January 21, 2022 by John Fernandez
Knee and Hip Arthritis: Self-Assessment and Management
Could the pain you are feeling be arthritis? Francisco J. Garcia, physician assistant at the arthritis clinic at Miami Orthopedics & Sports Medicine Institute, answered this commonly asked question when he addressed the self-assessment and management of knee and hip arthritis at a recent virtual community health discussion.
“The symptoms of knee and hip arthritis can impede your ability to exercise, participate in social activities and go on vacation, and this decrease in activity can lead to muscle weakness, obesity, falls and, ultimately, depression,” Mr. Garcia said.
Arthritis may be classified as osteoarthritis, inflammatory arthritis or posttraumatic arthritis, Mr. Garcia explained.
Osteoarthritis involves the degeneration of hyaline cartilage — the hard, slippery tissue that covers the ends of bones where they form a joint. The condition is usually caused by the wear and tear over time. The joints most commonly affected include the knees, hips, neck, lumbar spine and hands, Mr. Garcia says. Osteoarthritis is genetic- and age-related, with early signs manifesting around age 50.
Inflammatory arthritis is triggered by an autoimmune disease that attacks the lining of the joint capsule, most commonly in the wrists, hands, fingers, toes and knees. The inflammatory process can eventually destroy cartilage and bone within the joint, Mr. Garcia explains. The most common types are rheumatoid arthritis, gout, lupus and psoriatic arthritis. These diseases have a genetic component, can occur at any age and affect women more than men.
Post-traumatic arthritis is caused by a physical injury that damages the cartilage and/or bone and changes the mechanics of the joint, making it wear out more quickly. The injury can be from sports or a vehicle accident, fall or military injury.
Since the knees and hips bear weight, they are among the most common joints affected by arthritis.
Arthritis in the knee occurs when the cushion between the femur and tibia has deteriorated. When self-assessing your knee health, consider these symptoms of knee arthritis:
- Pain, which can be constant or intermittent and present with weight-bearing activities such as walking, standing or kneeling
- Deformity, which occurs when the knee is misaligned, causing knee varus (bow-leg) or knee valgus (knock-knee)
- Instability and gait imbalance
- Loss or decrease of range of motion
- Muscle atrophy
- Crepitus, which is a grating sound or sensation produced by the friction between bone and cartilage
Arthritis in the hip occurs when the cartilage in the joint gradually wears away and the protective joint space between the bones decreases. In addition to osteoarthritis, inflammatory arthritis and post-traumatic arthritis, this degeneration can be caused by hip dysplasia – a genetic condition in which the hip socket does not fully cover the ball portion of the upper thighbone.
When self-assessing your hip health, Mr. Garcia recommends that you consider these symptoms of hip arthritis:
- Pain with active and passive range of motion
- Pain with hip rotation
- Pain that radiates to the groin and anterior thigh, buttock or knee
- Decreased range of motion, including difficulty crossing legs, putting on shoes and trimming toe nails
- Hip tightness
- Development of limp
- Leg length discrepancy
To reduce the effect of arthritis on your quality of life, Mr. Garcia recommends seeing a specialist to evaluate your condition and initiate a non-surgical management plan to reduce your symptoms. Your conservative care plan may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, if tolerated
- Weight reduction – A one-pound weight loss leads to a five-pound pressure reduction on the knee
- Topical creams
- Natural products, such as chondroitin, glucosamine, honey, turmeric and ginger
- Assistive devices, such as canes, walkers or crutches
- Physical therapy, which can strengthen muscles and improve balance, gait and proprioception
- Low-impact exercise, such as swimming, walking, yoga, Pilates and Tai Chi – “Patients see better results when they combine low-impact exercise and/or physical therapy with other treatment modalities,” Mr. Garcia said.
- Injections, such as cortisone, hyaluronic acid, platelet-rich plasma, stem cells and amniotic fluid
“Injections can lubricate the joint and reduce pain and inflammation,” Mr. Garcia explained. “For the knee, a cortisone injection can provide two to three months of relief while a hyaluronic acid injection is effective for three to six months. Injections in the hip give short, mild relief but do not last as long as knee injections.”
When conservative treatments fail and pain affects your quality of life, surgical management may be warranted. Partial knee replacements and total knee replacements are performed under spinal anesthesia and sedation. Some patients will stay one night in the hospital while other qualified patients will be discharged home on the same day. Mr. Garcia recommends that all patients attend physical therapy for six to eight weeks to achieve the best outcome.
Patients undergoing hip replacement surgery also may stay one night in the hospital or be discharged the same day. The orthopedic surgeons at Miami Orthopedics & Sports Medicine Institute use the anterior approach, which protects soft tissue from damage, rather than the posterior or lateral approach, which has a longer recovery and increases the risk of dislocation and leg length discrepancy. Patients will be ambulating on the day of surgery and start physical therapy immediately.
For most people, joint replacement surgery is a game changer, providing pain relief, improved mobility and a better quality of life, Mr. Garcia says.