“There are a lot of things in between doing nothing and getting a joint replacement for an arthritic joint,” said Dr. Andrew McMarlin of Winning Health Sports Medicine, Musculoskeletal and Arthritis Care.
Dr. McMarlin explores and explains preventive medicine, treatments with clinical evidence and guided joint injections with his patients: “Having your patients understand what their risks are and potential benefits is really important for them to be able to make an educated decision about their care.”
Movement plays a large role in a patient’s healing journey.
“The more we move our joints, to a point, the healthier they are,” said Dr. McMarlin, advocating for daily aerobic exercise that yields additional benefits for reducing weight, improving blood sugar and preventing or slowing senile dementia and Alzheimer’s disease.
To support a joint with arthritis or other degeneration, patients can use stability bracing or unloader bracing to dramatically lower joint pain while exercising. There are other steps they can take concerning what they put into their bodies.
“You want to avoid things in your diet that are really pro-inflammatory – things that your body turns into sugar immediately,” Dr. McMarlin said.
These items include high amounts of bread, pasta, rice, potatoes and things like sweet tea. A large spike of glucose increases insulin in the bloodstream, increasing inflammation in the blood vessels and in the joints. In addition to controlling consumption of those foods, patients can explore supplements that clinical evidence shows to work as a pain reducer.
When a person is in a lot of pain, it might take some time for the preventive measures of physical therapy and bracing to help, but a steroid injection with a nonsteroidal anti-inflammatory, low-temperature lasers or radio frequency ablation might help. The latter ultrasound therapy targets the nerves around the knee joint, knocking out the pain fibers and reducing pain for three to six months.
“It’s something that will give someone short-term pain relief that allows them to exercise more and do physical therapy and all the different things that over time will help with the knee pain,” Dr. McMarlin said.
If a more invasive option might be necessary, patients can achieve pain reduction with an ultrasound-guided injection using leukocyte-poor/platelet-rich plasma therapy or a cartilage gel injection. The guided component is especially crucial. When performed by an experienced orthopedic surgeon, “blind injections,” those done without ultrasound guidance, only get into the identified joint approximately 4 out of 10 times, according to a meta-analysis of many studies detecting the greater accuracy of ultrasound-guided knee injections.
If the injection does not make it into the joint capsule, patients assume the treatment was not right for them and believe joint replacement to be their next option. However, “It’s not necessarily because that therapy wasn’t right for you” – it’s because it wasn’t applied properly.
Impacting an arthritic bone with a needle during a blind injection can cause pain for weeks, and injecting cartilage gel into one of the several fat pads surrounding the joint capsule by accident “does nothing to improve the impact inside your knee, the lubrication or the friction,” Dr. McMarlin said of an un-guided injection.
Using lifestyle, bracing, physical therapy and accurately administered injections, Winning Health tries “to go through what is the most scientifically proven way to improve pain but also less invasive,” said Dr. McMarlin.
For more information, visit winninghealth.md or call 843-471-0375.
By Molly Sherman