Mr Sean Curry MB BS FRCS (Tr&Orth)
Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital
Mr Mark Webb MBBS MSC FRCS (Tr&Orth)
Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital
Not everyone with advanced osteoarthritis may be suitable for a surgical intervention. So, what are their alternative treatment options — and how effective are they?
Our risk of developing osteoarthritis — a painful condition where joints become stiff and sometimes swollen — increases with age.
Yet osteoarthritis can develop at any time in our lives, explains Mr Sean Curry, Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital. “In the younger age group, it’s usually as a result of injury,” he says. “One of the worst knee X-rays I ever saw was a 27-year-old — although he was an ex-international rugby player who had suffered a ligament injury but carried on playing.”
Main challenges in osteoarthritis care
Osteoarthritis can develop in any joint, including hips, knees, hands and feet. Symptoms include aching, swelling and stiffness, which may start off as a twinge and becomes progressively painful.
If joint pain is stopping you from enjoying the things that give you pleasure in life, it’s important to see your GP, notes Mr Mark Webb, Consultant Orthopaedic Surgeon, The London Orthopaedic Clinic, King Edward VII’s Hospital.
There are, however, challenges to consider. For instance, if your osteoarthritis is so advanced that you need a hip or knee replacement, or other surgery, you may have to wait a considerable time for it. “NHS wait times are currently the longest I have known in my career,” admits Mr Webb. “These were long before the pandemic, but worse now. That’s not good for people who are in pain.”
If joint pain is stopping you from enjoying the things that give you pleasure in life, it’s important to see your GP
Mr Mark Webb
Although treatment is considered on a case-by-case basis, the under 60s may find it harder to reach the suitability threshold for hip and knee replacements. “Hip and knee replacements don’t last forever,” says Mr Curry. “Therefore, a younger patient may need two or three replacements in their lifetime. The trouble is these are progressively harder to accomplish from a technical point of view and the results may not be as satisfactory.”
Considering effective non-surgical alternatives
Thankfully, other non-surgical options are available. Physiotherapy and exercise are important in osteoarthritis management. Plus, corticosteroid injections can ease symptoms, although any relief only lasts for a matter of months.
However, a new injection of non-biodegradable hydrogel is now available, with controlled studies suggesting that it could offer benefits lasting two years or more. At the present time, though, this treatment is not available on the NHS.
“Data shows that most people who have the injection do not need further injections or surgery” says Mr Webb. “That’s exciting, however, it would be wrong to suggest that any injection – including this one – will significantly reduce waiting lists. The main goal is to keep people active so the need for surgery is lower, which will reduce waiting lists.”
“It isn’t a magic bullet,” agrees Mr Curry. “It’s not going to work for everyone and it’s not going to replace knee replacement. But if it keeps more of our patients active and doing the things they enjoy, then that’s our primary aim.”
