Arthritis myths vs facts: Surgeon explains common misconceptions about symptoms, causes, treatment

From hindustantimes.com 

By Anukriti Srivastava

From joint cracking to exercise, a surgeon busts common arthritis myths that could mislead you about joint health

Many patients arrive believing that arthritis is an unavoidable part of ageing, that nothing can be done about it, or that surgery should always be the last resort. These myths can sometimes prevent people from seeking timely care. In an interview with HT Lifestyle, Dr Tushar Kohli, gold medallist, arthroscopy and joint replacement surgeon, senior consultant at Hari Ram Kohli Memorial Hospital, Dehradun, debunks common myths about exercise, pain, and joint health.

Myth 1: Arthritis only affects older people.

While the risk of osteoarthritis increases with age, it is not exclusively an age-related condition. Dr Tushar Kohli highlighted that previous injuries, obesity, genetics, repetitive stress and certain medical conditions can contribute to joint damage in younger people too.

Myth 2: Exercise will make arthritis worse.

The opposite can often be true. Appropriate, low-impact physical activity can strengthen the muscles supporting a joint, improve mobility, and help manage pain. The key is choosing exercises suited to the individual's condition, rather than avoiding movement altogether.

Myth 3: Joint pain is something you simply have to live with.

“Persistent pain should not be dismissed as a normal consequence of getting older,” highlighted Dr Kohli. Depending on its cause and severity, arthritis can often be managed through weight management, physiotherapy, medication, lifestyle changes and other non-surgical approaches.

Delaying treatment despite severe pain, stiffness, or declining mobility can affect independence and overall wellbeing. (Unsplash)

Myth 4: Knee or joint replacement means the end of an active lifestyle.

Modern joint replacement procedures have evolved significantly. For patients with advanced arthritis who have not found adequate relief through conservative treatments, knee or joint replacement can help restore mobility and improve quality of life. The goal is not simply to reduce pain, but to help patients return to meaningful everyday activities.

According to Dr Kohli, advances in surgery have also changed how we approach these procedures. Minimally invasive techniques can involve smaller incisions and reduced disruption to surrounding tissues in appropriately selected patients. Robotic-assisted technologies available at selected sites can further support surgeons in complex cases with significant deformities.

Myth 5: Surgery should always be avoided for as long as possible.

There is no universal timeline for surgery. Delaying treatment despite severe pain, stiffness, or declining mobility can affect independence and overall wellbeing. The right approach is an individualised one, based on symptoms, imaging, lifestyle and response to other treatments.

Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.

https://www.hindustantimes.com/lifestyle/health/arthritis-myths-vs-facts-surgeon-explains-common-misconceptions-about-symptoms-causes-treatment-101791617482361.html

Thumbs up: New thumb joint replacement surgery relieves arthritis pain

From uchicagomedicine.org

The osteoarthritis pain in Mary Wolf’s left thumb was so sharp and intense, it sometimes woke her up in the middle of the night.

It throbbed when she tried to grip or pinch things, making two of her favourite activities — cooking and knitting — nearly impossible.

Daily tasks were also tough: To close a sandwich bag, she would have to tuck it under her left arm and use her “good” right thumb to help zip it shut.

Steroid shots every four months brought temporary relief over a period of three years, but they became less effective over time.

“The pain was ridiculously impacting my life,” said Wolf, 63, a retired fifth grade teacher.

Last spring, Wolf found new hope.

Jeffrey G. Stepan, MD, MSc, her orthopaedic surgeon at the University of Chicago Medicine, became one of only a few hand surgeons in the United States to train on an innovative new implant surgery that replaces a patient’s arthritic thumb joint with a small, prosthetic version.

When the surgery became available at UChicago Medicine in May 2026, Wolf didn’t hesitate.

“I said, ‘Sign me up,’” she said. “I had to do something drastic to change this.”

How does a thumb osteoarthritis implant work?

Thumb osteoarthritis, which causes joint pain at the base of the thumb, is a common condition that affects millions of Americans. It occurs when the protective cartilage that cushions the end of the bones wears away, causing bones to rub against one another.

It’s most common in people over age 50, and it affects women more often than men, according to the American Society for Surgery for the Hand, a medical specialty society.

