The resources below are intended to help you when you are researching information about orthopedic conditions and treatments. Please contact our staff at 817-968-1862 with any questions or concerns you may have.
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Whether you are a Baby Boomer or Weekend Warrior, we want to find a solution to your joint discomfort. We are dedicated to partnering with you to form a trusted relationship and improve your musculoskeletal health. Our goal is to deliver leading-edge technologies and advanced treatment options to help you rediscover your “go.”
Below are some trusted resources to help you when you are researching health information and finding out more about orthopedic conditions. Please contact our staff with any questions or concerns you may have.
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Helping You Get Back to Living
The most common type of arthritis is osteoarthritis, also known as degenerative or “wear and tear” arthritis. The joints in the body most commonly affected by osteoarthritis are the knees, hips, shoulders, back and fingers. The cause of osteoarthritis is not completely known but can be both hereditary and due to the events of living.
At The Texas Hip and Knee Center, we are dedicated to providing treatments to help you feel better, continue to lead a relatively active lifestyle, and hopefully slow the course of the disease.
Learn more about our Basic Arthritis Program and available solutions by reading the content below.
The most common type of arthritis is osteoarthritis, also known as degenerative or “wear and tear” arthritis. Osteoarthritis involves the breakdown of the gliding smooth surface of a joint called cartilage. Normal cartilage has the appearance and feel of a smooth, slick, white piece of rubber. Cartilage with osteoarthritis wears, cracks and breaks. As you would expect, this hurts. It may progress to the extent that all of the cartilage is gone, exposing the underlying bone.
The joints in the body most commonly affected by osteoarthritis are the knees, hips, shoulders, back and fingers. The cause of osteoarthritis is not completely known and can be both hereditary and due to the events of living. We know that people who have had previous injury to either a bone near a joint or the cartilage of a joint are more prone to develop osteoarthritis. People that are active in certain jobs or lifestyles are also more prone to develop arthritis, but this is mainly because that job or lifestyle puts the person at risk for injury, which then increases the risk of arthritis. Simple walking or “spending all day long on my feet” does not in and of itself cause arthritis. Obesity and abnormal alignment of the bones (bow legs) do increase the stresses on the cartilage and cause arthritis.
What can you do if you have osteoarthritis? We are constantly learning more about what causes osteoarthritis, but there is still no “cure” for osteoarthritis. This means that as of yet, there are no known medications or surgery that can restore your cartilage to “normal” once you develop osteoarthritis. However, there are many things that can be done to make you feel better and continue to lead an active lifestyle even if you develop osteoarthritis.
In looking at this information you should particularly note the following:
- This program is for Osteoarthritis. There are many types of arthritis, and the following treatments do not apply to all of them.
- This program is designed to reinforce and clarify some of the information given to you during your visit in the office.
- If you have a history of heart or lung disease do not start an exercise program without first consulting with the physician that cares for these problems.
- We generally try to progress from the top of the list and work down. If you have already tried the things at the top of the list then you may be starting further down the list.
- These treatments are written with the hip and knee particularly in mind. They may apply to other joints to some degree, but probably not as well.
In this discussion we try to cover the things that have some scientific backing, that make sense, and that have relieved the pain of arthritis according to my patients. This doesn’t mean that these are the only treatments available. There are new medications and treatments coming out all the time. You can find anything from acupuncture to gin soaked raisins to magnets that have been reported to help arthritis in somebody. I am not going to disagree with anyone who says that they have received some relief from any treatment, but I feel that to be responsible to my patients a new treatment should have some scientific evidence with good clinical studies before I recommend it to others.
This is probably self-evident. But you may not be aware that due to the mechanics of the hip and knee, every pound that your hip or knee has to carry translates into as much as four to seven pounds of pressure on the cartilage of the joint. The more weight on the cartilage the faster it wears out. To make a comparison, this is just like the tires on a car, which wear faster with a heavy load. Losing weight is not only good for your joint but, at least as importantly, good for your overall health.
Unfortunately, don’t look to me for any easy answers to this problem. As a general rule, fad diets don’t work, and any long lasting weight reduction will take a permanent change in activities and diet. Once again consult your primary care physician before starting an aggressive exercise program.
