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Step 8: Other options
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This step discusses other treatment options you may have heard about:

  • Transcutaneous electrical nerve stimulation (TENS)
  • Acupuncture
  • Glucosamine and chondroitin
  • Stress control
  • Surgery
  • Moving to a different climate
  • New techniques for cartilage repair

Transcutaneous electrical nerve stimulation (TENS)

This is a technique that directs small pulses of electricity to specific nerves. The aim is to reduce the sensitivity of nerve endings in the spinal cord, thereby closing the pain "gates." Although TENS is not effective in all arthritis sufferers, some people find it to be a practical means of pain control. The procedure, which produces a tingling sensation at the site of the electrical pads, has few side effects. (Some people have reported allergic reactions to the jelly used to apply the pads.) TENS instruction usually is provided by a physiotherapist, who can explain how to position the pads, select the correct electrical frequency and pulse strength, and time how long the treatment should last.

During transcutaneous electrical nerve stimulation (TENS), low intensity electrical pulses are passed across the area of pain to block pain carrying nerve signals.

Acupuncture

This may provide short-term relief of pain. If performed properly with sterile needles, acupuncture usually causes no harm. Acupuncture therapy is believed to work by stimulating the body's own pain-relieving hormones. However, acupuncture cannot "cure" arthritis -- its effects are temporary.

Glucosamine and chondroitin

Glucosamine sulfate and chondroitin sulfate are nutritional supplements. Because they are normally produced within the body and are used in the manufacture or repair of cartilage, the synthetic versions have been presumed to aid the body's repair mechanisms in osteoarthritis.

Several reports indicate that both supplements may indeed relieve the pain and stiffness of osteoarthritis, especially when combined with exercise, weight loss, physical therapy, and other measures. These effects tend to be mild, though, and both often need to be taken many months before any benefit is felt. Nonetheless, potential side effects appear to be minimal. As a result, while some people find glucosamine and chondroitin helpful, many find that they make no difference.

Glucosamine and chondroitin products -- like all dietary supplements -- are not subjected to the strict regulations of the Food and Drug Administration (FDA), so buyer beware. Arthritis sufferers should check with a physician before taking them, and, if glucosamine sulfate or chondroitin sulfate are already being used, report such use (and the use of any other nutritional supplements) to a physician.

Stress control

Emotional stress sometimes causes arthritic symptoms to worsen. Repeated daily stresses -- such as money problems, traffic jams, or shopping difficulties -- may increase joint discomfort.

Although emotional anxiety does not appear to be as important a factor in osteoarthritis as it is in rheumatoid arthritis, osteoarthritic pain may develop after stressful life events, like the loss of a loved one or separation from a spouse.

Arthritis itself is a source of stress.

  • Individuals may feel trapped in a vicious cycle in which arthritic pain causes stress, and stress causes more pain.
  • In addition, they may have a low self-esteem and feel a loss of control because of arthritis-related concerns such as pharmaceutical bills, side effects from medicines, limited mobility, or unwelcome physical changes.

Stress management techniques are especially significant, because they can help people regain a sense of control while relieving their arthritic pain.

Proven techniques for stress management include:

  • Muscle relaxation
  • Controlled breathing
  • Biofeedback
  • Self-hypnosis
  • Time management
  • Social support
  • Assertiveness training
  • Coping skills training

Other techniques that may help include therapeutic massage, yoga, and physical therapy.

Surgery

Although recent advances in joint surgery have improved the lives of millions of people throughout the world, surgery is NOT the first line of treatment for osteoarthritis.

Surgery is reserved for people who have:

  • Severe pain that is not relieved by available treatment methods
  • Marked joint instability
  • Significantly impaired ability to perform important daily activities due to pain and loss of mobility

Before surgery is contemplated, simpler treatments are usually tried first. Moreover, most surgeons prefer not to perform operative procedures in younger people unless their quality of life is severely affected by arthritis.

When surgery is necessary, it is performed by an orthopedic surgeon -- a specialist in surgery of the bones and joints.

There are four main types of surgery available:

  • Fusion
  • Osteotomy
  • Arthroscopy
  • Total joint replacement

Fusion

Fusion of the joint, otherwise known as arthrodesis, is a procedure in which the surfaces of the joint are removed and the bone ends are united. This provides pain relief and stability, but the joint cannot bend.