Treatment starts with a thumb brace, hand therapy and steroid injections.

If the thumb pain persists, patients may choose to have thumb carpometacarpal joint trapeziectomy — a surgery that involves removing the arthritic joint. Although the surgery is effective and has high satisfaction rates, recovery can be painful and take 6 to 9 months, Stepan said.

Meanwhile, doctors in Europe have been performing a simpler and more efficient version of this surgery, using an implant called TOUCH CMC 1 Prosthesis, since 2018.

“Instead of removing the arthritic joint, they were replacing the joint with this implant,” Stepan explained.

Patients who had this implant were pain-free and regained thumb movement in less than six weeks, Stepan said. But the implant, which uses a ball-and-socket design, wasn’t approved for use in the U.S.

When Stepan heard that the U.S. Food and Drug Administration was going to approve this implant, he flew to France in April 2026 to learn how to do the surgery. He is one of only a handful of surgeons in the U.S. who are trained and approved to perform this surgery.

Thumb osteoporosis joint replacement surgery ‘absolutely life-changing’

Wolf had her surgery at the University of Chicago Medical Center in Hyde Park on May 20, 2026, and she was in and out of the hospital in less than five hours.

She received twilight anaesthesia and a nerve block in her shoulder, so she didn’t have feeling in her left arm for 24 hours. But she experienced no side effects. She wore a splint to immobilize her thumb for two weeks, but she was able to move it in “teeny circles” without pain just two days after the surgery.

“I haven’t had any pain since that first night,” she said. “The surgery was absolutely life-changing.”

Since then, Wolf has resumed her cooking and blanket-knitting project.

Stepan, who performed his third thumb osteoporosis joint implant surgery in June, said the option is available for anyone who has struggled with pain in the base of their thumb and wasn’t helped by standard treatments.

“Patients are quickly getting back their strength and getting back their motion,” he said. “Everyone’s been doing really well.”

 https://www.uchicagomedicine.org/forefront/orthopaedics-articles/new-thumb-joint-replacement-surgery

What you should be doing to manage arthritis pain

From msn.com/en-us

Arthritis is a condition that affects the joints, causing pain, inflammation, and stiffness. Some people with arthritis have trouble moving their joints over time, long considered a classic symptom. However, various forms of arthritis behave differently in the body and can affect the type and severity of symptoms. In fact, the Arthritis Foundation states that there are more than 100 kinds of arthritis and related conditions.

Osteoarthritis and rheumatoid arthritis are the two primary types of this condition. Osteoarthritis breaks down the cartilage that cushions joints, while rheumatoid arthritis causes the immune system to damage the joints directly. Other kinds include gout, septic arthritis, and ankylosing spondylitis (via Mayo Clinic).

©Sasin Paraksa/Shutterstock

As for where it comes from, arthritis can stem from genetics, lifestyle, autoimmune diseases, infections, or exacerbated wear and tear on the joints (via Cleveland Clinic). Once it hits and starts damaging joints, arthritis can cause mild to severe pain that can be difficult to manage. Thankfully, making some lifestyle changes and understanding therapeutic strategies can lead to better pain management for this type of inflammation.

Fight inflammation through diet

A significant cause of the pain associated with arthritis is inflammation surrounding the joints. That pain often arrives as the immune system fights against whatever it deems to be an issue. In the case of arthritis, that's the joints.

Therefore, reducing the inflammation response in the body is a potentially good idea for people with arthritis. The Arthritis Foundation notes that the Mediterranean diet — one that's filled with whole foods and low in processed stuff and "bad" fats — is one of the best for combating arthritic pain. The diet incorporates fish, nuts, seeds, healthy oils, and plenty of fresh fruits and vegetables. These categories include several anti-inflammatory foods that help to keep that symptom at bay.

The Harvard T.H. Chan School of Public Health also explains the importance of an anti-inflammatory diet, especially in those with chronic inflammation. Rather than focus on calories and portions, an anti-inflammatory diet focuses only on the foods you eat and don't eat. Tea, coffee, herbs, whole grains, and monounsaturated fats get the green light, for instance. But those following this diet must typically stay away from sweetened drinks, fried foods, and processed meats. 

