Bones and joints Archive

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Q. I was an active runner before my hip replacement. Is it okay to return to jogging several times a week?

A. Hip replacements help relieve pain and improve function for people with worn-out hip joints. However, replacement joints also can wear out over time and require what's called a revision surgery. Therefore, activities that may increase stress or wear on the joint are often discouraged.

In the journals

Corticosteroid injections are used to ease short-term knee osteoarthritis pain, but a new study in the May 16, 2017, Journal of the American Medical Association suggests the treatment may not help in the long term.

Researchers recruited two groups of 70 people, average age 58, with knee osteoarthritis. One group received 40 milligrams of the steroid triamcinolone (Kenacort, Kenalog, Artistocort) every three months for two years, while the other group got placebo injections. By the end, pain scores — measured on a scale from zero for no pain to 20 for extreme pain — had dropped by only 1.2 points among the steroid group, while the placebo group's score dropped by 1.9 points, neither of which was clinically significant.

Physical therapy may be an effective alternative to surgery in relieving joint and back pain.

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Exercising may be the last thing you want to do when you have a sore knee or aching back, but it might be the first thing you should do. Physical therapy has long been recommended following surgery. But for some, trying physical therapy before opting for surgery may be the better choice.

"You may be able to spare yourself the expense, pain, and recovery time of surgery," says physical therapist Karen Weber, clinical supervisor at Harvard-affiliated Spaulding Rehabilitation Outpatient Centers in Braintree and Quincy, Mass.

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Although bone-weakening osteoporosis is quite common among older people, it isn't an inevitable part of aging. There's a lot you can do to shield your bones from this disease.

The best insurance against osteoporosis is building the highest bone density possible by your 30s and minimizing bone loss after that. But if you you're already in midlife or beyond, there is still much you can do to preserve the bone you have and perhaps even to replace lost bone. Daily weight-bearing exercise, like walking, is the best medicine. Getting enough calcium and vitamin D are two other critical strategies for keeping bones strong.

Aches or numbness may keep you from doing the things you love. Find out what's behind your pain, and do something about it.

Hand pain becomes common as we get older. Tingling and numbness, aching or locking joints, and difficulty grasping objects are frequent complaints. But don't make your own diagnosis and suffer in silence. "It's difficult to discern between different types of hand pain. Some have overlapping symptoms," says Dr. Sang-Gil Lee, a hand surgeon at Harvard-affiliated Massachusetts General Hospital.

Dr. Lee advises that you seek treatment as soon as possible for persistent hand pain, before it gets so advanced that it's tough to use your hands for even the simplest jobs, like brushing your teeth or buttoning a shirt.

Men considering surgery for back pain relief may benefit from more conventional treatment methods.

Back pain remains one of the top reasons people seek medical care for pain. For many older men, the source of their pain is spinal osteoarthritis.

Finding relief is an ongoing struggle, but men should think hard before turning to surgery without first trying less invasive treatments. "No one ever goes from initial back pain to needing surgery, unless the pain is due to something like cancer or an infection," says Dr. Steven Atlas, an internist with Harvard-affiliated Massachusetts General Hospital. "You can't fix arthritis. Surgery may help control the pain in some cases, so you can function better, but it won't cure your pain — no matter what doctors may promise."

In the journals

A study published online March 14, 2017, by The Journal of the American Medical Association suggests that when it comes to speed of recovery after a total knee replacement, a home-based rehabilitation program is as good as rehab that starts with a stay in the hospital.

Researchers randomly assigned people with osteoarthritis undergoing total knee replacement into two groups for 10 weeks of therapy. Those in one group received 10 days of hospital inpatient rehabilitation followed by a clinician-monitored program that they attended two to three times a week for eight weeks. Those in the other group skipped the hospital rehab and went straight into the clinician-monitored program but then progressed to at-home exercises.

News briefs

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Many older adults have pain from knee osteoarthritis, a condition in which cartilage in the joints wears away. But when is it time for joint replacement? An observational study published March 28, 2017, in The BMJ suggests that a new knee improves quality of life only in certain cases. The study included over 7,400 middle-age and older adults who already had knee arthritis or were at high risk for the condition. Compared with people who didn't have knee replacement, those who had the surgery during the 26-year study period appeared to have a better quality of life afterward. However, the improvements were minimal, except in people who were less physically functional before the surgery because of more severe arthritis symptoms. The authors suggest that the high costs of knee replacement may be justified only in those who are severely affected by arthritis. What if your symptoms aren't severe? As we reported last month, it may be possible to delay or avoid knee surgery by strengthening your leg and core muscles, losing weight, and improving range of motion.