Considering a Joint Replacement? Try These Therapies First

If you are living with pain in your knee, shoulder, or hip that is interfering with your ability to go about your day normally, you may be curious about medical therapies and treatments that could help.

Our orthopedic specialists are among the region’s best and work closely with you to find lasting relief that may not necessarily mean joint replacement surgery. With a range of non-operative therapies available, you have plenty of options to choose from that can bring you the relief you need.

Scott Biehl, DO, is a sports medicine and interventional orthopedic specialist at RRH Orthopedics – Greece and Linden Oaks and sees patients in various stages of joint pain each day. He explains how patients and providers work together to determine if and when a joint replacement should happen, and the types of therapies available for people with joint pain.

Therapies to try before joint replacement surgery

NSAIDs

Non-steroid anti-inflammatory drugs (NSAIDs) are a typical starting point for first-time patients experiencing joint pain. Over-the-counter and prescription dosages of these medications can provide some level of relief in some cases.

Physical therapy

This is often one of the most underestimated treatments for joint pain. Physical therapists take your medical and personal history, perform a physical exam, and use a wide variety of tools to understand and treat underlying issues related to your pain.

“If you have a painful joint, you may start compensating in different ways and all the muscles and ligaments designed to make that joint function as optimally as possible are not working the way they should be,” Dr. Biehl said.

Using stretches, exercises, manual therapy, and other methods as directed by a physical therapist can improve joint mobility and reduce pain in many patients.

“With physical therapy, you can fix all those supporting structures around the joint and it ends up prolonging the life of the joint and allowing it to function better and thus reduce pain over time,” Dr. Biehl said.

Steroid injections

Often, this is one of the first treatments sought out by patients with joint pain. A steroid injection puts liquid anti-inflammatory medication directly to the joint, with varying levels of relief. Most patients experience positive effects for about 3 months.

While steroid injections are effective at pain relief, they are a temporary solution and require repeat visits to achieve the same effect.

Viscosupplementation injections

Sometimes referred to as a “chicken shot”, this injection uses synthetic hyaluronic acid gel that mimics high-quality joint fluid to lubricate and cushion joints.

These injections cater to patients with knee and shoulder pain, often due to arthritis.

“I will usually tell my patients that it may take 2-3 weeks to notice a difference, but the goal is to give them decreased inflammation for a longer period of time,” Dr. Biehl said.

This type of injection is usually repeated every 6 months, and works well alongside steroid injections. Check with your insurance provider to see if this treatment is covered.

Toradol injections

Toradol (Ketorolac) injections have a similar effect to steroid and viscosupplementation injections. An orthopedic specialist will inject the liquid anti-inflammatory into the affected joint to relieve the pain approximately every 3 months.

Research shows Toradol provides similar outcomes of pain relief and improved joint function compared to corticosteroids.

Orthobiologics

Orthobiologics uses the body’s own cells to heal itself and provide pain relief.

Lipoaspirate and bone marrow concentrate injections harvest stem cells from different areas of a patient’s body – love handles and back of the hip bones, respectively – then inject them into damaged cartilage and tissue. This allows the stem cells to regenerate healthy new cells in the affected joint, promoting healing and pain relief.

PRP (platelet rich plasma) therapy collects concentrated platelets from a patient’s blood, then injects them into the damaged joint to accelerate tissue repair and reduce inflammation. Patients with knee arthritis in particular benefit from this treatment. Often, PRP injections can be done alongside viscosupplement injections

Younger patients often choose this option over steroid injections because it better preserves the joint issue compared to other methods such as a steroid, which does not create a healing effect.

“PRP in particular for an arthritic joint is like a fertilizer program for your lawn,” Dr. Biehl said. “If you use fertilizer on your lawn once, you can’t expect to get that outcome forever without using it again. Typically, this is used 1-2 times per year in most cases, but sometimes even less is needed. Lipoaspirate and bone marrow concentrate injections are usually used once in most cases, which is going to be like reseeding your lawn.”

While insurance does not provide coverage for orthobiologic treatments, patients with HSA or FSA accounts can use these funds to pay for treatments; otherwise it is considered an out-of-pocket expense.

How to know if you are ready for a joint replacement

The ultimate decision of whether you are ready for a joint replacement is for you to make. You need to decide if and when you are ready.

“There is not any objective criteria for an MRI or X-ray to show a certain result that would automatically lead to a joint replacement,” Dr. Biehl said.

Some patients may have MRI or X-ray images of their joint that looks severe but can get the relief they need from non-operative treatments. Other patients may not have severe damage or wear on their joints but are not finding the pain relief they need from those non-operative therapies.

Dr. Biehl reminds patients they are their own strongest advocates and that having a conversation with a joint replacement surgeon does not automatically lead to joint replacement surgery. The non-operative and operative orthopedic teams at Rochester Regional Health work very closely together, referring patients as they need it and collaborating to find the best possible outcome for each patient

“It never hurts to have the conversation,” Dr. Biehl said. “If a patient can come out of any visit better informed about their condition and the treatment options available to them, they're going to do better in the long term.”