Lack of mobility is a serious disadvantage of this procedure. Nevertheless, this is the preferred surgery for some younger individuals who have a single involved joint. Mobility in the other joints often will compensate for the loss of movement in the fused joint. The joints most commonly fused are smaller joints, such as those in the toes or fingers.

Younger people with severe arthritis of the hip or knee, in whom fusion was once offered, are now considered for total joint replacement (see below), though depending on the individual a fusion may sometimes be preferable.

Osteotomy

Osteotomy is an operation in which the surgeon cuts the bone below the affected joint, realigns it, and resets it in a better position. This procedure changes and improves the contact between the remaining healthy areas of cartilage in the joint. Afterwards, the painful areas do not rub against each other.

Click the icon to see an illustrated series explaining a tibial osteotomy.

Osteotomy provides pain relief and leaves the joint mobile. However, it can only be performed in a joint that is not already stiff. Osteotomy usually is reserved for joints with uneven damage. It is not performed frequently, although the procedure sometimes is a good choice for younger arthritis sufferers, since it can prevent further joint damage and postpone the need for joint replacement surgery. [For example, osteotomy of the tibia (shinbone) is performed to correct curvature and weight-bearing in the lower leg of adults with osteoarthritis of the knee.]

Arthroscopy

Through the use of arthroscopy -- the examination of the inside of a joint using a device that contains a tiny video camera -- the physician can look for damaged tissue directly within the joint.

A small incision is made through the skin alongside the affected joint. Then, microsurgical tools are used to remove areas of cartilage or cartilage fragments that are causing irritation and thoroughly wash out the joint. Arthroscopy is an outpatient procedure and does not require an overnight stay in the hospital.

Arthroscopy may provide temporary relief from symptoms -- especially those caused by cartilage tears or particles. However, it does not stop the progression of osteoarthritis. It may help for a month in some, 6 months or much longer in others, and sometimes not at all.

Total joint replacement

Total joint replacement involves the complete removal of the painful joint, which is exchanged for a fabricated appliance. The artificial joint can be fashioned from a combination of materials, including stainless steel, Vitallium (a cobalt-chromium alloy), titanium, and high-density polyethylene plastic. Silicone rubber occasionally is used for joint replacements (such as the hand or base of the thumb), if the surgeon elects not to fuse the joint.

The hip and knee have shown the greatest successes of all joint replacement surgery. Over 90% of people are free of pain and have good mobility following hip replacement surgery for osteoarthritis. Other joints that are less commonly replaced are the shoulder and elbow.

Click the icon to see an illustrated series explaining a knee replacement surgery.

Click the icon to see an illustrated series explaining a hip replacement surgery.

Unfortunately, joint replacements tend to last only 10 to 20 years. But another replacement generally can be performed, if needed.

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Question & Answer

Q: I have osteoarthritis in my hip joint. Will I need surgery to correct it?

A: Very likely, no. Most people with osteoarthritis never need to have surgery. Surgery only becomes an option if the person suffers from:

  • Severe pain that is not relieved by available treatment methods
  • A dramatically impaired ability to perform daily activities
  • Marked joint instability.

Simpler treatments must always be tried before surgery is considered.

Q: Will moving to a different climate improve my osteoarthritis?

A: It is well known that arthritis sufferers often feel more joint pain in damp locations, just before it rains, or sometimes during humid periods. However, osteoarthritis occurs in all climates. The effect of the weather really is a temporary effect on symptoms and does not actually affect the disease. This means that climate does not improve or worsen arthritis, although it may affect the symptoms.

New techniques for cartilage repair

Many people have heard reports about new techniques to repair damaged joint cartilage. Such techniques include a surgical procedure known as "cartilage transplantation" and "cartilage regeneration."

Cartilage transplantation has been performed in Europe, but its availability in the U.S. remains largely experimental.

 

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Review Date: 12/24/2012
Reviewed By: Ariel D. Teitel, MD, MBA, Clinical Associate Professor of Medicine, Division of Rheumatology, NYU Langone Medical Center. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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