Your questions on joint care and joint pain have been answered by the consultants from Spire Healthcare

5together

I’ve been told I need TKR for severe arthritis in one knee, which had to be grafted, pinned and plated following an accident 25 years ago. I do have some pain from the joint, but it is mostly manageable and I only take painkillers during particularly severe attacks. I have been putting off surgery because pain isn’t a driver for surgery, although my range of movement has been steadily declining. Am I doing more harm than good by waiting or if I can manage longer should I? I’m in my mid 50s and otherwise fit and well.

Dear @5together, it sounds like you have been doing well in the last 25 years since your accident.

Trauma to a joint can often lead to the development of arthritis many years later. The range of movement of a joint before a joint replacement can often affect the range of movement after a joint replacement and trying to delay it for as long as you are able to do is often a sensible option. This discussion needs to be had between you and your treating surgeon.

- Stephen

kathcake

Is it normal for my joints to click everytime I get up?

Thanks @kathcake. Joint clicking and popping can be normal. It may be caused by the ligaments or bubbles in the synovial fluid.

There are also other mechanical reasons for a joint to click, such as damage to the internal structures or loose bodies within the joint. If the clicking and popping is not painful and is not causing discomfort then it can be considered normal. If it is associated with pain or if the joint is not able to go through its full range of movement and is locked, then this should be investigated.

- Stephen

CV2020

My partner gets painful hips in bed every night. This happens every night and really disturbs his sleep. He doesn’t want to take painkillers if possible. Any suggestions please?

Hi @CV2020, thanks for your question.

Night pain is a classic sign of arthritis, it is a constant dull ache like tooth ache in the hip or knee. I would suggest that if painkillers are not working then it may be time to see an orthopaedic surgeon after a review by your GP. Keeping active, and keeping the weight down can help reduce symptoms but they are unlikely to go away completely.

- Stephen

Lorraine1602

I have had both hips replaced. Now my knees are becoming very painful. Can you recommend anything to relieve pain so that I can perhaps at least delay having knee replacements?

Hi @Lorraine1602, great question.

The decision to replace a joint is made when the pain is no longer manageable with symptomatic control. Painkillers do help. Other non-surgical pre-joint replacement interventions can be reducing your body weight if this is an issue, improving muscle strength around the knee and also using a knee brace which can take some of the pressure off the knee. Injections of local anaesthetic and steroid can also help manage the painful symptoms before heading towards a knee replacement.

Unfortunately, there are as yet no proven therapies to restore the cartilage in the knee that has been damaged by osteoarthritis. Research is under way to look at new treatments as part of randomised control trials, although these are not available as routine patient treatments at the present time.

- Stephen

janeainsworth

I have pain in my right hip & knee, worse after exercise. Sometimes my right hip twangs as if something goes out of place & back again.
What is concerning me though is that for the last few months, if I’ve been sitting for some time, when I get up for a few seconds I can’t actually move because I can’t put weight on my right hip.
Eventually I can ‘get going’ & after a few steps I can walk properly.

What could be causing this? At the moment I’m trying to strengthen the muscles in my leg with resistance bands, use diclofenac gel, & take glucosamine tablets.

Can you recommend anything else I should or shouldn’t be doing? I don’t want to give up walking, cycling and tennis. So far I have resisted my husbands instructions to see my GP. Is it time to give in?

Thank you.

Hi @janeainsworth, thank you for your question.

Arthritis can often present in different ways. Patients can feel catching and also suffer from something we describe as start up pain, where the joint feels stiff and loosens off after a few steps. It is great that you have started muscle strengthening and non-steroidal anti-inflammatory gels can often help. I would stay as active as possible but avoid any activities that act as triggers. I think it may be worth seeing your GP to get an x-ray and have a clinical assessment to be sure that this is osteoarthritis.

- Stephen

Keffie12

I have Fibromyalgia and CFS: I was diagnosed in 2005. Obviously it's degenerative. I have 4 weekly reflexology which helps.

When we went into lockdown last year I found out how much it helps cos of the resurgence of the depth of fatigue, pain and heaviness in my legs.

The pain medication I take just didn't touch it. Thankfully I have been able to restart reflexology.

Have you any other suggestions for helping these conditions?

Apologies @Keffie12, fibromyalgia and CFS are not my area of expertise. Lockdown has definitely been difficult for everyone as it has been so hard to stay active. Keeping as active as possible would be my recommendation with trying to build an active lifestyle into your daily routine.

- Stephen

ktmd

How effective are steroid injections for arthritis in the knees?

Hi @ktmd, many thanks for your question.

Of all the possible joint injections, steroid injections have been around for a long time and have a proven track record in improving joint pain. The main drawback is the relatively short duration of symptom relief. Some patients can get several months of improved pain but other patients may only get a few days. In addition, the first injection tends to be the most effective but subsequent injections, less so.

Some studies have suggested that repeated injections can actually accelerate the progression of the arthritis as the patient is unaware of the increasing wear in their knee joint because of the steroid. Complications are thankfully rare, but infection following an injection has been documented and some patients can get a flare up of their pain before it subsequently improves.

It may also be advisable to delay joint replacement for six months after injection, which becomes an issue if the injection doesn’t work. In summary, injections can give some short term relief and can be very helpful in certain patients. I would suggest discussing the possibility with your general practitioner or orthopaedic surgeon as to whether it would be helpful in your case. I hope that was helpful.

- Chris

knittingnana24

I fell down an open manhole in my garden about 3 months ago. I attended the local walk in centre and they diagnosed the injury as a sprain to my left inner edge of the knee which should be better in about 3 to 6 weeks. I try to keep active but still have quite a lot of pain especially after sitting and it wakes me up at night when I turn over. My kneecap makes a strange clicking noise when I flex it .How long should I expect this pain to go on? Thank you

Hi @knittingnana24, poor you! That sounds horrendous.

