Osteoarthritis: Surgery versus Therapy

A great aspect of treating patients is never becoming bored. I see nearly every condition on a fairly regular basis. What is odd is the patterns of conditions that develop. I might not treat a case of tennis elbow for a month, then 6 new cases of it in a day.

That's been the case over the past week with osteoarthritis of the knee. It's a very common condition, related to use (actually to misuse rather than overuse), body weight, lifestyle (smoking!) and genetic factors.

It is very common for a patient to tell me--in a depressed and resigned tone--that he/she had an x-ray of the knee and has been diagnosed with arthritis of the knee. I usually reply, "Okay. Big deal. "

What I mean is that x-rays and MRIs and CT scans only tell a tiny portion of what is going on in your body. Some people with hideously awful x-ray findings have no pain whatsoever. While others with nearly normal x-ray findings have truly debilitating pain.

My opinion is that the over-reliance on these imaging modalities is the reason that surgery for osteoarthritis is no more effective than exercise therapy. I think that often both patient and doctor see the scariness of the x-ray results rather than the treatable patient and condition.

There are times when surgery is necessary, but many of the post-operative patients I see could have and should have undergone a thorough strength, flexibility and endurance regime before opting for surgery.

What does all of this mean? As I tell all of my patients: you're the boss. You pay me and other practitioners for a service. Ultimately it is your decision, your motivation and your consequences. Don't rely on just one x-ray or just one opinion or just one course of therapy. In today's health care system, you need to take the lead on all decisions regarding your health.