This might sound kind of crazy, and you might be saying “my knees hurt so bad that I can’t exercise”, but exercising can actually help the cartilage in the joints. Also we know that exercise is important for your general health, the strength of the bones, and for losing weight. The question then becomes not so much whether or not to exercise, but what kind of exercise is best. Generally exercises for people with osteoarthritis should be low impact and repetitive.
Without a doubt the best exercise for patients with arthritis of the hip and knee. This is like an instant weight loss program and your joints love it. There are several pools in the area with arthritis classes. They are all heated, and don’t think that you are the only one that hasn’t put on a bathing suit in years. Consult your local Arthritis Foundation for locations and programs near you.
Bicycle riding is often very therapeutic for arthritis. Most of the weight during bicycle riding is put on the seat so the knees and hips get moving pretty fast with little pressure on them.
We generally recommend stationary bicycle riding until you have little or no pain. Riding on the street is not as safe as stationary riding (particularly if you are thinking about your hurt knee), and does not always allow the exercise to be stopped if pain develops.
The seat should be set at a height such that you can just touch the pedal with your heel at the down stroke with your knee fully extended. Make the resistance light enough so that you can pedal at 60 to 90 revolutions per minute for 20 to 30 minutes without pain.
Walking is an excellent exercise that is recommended, if you don’t hurt. If your knees or hips hurt when walking, then you should try water exercises or bicycle riding that take the pressure of weight bearing off of your legs.
When walking, start with a short distance (maybe as little as 100 yds) and build up. Use cushioned shoes, of course.
Organized Physical Therapy
A short course of therapist directed physical therapy can be very helpful, but an extended cource is not usually recommended because of the cost. Exercises for arthritis will need to be continued for a long time and possibly for the rest of your life. A physical therapist can help you develop a plan.
A soft sole or cushion in your shoe can make a big difference particularly if you spend a lot of time standing on hard floors. Hard leather shoes, cowboy boots, or flats tend to make arthritic hips and knees hurt the worst. Although the style of cushioned shoes may not be fashionable, there are many styles available and the pain relief will probably make it worthwhile.
Often an elastic wrap around the knee can provide a little support and add warmth to the knee. Some people say that this helps. If you don’t mind the inconvenience or the cost it is probably worth a try. Probably an elastic brace or wrap bought over the counter is as good as a prescription model.
There are also some more expensive, prescription braces that may help in special cases. These are generally worth the cost and inconvenience only if you have osteoarthritis that involves just one area of the knee and a dramatically bowed leg. Further, these braces are usually less effective in people that are overweight.
You will see below that the list of medications to help you feel better by relieving pain is fairly long, but, unfortunately, the list of medications that actually improve the health of the cartilage is very short.
There are many of these medicines. Many of the ones that have been around for a long time are just as good as the new ones. These medications help most people, at least for a while. Unfortunately the complications with these medications are potentially significant, making the treatment of the disease worse than the disease itself. These complications include, in particular, bleeding, ulcers, liver damage and kidney damage. There have been some advances in the prevention of complications with these medications, but they should all be taken under the direction of a physician if taken for more than a month or so. As with any medicine, check with your physician to make sure that whatever medicine you want to take, even one bought over the counter, does not interfere with another medicine.
Let me say again that these medications do not cure the disease, but they can sometimes be taken and remain effective for years. Generally the risk of complications and side effects increases the longer that you take them.
I usually recommend starting with the cheapest and trying others from there. They can get pretty expensive ($2 / day).
This is my simplified opinion of the various drugs available based in part on the literature but also on my experience in treating patients:
Aspirin: still a good drug but tends to cause ulcers and bleeding
Ibuprofen (Advil, Motrin): probably the best place to start. Cheap, over the counter, about as effective as any of the others, but like all of the anti-inflammatory drugs it can cause the complications described above.
Lodine, Relafen, Feldene, Ansaid, Voltaren, Naprosyn, Anaprox, Dolobid (and some others I probably left out): Each of these may work in some people and not in others. They all have the same potential complications of anti-inflammatory medications.
