Someday orthopedic specialists may be able to grow an entire new cartilage for a knee or a hip ravaged by osteoarthritis. Already, they can remove a few cells and grow small patches of it to repair lesions on the femur.
Meanwhile, companies have come out with new and improved hyaluronic acids to ease joint pain and upgraded the materials used in artificial hips and knees over the past two years.
But orthopedic surgeon Brett Smith thinks "global cartilage repair is a far way away," and the newly improved joints don't excite him as much as if he could guarantee them for a lifetime.
"I hate to sound so negative," says Dr. Smith, an adult reconstructive surgeon in the Center for Restorative Joint Diseases at Allegheny General Hospital, "but the biggest thing for me in terms of treatment is the things you can do for yourself."
And those are:
• Stay active and exercise. "It's well-documented, and the Arthritis Foundation has said this: 'If you decrease activities, your arthritis will get worse faster.' " Dr. Smith cautions the activities you engage in be noncontact, nonimpact activities. "Running is out; swimming is best; cycling is second best; and elliptical training is third best," he says. "Lifting is fine, not excessive weight, but lifting for endurance."
• Lose weight. "Just for the hip and knee," Dr. Smith says, "these are the biomechanics: They support three times your weight with each step. If you weigh 300 pounds and lose 100 pounds, that's 300 less pounds on your joints."
• Control inflammation. "Take anti-inflammatories like Advil or Aleve and take them consistently."
• Try glucosamine. Dr. Smith also suggests taking the supplement called glucosamine. "There was a recent article published on glucosamine that says there is a benefit if taken for an extended period of time. If you take it for one or two months, no. You need to take it on a continuous basis for numerous months to find its full benefits.
"And that's all patients can do for themselves."
But if you do all that and still have excruciating pain in one of your weight-bearing joints, it does not mean you're headed to the operating room for a knee or hip replacement. There are other things an orthopedist can do to relieve your pain, particularly in the knee.
"We can do braces for the knee that unload the arthritic portions. We can do injections of hydrocortisone or hyaluronic acid, then physical therapy. What's great is aquatherapy," Dr. Smith says. "The other thing I can do is prescribe prescriptions ... Celebrex and a combo Celebrex and Neurontin. There have been numerous advances in the pain medicine field, including topical steroids like steroid Bengay. ...
"You could get one to 10 years out of conservative [nonsurgical] treatment; it just depends on how bad your arthritis is."
There aren't quite as many nonsurgical options for arthritic hips.
"There is no brace for a hip, and injections are not as successful," Dr. Smith says. "Hyaluronic acid is not FDA-approved for the hip."
And the help available for other arthritic joints is pretty much the same.
"Whether it's an ankle, big toe or an elbow, all that can be done and then there is some surgical option," he says. "It just depends on what option is available."
Pohla Smith can be reached at firstname.lastname@example.org or 412-263-1228.