Even though Nigel is a surgeon, with certain conditions pursuing non-surgical treatment options are advised initially. In a small set of conditions, surgery may only be considered as a last resort, as not all conditions will have a greater benefit than risk ratio following surgery.
Nigel will discuss with you what is best for your condition in terms of treatment. Options may include non-surgical treatment, no surgery initially, or surgery.
Treatment Options
Non-surgical treatment options can be classified as follows and usually involve a combination of them:
- Medication/s
- Physiotherapy
- Injections
- Stem Cell Therapy
- Splints / Braces
- Activity modification
- Smoking Cessation
- Weight-Loss
- Natural Therapies
- Other therapies
Medication/s
Not everyone likes to take pills, however, you are not masking pain by taking painkillers or anti-inflammatory (NSAIDS) medications. A lot of the time especially for arthritis determining what your level of pain is important in guiding Nigel as to whether joint replacement is suitable for you or whether you need to trial painkillers or NSAIDS (if you are able to take them) before a knee replacement is considered.
There has been a lot of information recently regarding the use of anti-inflammatory medications. These studies have shown that there could be a link between taking an anti-inflammatory and heart attacks or strokes for those people that have pre-existing heart conditions. If you are unsure about what to do then please do not hesitate to discuss this with Nigel, or your GP.
Physiotherapy
Nigel considers a patients link with their physiotherapist as a vital and important component of rehabilitation for any condition of the knee whether surgery is indicated or not. For most patients Nigel will actively encourage you seeing a physiotherapist prior to surgery to start pre-surgery rehabilitation (pre-hab). This will aim to optimise your knee condition and look at giving you the best possible outcome after your surgery.
Injections
Rarely will Nigel consider an injection to be an effective non-surgical treatment option.
Steroid (Cortisone) injections
These may be considered for certain conditions but Nigel will discuss the reasons with you for or not for doing a steroid injection.
Hyaluronan injections
These are only indicated for a small sub-group of patients with arthritis and Nigel will discuss with you whether you may be a candidate for this injection or not. Recent literature is guarded against there use and they are expensive.
PRP (Platelet Rich Plasma) injections
There has been a lot of literature looking at PRP in Orthopaedic surgery. To date the systematic reviews (these are reviews that look at all studies in the literature) are not conclusive and hence there remains debate on whether there is a benefit to be gained.
Stem Cell Therapy
Is an exciting development in Orthopaedic surgery. The literature supports there use in tendon healing / regeneration. However there is no conclusive support to say stem cells are better than other treatments for articular cartilage (cartilage that lines the bones and forms a joint) defects. This form of treatment is also very expensive. There is still a lot of work that needs to be done to understand how stem cells work, and if they are better than what is already available. If this is an option Nigel will discuss this with you.
Splints / Braces / Taping
For some people and for some conditions it may be wise to wear a brace prior to surgery, following surgery, or as part of your rehabilitation, or as part of your return to sport. Nigel will be able to outline if you require bracing at any point of your treatment.
Bracing unless the brace is custom-made for you is generally nothing more than a psychological warming blanket for knee conditions. By all means if you think it helps you continue to do so, but it is unlikely the brace will be able to prevent further damage or the progression of your knee condition.
Taping is utilised most often on the sports-field. Although initially effective, it has been shown that within 10-15 minutes of commencing an high-impact activity that taping does lose its effectiveness in trying to prevent what it was set out to do.
Activity Modification
It may be necessary to modify work, leisure, sports activities to help alleviate some or all of your symptoms. By doing this, you may even be able to delay or not undergo surgery altogether. It is also an excellent opportunity to evaluate what activities will help preserve and subsequently restore knee function. Sports activities must be carefully evaluated as further injury to your knee could result in more complex surgery with a potential for a poorer result than if you had not continued with sports
Smoking Cessation
Everyone knows the risks of smoking on a person’s health. What people fail to realise at times is that smoking affects healing of all tissues, and slows down healing of all tissues (cartilage, bone, meniscus, tendon, ligament). Most importantly it increases the rate of infection and increases complication rates significantly. If you smoke Nigel will tell you in no uncertain terms that you either need to quit smoking or cut-down significantly for an extended period of time.
Weight-Loss
Given Australia is one of thee most obese nations on the planet (based on per capita figures) weight gain has become an important health issue.
As part of your treatment for your knee condition, if you are overweight, Nigel will ask that you consider weight-loss as part of that treatment. He will be more than happy to refer you to a dietician. If you are extremely overweight he may ask that you consider a surgical option to reduce your weight prior to surgery.
The reasons for this are that any extra weight places extra stress on your knee joint and may in fact be accelerating the progression of certain conditions.
Weight-loss has been shown to be effective in alleviating some of the symptoms associated with arthritis, and not only does it help your knee, it will also help reduce or improve other conditions that may exist, importantly – blood pressure, diabetes, risk of heart disease, heart attack, blood clots and stroke.
It has been shown that you only need to lose 5% of your body weight irrespective of how much you weigh. Losing that amount of weight will improve your symptoms in the majority of patients.
Natural Therapies
There has been an explosion of the use of natural therapies in all conditions
With respect to the knee, glucosamine, chondroitin sulphate, fish oil, and krill are used most often.
Unfortunately the systematic reviews are conflicting in that there is either not enough evidence, no evidence, or conflicting evidence as to there use.
Initial claims by suppliers that they re-build damaged cartilage were unfounded. It is now thought that both glucosamine and chondroitin sulphate act as natural anti-inflammatories.
The effect Nigel has seen with his patients are no effect, through to patients swearing by them. Nigel’s take on them is trial them for 6 weeks. If you consider them to be of benefit to you, then continue to take them. If you feel you have had no benefit then stop taking them.
Other Therapies
There are a wide variety of other therapies available in Victoria, ranging from chiropractic, osteopathy, acupuncture, massage, creams, balms, other natural remedies, various cultural therapies which may help and provide a good feeling but will not prevent the progression of or stop further damage occurring to the knee.
Please feel free to discuss any therapy that you have been trialing with Nigel, he is always more than happy to discuss these with you.