Cox – 2 Inhibitors (Celebrex)
This medication is designed to spare the stomach from the side effects caused from the other medicines. It seem to work about as well at relieving pain as do the anti-inflammatory drugs. Other side effects can still occur (including stomach bleeding). Expensive.
Health Foods and Herbs
The only currently used medicines that I know of that possibly improve the health of the cartilage, rather than just relieving pain, are classified as health food supplements. These are Glucosamine and Chondroitin sulfate. To my knowledge there is no solid evidence that Glucosamine and Chondroitin sulfate actually make new cartilage grow, but they do seem to help most people to some degree. The mechanism for this is uncertain. Although the scientific data that supports these supplements is not as strong as we would like to see, I generally recommend them. They are usually taken together and cost about a dollar a day. I usually recommend that you give it a try for at least a month before giving up on it. They are available at most pharmacies, drug stores, or health food stores. I know of no studies that clearly show one brand to be superior to the other, and the content of the medication is not monitored by the government since they are classified as food supplements and not medications.
There are many other health foods and herbs that may help some people with arthritis feel better. I would refer you to a book named “The Arthritis Foundation’s Guide to Alternative Therapies” for more information.
There are basically two types of injections and both involve shots into the joint, cortisone and viscosupplementation (Hyalgan and Synvisc).
Cortisone has gotten a bad name over the last 10 years or so because for a long time it was overused. It is still an excellent drug in the right situations. The cartilage basically becomes less healthy and wears out faster if cortisone is injected into the joint more than 3-4 times a year. If the cartilage has already worn down to bone and the joint is destroyed, cortisone probably won’t cause additional damage to the joint. In general, the more severe the arthritis the less likely that a cortisone shot is likely to work. The length of time that a shot will help is difficult to predict and depends on the severity of the arthritis. Some injections may help for years; others may not help at all.
Viscosupplementation is a relatively new type of treatment that is given through a series of injections into the joint. The names of the two most commonly used medications of this type are Synvisc and Hyalgan. These medications may work in several ways including acting as a pain medication, lubricating the joint, and providing nourishment for the injured cartilage. Pain is usually relieved at least to some degree in about 50 to 70% of the people that get the injections. As with cortisone the success rate is lower if the disease is more severe. When the medicine works, it may be effective for up to 18 months. The major problem with these medications is that they require three to five injections and they are expensive, however when simpler methods have failed and surgery is the only other alternative they are probably worth a try.
If all of the above hasn’t helped or your pain is too severe to take the months that it may require for the above to work, surgery may be necessary. Like the other above treatments, however, surgery is not a cure for arthritis. Surgery is a treatment designed to alleviate pain and allow you to return to a more active lifestyle with hopefully much less or no pain.
The detailed description and indications for the various types of surgery is not included in this Basic Arthritis Program, but the three basic types of surgery for arthritis are arthroscopy, bone realignment, and joint replacement. If you have pain that limits your activities and that is not relieved sufficiently without surgery, then don’t be afraid to consider surgery. Although there is some pain with the operation and recovery, the pain relief with joint replacement surgery has made it one of the most common and successful operations in the world.
Is Joint Replacement For You?
Modern-day joint replacement surgery has been performed in the United States since the 1970s. Today, more than 700,000 total hip and knee replacements are performed each year — often involving individuals age 65 and younger in response to some form of arthritis.
Most individuals who undergo joint replacement experience pain relief and improved mobility. We will be happy to discuss whether joint replacement surgery will offer you the best chance for permanent pain relief and the ability to rediscover your “go.”
Consideration may also be given to treating your condition with anti-inflammatory medication, physical therapy, vitamins or some form of surgery other than total hip or knee replacement. Our ultimate goal is to get you moving forward with a restored quality of life.
Take the Joint Health Quiz
How much is joint pain affecting your daily life? Answer these brief questions to find out.
- Do you have trouble sleeping because your hip or knee makes you uncomfortable?
- Do you experience regular pain in your hip or knee?
- Have you had to cut back on everyday activities such as driving, working or playing sports?
- Does your joint pain require prescription medication?
- Are you forced to stop when you walk for more than 10 minutes, or when you climb a flight of stairs?