Most soft tissue injuries following a fall recover over 3 to 6 weeks as you were advised. As you are still getting symptoms, I would suggest that you seek medical attention from your general practioner and possibly seek an onward referral to an orthopaedic surgeon.

- Chris

Tricia1

I had a full left hip replacement , four years ago. I have been in constant pain ever since and cannot lie on my left side at night, making sleep very difficult as my right side also needs a new hip. I have had steroid injections into my groin and hip , which were very painful and have

had no result. I'm being told it's Tronchial Bursitis, however I feel if it was I would be free from pain by this time.I'm concerened re the injections as now have had probably 8 in the past four years, I have daily antibiotics for other infections.

Hi @Tricia1. I am so sorry to hear that you have had so much pain following your total hip replacement.

From what you describe you may well have developed trochanteric bursits. This can occur following a total hip replacement. This means that there is some inflammation of the bursa or fluid filled sac over the trochanter which is the boney bit on the outer aspect of the hip which you can feel.

This can be treated with steroid injections to the bursa to settle the inflammation rather than injections into the hip itself. These injections can also be performed under ultrasound guidance to ensure that the area of inflammation is being injected rather than doing it without guidance. However, in combination with the injections physiotherapy can also be helpful to help strengthen the muscles around the hip and also some stretching exercises.

It would definitely be worth talking to your orthopaedic consultant about your concerns about the left hip before proceeding with the right total hip replacement. I hope that helps and very much hope that your symptoms improve.

- Chris

dahville

I have just started having hip pain which I assumed was ITB pain due to doing 20-40 km a day on my exercise bike. Today my knee has started hurting medially whilst walking, it almost feels like it is in spasm. I am treating both with ibuprofen and icing. Are they likely connected or separate problems? There has been no injury, I assume this is overuse pain.

Hi @dahville, many thanks for your question.

That is very impressive to be doing 20-40km/ day on your exercise bike! There are many potential causes for your symptoms and without taking a full history and examining your hip and knee, its hard to give you specific advice. However, whilst you have pain I would suggest stopping your exercise bike routine and to rest for 2 weeks.

In addition, if the pain persists and in discussion with your GP a course of anti-inflammatories such as Ibuprufen may help to settle any inflammation that you may have. If the pain resolves then before restarting your exercise bike routine, some stretching exercises before hand could well help. Whilst there are potential sources of information on the internet which may suggest some possible stretching exercises a session with a physiotherapist would also be helpful. Should these measures fail, I would suggest speaking to your GP about your symptoms and possibly consider a referral to an orthopaedic surgeon. I hope that helps and good luck!

- Chris

Goodness

I have osteoarthritis in my knees and this is hindering my ability for brisk walking which I enjoy. I have tried using gels but no change and am not keen on painkillers. Would welcome any suggestions. Thanks

Hi @Goodness, great question.

You are not alone, many patients with joint pain understandably are keen to avoid taking painkillers. I am not sure what gels that you have been using but an anti-inflammatory gel tends to be the most effective. These can include ibuprofen, Voltarol or ketoprofen. It may be worth trying each one to see if there is one in particular that works for you.

Alternatively, a knee brace can be helpful but this can depend on which part of your knee joint is affected. If the arthritis is limited to one part of the knee, say the inner aspect of the knee, then an unloader or offloader knee brace can be helpful. This brace attempts to unload the painful part of your knee and instead redirect the load to part of your knee which is less painful. Whilst the benefits of the brace may not last for ever, it may give you some relief without resorting to painkillers.

If this is something that you would be interested in trying, I would suggest discussing with an orthopaedic surgeon as to whether it would be suitable for you.

- Chris

burwellmum

I have pain in my right hip. I started yoga during the first lockdown and it seemed to really help at the outset but after a few months the pain got worse again. I can't believe it was the placebo effect - any other ideas and would yoga normally help?

Hi @burwellmum, many thanks for your question.

Obviously without taking a history and examining your hip, I cannot be sure what is causing your pain. The pain maybe due to soft tissue inflammation around the hip, it could be due to arthritis or it could be referred from elsewhere, such as your back.

I agree, that I am sure that when you did the yoga that it wasn't a placebo effect. As a rule of thumb, exercises can certainly help and gentle yoga can certainly be helpful and I have many patients who would testify to that fact! The key with yoga or any exercise is that the potential benefit does not happen overnight and it is often through repetition, little and often, that you can begin to see the benefits. If however, the exercise you are doing starts to actually cause you pain then I would suggest either resting and avoiding that exercise or do it less intensively.

- Chris

Nortsat

I have osteoarthritis in my left knee, which is quite well managed with gentle exercise.

In consultation with my GP, I do 35/40 mins of gentle exercise x 5 times a week, usually walking or the exercise bike. I have gently increased the duration over many months and can now manage to walk 1.5 miles per day.
I am on a calorie counted eating plan and have lost 22.5% of my body weight in 18 months.

My issue is that often my knee hurts when I am taking exercise (maybe 3 on a scale of 1:10) but I continue with the walk/cycle.
Is this the right approach?

Hi @Nortsat, thanks for your question.

To minimise your pain I would perhaps suggest a graded exercise programme and gradually increasing the duration or intensity of your exercise regime each week.

- Gerard

Hi @ems07957, @ExD, @pamelaJEAN, @wendycl and @RubyGran. Thanks for your questions.

It best that you get seen by either your doctor or specialist so they can work out exactly where your pain is coming from and advise on the best treatment.

- Gerard

Thank you all for your questions. We hope that our answers have helped you. If you'd be interested in finding out more about Spire Healthcare, you can click here.

- Stephen, Chris and Gerard