Hip, knee pain have many causes, varied treatments

SALT LAKE CITY — What to expect from hip or knee replacement, how to prevent wear and tear on those joints and pain management were among the questions asked Saturday during an exceptionally busy Deseret News/Intermountain Healthcare Hotline.

The demographics of the callers are to some extent the story of failing hips and knees: Callers ranged in age from their 40s to 91, and they were about evenly divided between men and women. The calls, fielded by orthopedic surgeons Dr. Brandon Ferney of The Orthopedic Specialty Hospital and Dr. Rhett Hallows of LDS Hospital, came from as far away as Maryland and Manitoba, Canada.

Asked what to expect from knee replacement surgery and how to prepare, Hallows said studies indicate that with arthritis, working on strength of the large front thigh muscles helps, as do range of motion exercises. Such "prehab" is similar to rehabilitation after the surgery.

The two doctors agree that pain should be addressed early. There are many treatment options, from therapy and strengthening to steroid or viscosupplement injections, that may provide relief to closely monitoring arthritic damage.

"See a doctor and see what's going on," Hallows said.

The time to consider surgery is when pain is bad enough to strip your life of activities that matter to you, Ferney said. "At least that's time to talk to an expert."

The exception is for patients with serious heart problems for whom the rigors of the surgery itself could be dangerous. Then, Ferney said, it's important to consult a cardiologist to learn the risks and weigh it against possible benefits.

After joint-replacement surgery, he recommends low-impact exercises such as swimming and cycling and avoiding running and jogging, which are harder on joints.

One caller asked if he could have a hip surgery with cemented replacement joints, rather than "pounding" the new joint into the patient's bone. The strongest replacement hips allow a patient's own bone and tissue to grow into and around it. Those are pounded in. But Hallows noted that some people have bone conditions that won't allow that.

They told a number of callers there are various reasons for arthritis, from an injury to genetics, but worn-out cartilage is arthritis.

Intermountain and Deseret News team up for the hotline on a different topic the second Saturday of each month.

e-mail: lois@desnews.com

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