- Are you in pain more than four days a week?
- Have you suffered from this problem for more than one year?
- Have you been diagnosed with rheumatoid arthritis or osteoarthritis?
If you answered YES to four or more questions, surgery or treatment might be the right option for you to relieve pain.
Benefits of Joint Replacement
In addition to pain relief, the benefits of joint replacement include better use of the joint and increased flexibility, as well as better alignment of a deformed joint resulting from years of wear and tear, arthritis, a fracture that didn’t heal well or some other condition.
Our orthopedic surgeons will help you explore your options and provide information about joint replacement. We offer the latest and least invasive techniques to relieve joint pain. No matter what your treatment decision, we will be there every step of the way.
You Have Questions, We Can Help.
Questions about your joint replacement are to be expected. Here, you can get answers to some frequently asked questions about hip and knee replacement. Please contact our office with any other questions or concerns you may have.
Is joint replacement surgery permanent?
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, approximately 90 percent of people who have hip or knee replacement surgery will never need revision surgery. However, because more younger people are having joint replacements, and wearing away of the joint surface becomes a problem after 15 to 20 years, revision surgery is becoming more common.
What happens during hip replacement surgery?
The hip is essentially a ball-and-socket joint, linking the “ball” at the head of the thigh bone (femur) with the cup-shaped “socket” in the pelvic bone. During total hip replacement, a hip prosthesis is surgically implanted to replace the damaged bone within your hip joint.
What happens during knee replacement surgery?
During total knee replacement surgery, the surgeon removes damaged knee cartilage and bone. The procedure takes about two hours. The surgeon then inserts new metal and plastic joint surfaces in the knee to improve function and restore alignment.
How long will I have to stay in the hospital?
An important factor in determining your length of stay in the hospital is how well you heal after surgery. Your hospital stay may range from three to ten days.
Hip replacement surgery: Patients who have minimally invasive hip replacement surgery, requiring only several small incisions, may have a shorter hospital stay.
Knee replacement surgery: Patients are generally in the hospital for several days.
How should I prepare for surgery and recovery?
If you and your doctor choose joint replacement surgery for your joint relief, you will be thoroughly instructed on how to prepare for the procedure and what will happen during and after surgery. In general, here are some things you can do before and after surgery to make everyday tasks easier and help speed recovery.
- Learn as much as you can about your procedure.
- Arrange for someone to help you around the house for a week or two after coming home from the hospital.
- Arrange for transportation to and from the hospital.
- Set up a “recovery station” at home. Place the television remote control, radio, telephone, medicine, tissues, wastebasket, and pitcher and glass next to the spot where you will spend the most time while you recover.
- Place items you use every day at arm’s level to avoid reaching up or bending down.
- Stock up on kitchen supplies and prepare food in advance as much as possible.
- Follow your doctor’s instructions. A physical therapist or other healthcare professional may be included in your post-surgery treatment plan to rehabilitate your hip or knee.
- Wear an apron for carrying things around the house. This leaves hands and arms free for balance or to use crutches.
- Use a long-handled “reacher” to turn on lights or grab things that are beyond arm’s length. Hospital personnel may provide one of these or suggest where to buy one.
What should I expect immediately following surgery?
You will be allowed only limited movement immediately after hip or knee replacement surgery. When you are in bed, pillows or a special device are usually used to brace the joint in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid. Your doctor will prescribe medicine for pain or discomfort.
You will begin exercising on the day after surgery or sometimes on the day of surgery with help from a physical therapist. These exercises reduce the collection of fluid in the lungs after surgery and help speed recovery. As early as one to two days after surgery, you may be able to sit on the edge of the bed, stand and even walk with assistance.
How long will my rehabilitation take?
Full recovery from joint replacement surgery takes about three to six months, depending on the type of surgery, your overall health and the success of your rehabilitation.
Is joint replacement surgery safe?
Although the majority of joint replacement surgeries in the United States are performed without complications, there are some known risks associated with this procedure. When complications occur, most are successfully treatable. You should discuss the benefits and risks of this operation with your orthopedic surgeon. Possible complications include:
- Blood clots
- Loosening of the prosthesis
- Wear or breakage of the metal or plastic components
Knee Pain. Know More.
