The query: My knee substitute surgical procedure was postponed due to the COVID-19 pandemic. I’m undecided when will probably be rescheduled. The ache in my knee is excruciating. What am I speculated to do within the meantime?
The reply: You’re actually not alone. Many elective – or non-emergency – procedures had been placed on maintain when hospitals cleared the decks to make approach for COVID-19 sufferers in the course of the numerous waves of the pandemic.
And sufferers ready for knee and hip surgery were disproportionately affected by these delays, says Dr. Mohit Bhandari, president of the Canadian Orthopedic Affiliation.
As hospitals grappled with restricted working room time, precedence was often given to sufferers needing speedy and doubtlessly life-saving surgical care.
Knee and hip substitute instances tended to be deferred as a result of they had been “perceived as being life-style surgical procedures, which is the furthest factor from the reality,” says Dr. Bhandari. “They’re restorative surgical procedures for debilitating circumstances.”
“This unlucky ‘life-style’ branding has de-prioritized a few of these sufferers who’re really in agony.”
Earlier than the pandemic, the ready time for knee and hip operations ranged from six to 12 months. That wait will now be considerably longer till the backlog of instances is cleared, Dr. Bhandari says.
Orthopedic surgeons fear that their sufferers will proceed to deteriorate in the course of the delay.
It’s critically vital that sufferers who want both a knee or hip substitute hold bodily lively, says Dr. Vickas Khanna, an orthopedic surgeon and assistant professor at McMaster College in Hamilton.
A focused train program strengthens the muscle tissues that help the knee or hip and may truly cut back ache. What’s extra, train helps keep a wholesome weight so there may be much less strain exerted on downside joints.
Docs often advocate low-impact actions comparable to utilizing elliptical machines, swimming, biking, strolling and Tai Chi.
Nevertheless, Dr. Khanna readily acknowledges, “it’s onerous to inform sufferers to train once they can barely transfer a knee or hip.”
In such instances, docs may counsel numerous remedies to ease discomfort.
“Every possibility has professionals and cons,” explains Dr. Khanna, including that they might present solely “minimal profit in folks with extreme degenerative adjustments of their joints.”
The therapies embody:
- An injection of cortisone into the joint can cut back irritation and stiffness for 4 to eight weeks. However cortisone have to be used judiciously. Analysis suggests repeated photographs might speed up the deterioration of cartilage, the shock-absorbing materials between the bones.
- An injection of hyaluronic acid works for about six months. It’s an artificial materials that mimics the pure lubricating fluid discovered inside wholesome joints. Not like cortisone, hyaluronic acid is just not related to cartilage breakdown. However the price is just not lined by most provincial well being programs. Some personal insurance policy will choose up the tab. Sufferers with out such protection can pay about $500 out of pocket for the remedy.
- Platelet-rich plasma, or PRP, is claimed to harness the physique’s personal therapeutic powers and may ease ache and irritation for six to 12 months. Blood is drawn from the affected person and put right into a centrifuge. The machine spins the blood, separating it into totally different components. A number of the parts, comparable to platelets and progress components, are used to provide the PRP, which is then injected into the sore joint. Generally a number of injections are given over a course of a number of weeks. Every injection prices between $500 and $700.
Dr. Moin Khan, an orthopedic surgeon and assistant professor at McMaster College, says the effectiveness of the injections, significantly within the case of PRP, can fluctuate from affected person to affected person. “There are totally different industrial formulations of PRP available on the market,” he says, including that there’s an absence of high-quality comparative research displaying which one is greatest.
Along with injections, docs may advocate a custom-made brace that redistributes the load on an inconsistently worn joint. However, as soon as once more, value could also be a difficulty for sure sufferers. “A carbon fibre medical-grade brace can value $1,500,” Dr. Khanna says.
There’s little question the expense of a few of these specialised therapies will put them out of attain of many people.
Even so, “there are many issues folks can do on their very own to take care of their muscle energy,” says Dr. Jihad Abouali, an orthopedic surgeon and assistant professor on the College of Toronto.
He notes that the Canadian Arthritis Society web site supplies details about home-based workouts for knees and hips.
And, for ache management, docs typically counsel topical analgesics as a result of extended use of non-steroidal anti-inflammatory tablets could cause abdomen issues.
Regardless of their greatest efforts to remain match, some sufferers “are going to worsen whereas on the ready listing,” Dr. Bhandari says. He feels each effort have to be made to supply them with “restorative” surgical procedure. “Sufferers in ache can’t wait.”
Paul Taylor is a former affected person navigation adviser at Sunnybrook Well being Sciences Centre and former well being editor of The Globe and Mail.