How can osteoarthritis be managed before surgery is considered?

In this informative article, revered consultant trauma and orthopaedic surgeon Mr Jose Blanco shares his expert insight on when surgery is indicated for patients living with osteoarthritis and the various conservative approaches used to manage the condition. The leading specialist also details the importance of maintaining physical activity levels through both physiotherapy and regular walking.

How can osteoarthritis be managed effectively before surgery is considered?

Prior to surgery, osteoarthritis has a long protocol of approaches which aim to manage the condition and this process usually begins with the patient’s GP. Typically, this would involve routine treatment with pain killers while trying to maintain function, which is probably the most important part of the whole process. Patients will also be referred for physiotherapy and will get advice about the benefit of hot and cold compresses on the affected joints which can help to improve pain symptoms.

Generally, we consider paracetamol as the first line of treatment. The latest guidelines advise using anti-inflammatories which are applied topically to the affected joint for pain relief. Ultimately, if this is not sufficient, we may add in more tablets up to opioid or morphine type medications, which are clearly much stronger.

In terms of non-drug or pharmacological methods of treating arthritis, we often talk about exercise and maintaining activity. This doesn’t have to be exclusively with physiotherapists and a great deal can be achieved by going for regular walks to maintain your activity levels. When the distance you are able to walk and your ability to perform daily tasks start to really deteriorate, it may be time to think about surgery to minimise and prevent that loss of function.

Probably the single biggest thing that a patient can do to help with their osteoarthritis is weight loss. In the initial stages, losing excess weight will help by reducing pain and will allow you to walk further and do more. Ultimately, it’s such a valuable thing to do because it will also improve the longevity of your joint and any replaced joints, as well as helping with the surgery and minimising the risks of blood clots, infections and any complications that can arise from obesity in an operation.

Walking aids and orthotics, such as walking sticks and low impact shoes, can also be beneficial in offloading the joints and making them more comfortable. They can, however, be a bit of a mixed bag and a lot of patients don’t like the idea of using a walking stick. However, if conservative measures can buy you more time and they make you more comfortable, they are definitely something worth considering. They can also help to get you used to the idea of using a walking aid for a short period after your surgery.

Glucosamine and Chondroitin used to be recommended and in fact, acupuncture was for a long time approved by NICE guidelines but more recently these treatments have fallen out favour. Nonetheless, if these treatments work for you, they should be encouraged.

Recently, many of my patients have mentioned adding turmeric, which is known to be a natural anti-inflammatory, to their diet. My advice is that if it works for you, whether there is a huge evidence base for it or not, it’s certainly worth doing. I would never recommend that patients stop taking something that was of benefit to them, just because there was no evidence to justify it. If it helps with your pain and it delays your surgery, it is certainly beneficial.

Is surgery always necessary as a treatment option for osteoarthritis?

No, surgery is not always required and is very often the end point of osteoarthritis treatment. Surgery is a very effective tool and certainly, operations like total hip replacements are very well recognised to be extremely effective.

I think it’s very important that the patient is assessed holistically and this should include all aspects of their lifestyle, not just the arthritic joint. For example, some patients might have a particularly active lifestyle involving a lot of sports and they want to be at a certain activity level in order to maintain this, but are unable to do so with their arthritis. In cases such as these, the threshold for surgery may well be slightly lower than in other cases. It is well known that being unable to engage in the activities you want to can have an effect your mood and can even lead to depression or other issues. It’s important not to neglect these other key concerns by concentrating simply on the joint when considering if surgery is indicated.

Pragmatically, most people want to know the impact that surgery will have on their work and for some people, the necessary downtime is something they are not willing to commit to at a particular stage in their life. Conversely, some patients feel that they are unable to work because of the restriction in their function caused by arthritis.

When considering surgery, we assess issues around co-morbidities, the risks of surgery and attitudes to exercise and pain. Another key factor is the impact of end stage arthritis on a person’s ability to sleep. Trying to cope with and manage your arthritis in the context of your everyday life is challenging and with the addition of a really poor night’s sleep, it’s very difficult.

Although surgery is not always the answer, it’s a really important part of the final treatment pathway for some patients.

If you require treatment for osteoarthritis and wish to schedule a consultation with Mr Blanco, you can do so by visiting his Top Doctors profile.