The older you get, the more important it is to be active. Knee pain is frustrating and can slow you down from doing the things you love to do, like taking walks or chasing your grandchildren.
Texas Hip & Knee Center has spent years advancing the diagnosis and treatment of knee pain problems. With new and less invasive techniques, we minimize your downtime, getting you up and going again, faster — it’s what we do.
Let us answer your questions about what causes chronic knee pain, and help prepare you with valuable information, potential treatment options, and how to take the next steps.
Q — Is my knee pain arthritis?
A — Stiffness and limited range of motion could be symptoms, especially if the pain worsens with activity. Other indicators may be swelling, degeneration and deformity. Together, we can determine what the best arthritis treatment options are for you.
Q — Can I avoid knee surgery?
A — There are several great options for treating knee pain that possibly can help you avoid surgery. Weight loss and low impact exercises are a few possibilities to consider first. Wearing a knee brace or sleeve when walking or being active can also help with knee pain and discomfort.
Once your doctor fully understands your knee issues, physical therapy may also be a recommended treatment option. For those whose pain is chronic or severe, your doctor may suggest surgery and rehabilitation.
Whichever your treatment option, Texas Hip & Knee Center is your knee pain resource to get you back on the walking trail or into the garden.
Q — Is knee pain prevalent among runners?
A — Knee pain is very common among those who run. Your doctor may refer to a term called Runner’s Knee. This condition can hurt, and is caused by repetitive impact. Over time, pain can worsen. Training longer distances and climbing hills or slopes may be triggers. Flat feet and poor form may also be other reasons for Runner’s Knee. Take note of your running patterns or routines, so that you can share them with your doctor at your next appointment.
Q — Why does my knee pop?
A — There are many reasons for popping knees. Arthritis is one common cause. Inflammation of the cartilage lining in the back of the kneecap can also be the root of it. Cartilage tears will frequently catch as the knee moves. And Runner’s Knee is often associated with popping knees.
If you hear any noisy popping, cracking, or snapping in your knee, tell your doctor, so that it can be diagnosed and treated properly.
Q — Does taking over-the-counter pain relievers daily for knee pain cause long-term harm?
A — Taking any drug for an extended period can cause side effects. Ibuprofen can cause life-threatening ulcers, and some NSAIDS, like Tylenol, can increase your risk of heart attack, stroke, or liver damage. Talk to your physician about long-term use of over-the-counter pain medications for chronic pain.
Physicians on the medical staff practice independently and are not employees of the hospital or Texas Health Resources.
Get the Max from a Mini
Millions of Americans suffer from osteoarthritis. Recent advances in medicine have brought new and exciting procedures for hip and knee surgery associated with osteoarthritis.
Mini-incision hip and knee replacement is a less invasive alternative to traditional joint surgery. Special implants are inserted through smaller incisions, typically two-five inches in length rather than the standard 10-12 inch incisions. As a result, the majority of patients who undergo these new procedures enjoy faster rehabilitation and shorter hospital stays. Some of our patients have been discharged from the hospital after just 24 hours. Such benefits may allow a faster return to work and daily activities.
At The Texas Hip and Knee Center, we have performed mini-incision hip or knee surgery (MIS) on patients as young as 36 years of age, as well as patients in their 70s. However, the majority of patients undergoing this procedure are 55+.
We will work with you to determine if you are a candidate for mini-incision surgery. A number of factors determine whether or not you may qualify to undergo MIS. An ideal candidate is someone who has osteoarthritis of the hip or knee, and is in excellent health and fairly active. Candidates may also include people who are not responding to other forms of treatment, such as medication or therapy.
The Texas Hip and Knee Center has performed more two-incision total hip and mini-total knee replacements than any other site in Texas. Additionally, our surgeons routinely teach these new techniques to other physicians from around the region and work to develop and improve the techniques and implants used.
We believe in making it easy for our patients to focus on their treatment and regaining good health. Texas Hip and Knee Center accepts a wide range of insurance plans and various forms of payment, and will verify benefits prior to your appointment. Please call us at 817-877-3432 if you have any questions.
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