Orthopaedic injuries often affect the joints including hip and knee joints. Other orthopaedic injuries are sprains, strains and bone fractures. Orthopaedic injuries are caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients. All these conditions require appropriate treatment, may be surgical or non-surgical to restore to normal activities. The non-operative orthopaedic treatment options include non-pharmacological and pharmacological interventions. They are aimed at providing symptomatic relief and improving the quality of life of the patients. They can be used as a treatment option to treat certain conditions or to decrease pain as well as promoting functioning and quality of life after the surgical treatment.
Non- pharmacological intervention
Non-pharmacological interventions may range from simple lifestyle modification or the physical exercises and rehabilitation programs. Some of the non-pharmacological interventions include:
- Weight reduction and physical exercise – The lifestyle changes resulting in weight loss in obese individuals and doing appropriate physical exercises plays an important role in prevention and management of the hip and knee conditions.
The optimal weight (BMI) should be 18.5 to 25. BMI of 25-29 is considered over weight and BMI over 30 is considered as obese.
Exercises are contraindicated in individuals suffering from cardiovascular diseases. Therefore rigorous exercises is not ideal for all patients and must be individualized for every patient and done under the supervision of a trained professional.
- Transcutaneous electrical nerve stimulation – The transcutaneous electrical nerve stimulation (TENS) method involves the use of low-voltage electric impulses to relieve the pain. It is believed to provide pain relief by inhibiting the conduction of pain impulses to reach the receptors in the brain and spinal cord. Patient is made to worn a device and this device generates the impulses that offer pain relief to the patients. Frequency of the impulses, duration of treatment and location of the electrical electrodes on the body are decided by your physician based on the severity of condition as well the response of the patient. Use for at least 4 weeks may provide better pain relief.
It should not be used by patients having pacemaker or cochlear implants, or those suffering from epileptic conditions. It should also not be used during pregnancy.
- Thermotherapy – Thermotherapy involves application of hot or cold packs at the affected area. There is some evidence to support the use of cold therapy in providing symptomatic relief. It is contraindicated in individuals with thermoregulatory impairments. Individuals having peripheral vascular disease, diabetes, cardiovascular disease and hypertension, or who are pregnant should use it with caution.
- Acupuncture – This method involves insertion of sterile needles into specific acupuncture points or pressure points. It is believed that insertion of needles at specific points restore the flow of “qi”, a form of energy and thereby relieves the pain. A modification in acupuncture is electro-acupuncture where the needles are stimulated by and electro-stimulator. Acupuncture performed by trained professionals is considered to be safe and offers pain relief however may have certain risks if treated by untrained professionals.
- Patellar tapping – Patellar tapping is used as a short term treatment particularly when performing normal activities deteriorates the knee condition. The principle behind the treatment is stabilization of knee joint by altering the distribution of stress and joint pressure. The response depends on the strapping technique used and the time for which it is strapped.
- Massage therapy – It is one of the oldest methods of treatment and reduces pain by increasing the circulation of blood and lymph as well by reduction of muscle tension or because of the therapeutic effect of the touch.
Pharmacological interventions include management of pain using medicinal preparations such as pain relieving capsules or injections.
- Steroid injections – Steroids are synthetic drugs that reduce inflammation, and help preserve the structure and function of the joint. They can be administered through IV, orally or locally. The injection of steroids into a joint helps in delivering a high dose of medication directly at the problem area. Steroid injections are indicated for conditions such as rheumatoid arthritis, damaged tendons or inflamed bursae.
- Non-steroidal anti-inflammatory drugs – These are known as NSAIDs and are found to be effective in reducing pain and inflammation of the hip and the knee. Caution must be taken while using NSAIDs for overdosing as they are known to cause hepatotoxicity. Patients with liver diseases must have extreme care while using them. They cause a range of side effects, chances of which increase with the concomitant use of diuretics, angiotensin converting enzyme inhibitors, angiotensin 2 receptor blockers, anticoagulants or oral corticosteroids.
- Viscosupplementation – This involves the injection of hyaluronic acid, a gel-like fluid that is naturally present in synovial or joint fluid. Hyaluronic acid lubricates the joints and helps the bones in a joint to move smoothly. Viscosupplementation is indicated for early-stage arthritis. The injection helps relieve joint pain for many months, but may have to be repeated usually after 6 months.
- Weak and strong opioids – Opioids are prescribed when use of analgesic medications or NSAIDs does not offer symptomatic pain relief, if other treatments have intolerable side effects or in whom the surgery is delayed or contraindicated. Though they offer better pain relief they are known to cause side effects such as dry mouth, nausea, vomiting, dizziness and constipation. Overdose may lead to respiratory depression. The dose is reduced slowly otherwise cause withdrawal effects. They are also known for addiction.
- Disease modifying anti-rheumatic drugs and biological agents – Disease modifying anti-rheumatic drugs (DMARDs) aim at halting the progression of disease and offer symptomatic relief. Biological agents are the antibodies against the disease causing agents manufactured using genetic engineering technology. These agents are recommended in individuals with severe disease condition.
- Other treatments – Your physician may recommend the use of braces and orthoses prescribe chondroitin sulphate, electromagnetic therapy, vitamin supplements, herbal and other dietary therapies. Therapeutic ultrasound has very less scientific proof of being effective.
Though there is little scientific evidence for various non-operative techniques in offering symptomatic pain relief they were found to be effective in certain cases and are considered to possess minimal side effects. Discuss with your physician about these therapeutic options before initiating the treatment.