Both medical management and lifestyle changes can help reduce pain and manage symptoms. "Weight loss of as little as 10 percent of body weight can lead to a significant decrease in pain," Dykes says. "NSAIDs, physical therapy, steroid injections and hyaluronic acid injections are the primary non-operative treatments that I use if other measures fail."
When a patient reaches the point where none of these treatments work, Dykes will recommend surgery. "I tell patients they will know it's time for surgery when they can't sleep at night because of pain or they can't travel or do basic things with the family," he says. "When patients begin to have sensations of the knee or hip giving way, they become prone to falling which can have huge ramifications for their lives. A new joint can help them maintain their independence."
When surgery becomes necessary, better implants and advanced treatments are making the procedure easier for patients. "Multimodal pain management is becoming a popular way to keep surgical patients comfortable," Dyke says. "I use a regimen of spinal adductor canal blocks and intracapsular blocks to numb the joint, along with anti-inflammatories and pain medicines that block nerve impulses. I rarely see a patient distraught from pain. Most are comfortable and their pain is manageable. In my opinion, this is the best innovation in the past two years."
There is a constant evolution of implants, metallurgy, and plastics used in joint surgeries. "The plastics are denser, they wear better, and they are less likely to de-laminate," Dykes says. "I use a plastic that is infused with Vitamin E. It prevents breakdown of the plastic, so the patient gets more longevity from the implant. I think we will have much more than 20 years of use with these new implants."
An innovation in wound care management is making recovery from these surgeries easier for both patients and doctors. The Prevena™ Incision Management System is a negative pressure wound therapy device intended for use on surgical incisions that continue to drain following sutured or stapled closures. It prevents fluid accumulation under the skin which can increase the risk of infection.
"I like this system because the patient can do rehab, flex, extend and shower with this wound dressing system. This has been a great device for patients," Dykes says. "Patients have enjoyed the convenience of the system because they don't have to wait days to shower, and the dressing decreases the hassle of wound care following surgery.
While most people will see an orthopedist when they begin to have problems with a joint, Dykes says that most primary care physicians can manage the non-surgical care of these patients and help to postpone referrals to an orthopedist if they are comfortable with intra-articular injections. He adds that the physicians also can improve surgical outcomes by optimizing the patient's medical conditions.
"Primary doctors also can provide weight-loss counseling, physical therapy, and anti-inflammatory medicines. Many of these patients just need reassurance," Dykes says. "The doctors can help maximize the health of these patients by trying to control their overall physical condition. For instance, studies show that a hemoglobin A1C level greater than seven and a body mass index (BMI) higher than 40 can increase the risk of infection and wound problems significantly. Medical doctors can help improve a patient's overall health which will make them better surgical candidates."