Managing Osteoarthritis Pain: Medication, Rehabilitation, or Surgery?

Medications for osteoarthritis? Rehabilitation?

Hello Doctor, my father is 57 years old.
He was hospitalized for peritonitis and underwent surgery in early July.
During his hospital stay, he experienced unbearable knee pain, and after an X-ray, he was diagnosed with mild osteoarthritis.
Due to his gastrointestinal issues, the doctor only prescribed a nighttime pain relief medication and a patch, stating that he could not take painkillers.
He has been taking the prescribed medication since then.
Additionally, my father has heart problems and is on cardiology medications.

Currently, due to the pain, he is unable to straighten his legs, stand, or walk, and can only lie in bed or sit in a wheelchair, always keeping his legs bent.
I am concerned that if this continues, his legs will become increasingly stiff.
I would like to ask the doctor whether we should return to orthopedics for further treatment or continue with the previously prescribed medication and go to rehabilitation for physical therapy.
I am worried that if he goes to rehabilitation, the movement may cause more pain and worsen his condition.
I am also unsure if we can ask the orthopedic doctor for more advanced treatment.
I would appreciate your advice.
Thank you!

Bi Bi, 20~29 year old female. Ask Date: 2017/09/03

Dr. Li Yongheng reply Orthopedics

Hello Miss Bibi, based on your father's reported condition, I recommend that he should not delay seeking medical attention and should return to the orthopedic outpatient clinic for an X-ray examination to check for any conditions other than osteoarthritis.
If it is indeed only osteoarthritis and he cannot take pain medication, I suggest that your father undergo rehabilitation therapy and consider intra-articular hyaluronic acid injections for the knee, which should be beneficial for his condition.
Wishing your father a speedy recovery.

Reply Date: 2017/09/03

More Info

Managing osteoarthritis pain can be a multifaceted approach that includes medication, rehabilitation, and in some cases, surgery. Given your father's situation, it is essential to consider his overall health, particularly his recent surgery for peritonitis and his existing heart condition, which complicates the management of his osteoarthritis.

Medication Management
Since your father has been prescribed a nighttime pain medication and topical patches, it is crucial to monitor their effectiveness. If the pain persists and significantly affects his mobility, it may be necessary to consult with his healthcare provider about adjusting his pain management regimen. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for osteoarthritis pain, but given your father's gastrointestinal issues and heart condition, these may not be suitable. Alternatives such as acetaminophen or topical analgesics might be considered, but these should be discussed with his physician to ensure they do not interfere with his current medications.

Rehabilitation
Physical therapy can be beneficial for managing osteoarthritis pain and improving mobility. A physical therapist can design a tailored rehabilitation program that focuses on gentle stretching and strengthening exercises, which can help maintain joint function and reduce stiffness. It is understandable to be concerned about exacerbating his pain during rehabilitation; however, a skilled therapist will be able to adjust the intensity and type of exercises based on your father's tolerance and pain levels.
In addition to physical therapy, other modalities such as heat therapy, ultrasound, or electrical stimulation may provide pain relief and improve function. It is essential to communicate openly with the rehabilitation team about your father's pain levels to ensure that the treatment plan is adjusted accordingly.

Surgical Options
If conservative treatments, including medication and rehabilitation, do not provide sufficient relief, it may be time to consider surgical options. Surgical interventions for osteoarthritis can range from arthroscopy to remove loose cartilage or debris, to more invasive procedures like knee replacement. However, surgery should be considered carefully, especially given your father's heart condition and recent abdominal surgery. A thorough evaluation by an orthopedic surgeon, who can assess the severity of the osteoarthritis and the impact on his quality of life, is necessary before making any decisions.

Conclusion
In summary, it is advisable to schedule a follow-up appointment with an orthopedic specialist to discuss your father's knee pain and the potential for further evaluation and treatment options. Concurrently, initiating a rehabilitation program with a physical therapist can help maintain mobility and potentially alleviate some pain. Always ensure that any new treatments or changes in medication are discussed with his healthcare providers to avoid complications, especially considering his complex medical history.
Your father's situation is challenging, but with a comprehensive approach that includes medication management, rehabilitation, and possibly surgical consultation, there is hope for improving his quality of life and mobility.

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