by Steven Ballinger, MD

Whether a joint wears out from a lifetime of activity, a disease process, or as the result of an accident, the strategy to postpone surgical intervention is the same. The things that all types of arthritis have in common are degeneration, thinning and eventual loss of cartilage.  Cartilage is like the tile on a kitchen floor—when it is new you can roll the refrigeration right out on it and it’s no problem. If the tile is old or loose, trying to pull out a heavy appliance may damage the tile so badly that you end up with a hole in the floor. Treading carefully will prolong the function and appearance of a fragile old floor. Similarly, avoiding lifting and carrying heavy loads, jumping, and running will prevent the acceleration of joint damage.

Once a degenerating joint makes itself known by hurting, swelling, or getting stiff, it needs to be protected.  If the joint is a lower extremity joint like the knee or hip, avoidance of jarring activity and heavy lifting will help. Sometimes repetitive motion can be very hard on an arthritic joint even though no heavy lifting or jarring is involved. Modifying activities can help you stay active—using a wheelbarrow to transport heavy items, or sitting on a stool instead of squatting, for instance. Break carrying tasks up into multiple light loads, and try to vary activities to keep from spending several hours in the same position. Starting with a warm-up is always a good idea—an easy light carrying task, or a relaxed “set-up” will prepare your delicate joint for more strenuous activity.

Even the most careful person will over-do it occasionally. When an increase in pain follows activity, inflammation is likely the culprit. Ice applied to the painful joint for 10 minutes, or non-steroidal anti-inflammatory medications (NSAIDS) such as aspirin or ibuprofen can be very helpful. If you are planning an aggravating activity, taking a dose of NSAID a half-hour prior to starting can pre-empt the problem. If the problem persists despite your best effort, you may need a cortisone injection into the painful joint. While taking pills for inflammation can be compared to squirting a campfire with a garden hose, a cortisone shot is like dumping a big bucket of water on the flames. Many people will have significant improvement for months following a cortisone injection, and if they resume activity modification the improvement can be much longer. 

Eventually a joint will wear completely out no matter what precautions and treatments are used. When activities are no longer possible despite a “full-court press,” it may be time to consider surgically replacing the joint. Every joint replacement operation has limitations, so it is important to remember that carrying a sack of Portland cement or jumping out of a truck aren’t recommended activities in any case. By modifying your activity and taking control of the stress your body experiences on a daily basis, you have prepared for having a successful and long-lasting joint replacement operation.