There were about 55,000 knee replacements and 45,000 hip replacements carried out in Australia per year in recent years, with osteoarthritis being the main reason for the operations. Ankle arthritis is less common than knee or hip arthritis, and replacements are a lot less common, with around 300 per year for the last few years.
However, the surgery is expensive, recovery is long and painful, there are long waiting lists, and replacement joints don't last forever, so it's best to have these operations as few times as possible in your lifetime – which means delaying it as long as you can.
What about stem cell therapy?
There have been some promising results using stem cell therapy to treat some types of osteoarthritis, and conversely people who've wasted a lot of time and money on treatment that had no effect. It's still early days for this treatment, it's expensive and there are no guarantees. If you're interested in trying it, your best bet is to take part in a registered clinical trial, where there are strict standards for patient safety, care and follow-up, and treatment is free. Go to the Australian Clinical Trials website and enter arthritis in the search box. You may also find trials other than stem cell therapy that interest you.
Alternatives to surgery
Recent research into the effects of shoes and orthotics shows promising evidence that simply changing your footwear can help prevent the further deterioration of arthritic knees.
Several studies have found that flexible, minimalist footwear (similar to shoes designed to provide an experience akin to barefoot running) appear to help people with knee arthritis by changing the way they walk, and therefore shifting the loading on the knee joint, which in turn reduces pain.
Some people swear by orthotics – though perhaps these should be custom-made, as there's little evidence that over-the-counter orthotics are effective for knee osteoarthritis. However, the right orthotics can be helpful for foot and ankle arthritis.
This research on the role of footwear in the management of arthritis is still in its infancy, and more research is needed.
Other non-surgical treatments offered include electrotherapy, such as ultrasound, laser or transcutaneous electrical nerve stimulation (TENS). However good quality studies have found these aren't very effective.
Tips for delaying joint replacement surgery
There are measures you can take to protect joints and minimise the painful symptoms of osteoarthritis:
- Achieve a healthy weight. Being overweight increases the stress on your joints and may speed up the breakdown of cartilage. Being overweight also increases the likelihood that mild arthritis will become severe. If you're overweight and already have arthritis, losing weight will reduce pain.
- Keep up – or take up – exercise. Regular weight bearing exercise, such as walking or jogging, protects against osteoarthritis by thickening joint cartilage and helping maintain joint and cartilage lubrication. Strengthening exercises using weights, resistance bands or body weight helps build muscle that supports joints. Water-based exercise such as swimming and aqua aerobics help you gain strength without putting stress on your joints. Yoga and other flexibility training will help retain range of movement.
- Heat and cold. Heat packs or a warm damp towel can help relax and soothe stiff joints, while cold packs can help with acute pain and swelling.
- Mechanical aids. A cane, crutch or walker can help take weight off joints, while an elasticised knee brace may decrease symptoms.
- Medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help reduce pain and inflammation. Topical NSAIDs, such as Difflam or Voltaren gel, can also help if the pain's in a small area, and reduces the risk of gastrointestinal effects. Talk to your doctor to ensure you're not overusing these medications, though.
- Glucosamine and chondroitin supplements help some people, but probably no more than a placebo. They're inexpensive and safe when taken in recommended doses with only minor side effects, so try them if you wish but stop if there's no relief within three months.
- Cortisone injections can reduce pain, inflammation and swelling, and can last many months. It's sometimes painful for a couple of days after the injection, and there's a risk of damage to tendons, bones and cartilage, so it's not recommended as a first line of treatment or for long-term management.
There are a couple of less-invasive procedures that some people try before surgery, although they're not recommended:
- Viscosupplementation, where hyaluronic acid is injected directly into the joint. A recent large review of clinical trials found that it gave little or no pain relief or increase in function, and there were serious side effects.
- Arthroscopic surgery (for knee osteoarthritis), where an arthroscope is inserted through a small incision in the skin, and damaged cartilage and bone is removed and washed away. However, the outcomes are no better than placebo surgery.