You see the words splashed across the pages of newspapers or medical journals:
"Arthroscopy doesn't work for arthritis!"
"Physical therapy doesn't make a difference in outcomes!"
"Supplements don't work!"
"Acupuncture no better than placebo!"
Headlines like these get people's attention, influencing patients and doctors alike. Insurance companies use the studies to limit reimbursement of various treatments. However, you are the consumer. It is your knee or hip or shoulder that hurts. How do you decide what study is relevant to your particular problem? The headlines are often generalities.
For instance, the headline that says arthroscopy doesn't work for osteoarthritis is completely misleading. You might have osteoarthritis, but also might have a loose body or a torn catching meniscus or an unstable ligament that when repaired provides a far superior joint than one left to degenerate on its own.
A recent 10- to 20-year outcome study by our clinic demonstrated that if you want to continue playing sports, replacing a missing meniscus before the arthritis becomes too severe provides years of improved function and delays the time when an artificial joint might be necessary. Yet in a study where all comers with osteoarthritis are treated with the same knee clean out, there was no clear benefit over physical therapy alone. In this headline world, patients are left to argue with their insurance companies for treatment of their specific osteoarthritis problem in order to not be lumped in with all the general information.
To get the most suitable treatment, it's important that you be your own advocate. To take care of yourself, I recommend the following basic steps:
Step 1: Get an accurate diagnosis. So often, medical treatments are given without a careful history, physical exam and diagnostic testing to pin point the real cause of a joint problem. Be extremely persistent on getting to the cause of your problem.
Step 2: Follow the recommendations of your expert caregiver and see if it works. If the cause is fixable, have it fixed. These days that means repairing, replacing or regenerating injured meniscus and articular cartilage and ligaments in joints.
Step 3: Line up a great physical therapist and trainer. Start a superb rehabilitation program today and don't quit until your fitness level is better than it has been in years.
Step 4: Be prepared for trial and error when it comes to non-operative treatments.
When arthritic problems need non-operative care the treatments become personalized. Yet the data is unclear. Certain treatments for joint diseases work for some people and not others. The list is long: acupuncture is highly effective for some people and not others; hyaluronic acid injections to lubricate joints work exceedingly well for about 30 percent of our patients, moderately for about 30 percent and not all for another 30 percent; glucosamine seems to have a significant pain relieving function for some people with arthritis but not others. (In one double-blind study, the GAIT study, glucosamine was equal in pain relief to Celebrex, a powerful anti-inflammatory for people with moderate to severe pain.)
Physical therapy when mostly focused on hands on soft tissue and joint mobilization tremendously helps people with joint range of motion, strength and improved activities. However, if physical therapy is mostly used for ultrasound or electrical stimulation or if the patient is doing self directed activities, the benefits are far less reliable.
So if patients respond differently to the same treatment, how will you know what will work for you? In the 21st century, the surprising answer is still trial and error. And trial and error is difficult for the insurance companies to get their heads around. My patients who find a specific treatment that works for them are encouraged to pursue that treatment. We often expose our patients to a wide range of non-operative methods and ask them to be good consumers — find what works for them and eliminate the treatments that don't.
I believe that almost all musculoskeletal problems are treatable, many fixable and that most people can be rehabilitated back to a high level of activities depending on the creativity and persistence of the patient and the medical team. Don't give up, don't stop exploring new methods, and know that many of us are pushing the edge of medical science in order to solve the problems that currently aren't well treated.
Dr. Kevin R. Stone is an orthopedic surgeon at The Stone Clinic and chairman of the Stone Research Foundation in San Francisco. He pioneers advanced orthopedic surgical and rehabilitation techniques to repair, regenerate and replace damaged cartilage and ligaments. For more info, visit www.stoneclinic.com.