Take inflammation-reducing medication as needed

Not all pain from arthritis can be managed by a healthy diet alone, unfortunately. People with severe arthritis symptoms might still need to take pain-reducing medications to keep them moving and able to function daily.

Corticosteroids are one form of medication commonly prescribed for arthritis. They target pain by reducing inflammation and are generally available in cream, pill, or shot form. Some arthritis patients may respond better to nonsteroidal anti-inflammatory drugs (NSAIDs), which include many of the typical pain relief medications you'll find in the pharmacy. Ibuprofen, naproxen, and aspirin are forms of NSAIDs, for example. These also decrease inflammation and can work relatively quickly for those seeking immediate relief (via Verywell Health).

Some people with persistent or severe arthritis may need high doses of NSAIDs that can only be prescribed by a doctor to manage their pain. Your doctor can use different doses and medicating schedules to find one that works best for your symptoms and body (via Arthritis Foundation).

Supplements might help to reduce inflammation

                                         ©Iryna Pohrebna/Shutterstock

Medication may not work well for everyone, and indeed some people may wish to try more natural routes before going with prescription medications. As such, a number of supplements have been shown to reduce arthritic symptoms, including pain, by reducing inflammation and even potentially by building cartilage. They could be worth a try, though it's always a good idea to talk to your doctor first before starting a supplement regimen.

The Arthritis Foundation lists vitamins A, C, E, D, and K as vital nutrients which also contain antioxidants and may aid in reducing arthritis symptoms, although researchers are still studying their efficacy related to arthritis. However, we do know that vitamins D and K both strengthen bones, while vitamin K is necessary for cartilage health. Glucosamine and chondroitin also have some mixed results in studies, but researchers have shown that joint cartilage contains these compounds. Some evidence has shown that these two could improve arthritis pain, especially when combined with NSAID treatment.

EPA and DHA, two omega-3 fatty acids found in fish and fish oil supplements, also have anti-inflammatory properties. An article published in the journal Atherosclerosis outlined the results of a study where participants with chronic inflammation used EPA and DHA supplements for 10 weeks. Researchers found that both fatty acids appeared to reduce inflammation, with DHA leading to slightly better results.

Pay attention to the numbers on the scale

Extra body weight, naturally enough, puts extra strain on joints. Pain management specialist and doctor Robert Bolash tells Cleveland Clinic, "Joints in your body's lower half — particularly your knees and hips — bear most of your weight. That's why years of carrying around excess weight contribute to achy, swollen, stiff joints." Bolash recommends using low-impact exercises, like swimming or water aerobics, to shed pounds without causing more pain and discomfort to joints in the process. Rheumatologist Elaine Husni also explains that losing a mere 10 pounds can sometimes be all it takes to improve knee pain related to osteoarthritis.

Not only can losing weight improve pain associated with arthritis, but it could actually improve joint function altogether. Richard F. Loeser, Jr., a rheumatologist and research leader, tells Everyday Health that a study he conducted showed that knee joint pressure improved over time with routine exercise and diet changes. Additionally, participants had decreased inflammation after losing weight, which is even more good news for the joints.

Get better sleep

It's no secret that getting plenty of shut-eye does a body good. Quality sleep can lower your risk of heart attacks, improve your mood, and keep many more of your body systems on track. Having good sleep hygiene that helps you get a full night of rest could also improve your arthritis pain. According to the Arthritis Foundation, pain from arthritis can certainly keep you up at night. However, it appears that not getting enough sleep can also trigger inflammation and pain, resulting in a cycle of sleeplessness and health consequences that's admittedly tough to break. Director of the Alabama Research Institute on Aging Patricia Parmelee explains that failing to catch enough sleep can contribute to increased pain the next day, while chronic sleeplessness may even progress one's arthritis further over time.

So, what to do if you're stuck in just such a cycle? According to Medical News Today, people with arthritis should prioritize their sleep by getting into a routine. Exercising during the day, avoiding naps, and sticking with the same bedtimes and wake-up times can be helpful. Managing stress and eating healthy, wholesome meals can also contribute to better sleep patterns and, therefore, decreased arthritis symptoms.

Keep your body active

                                                       ©Rido/Shutterstock

Add one more fact to the many reasons why exercise is essential: Apparently, people with arthritis may experience decreased pain when they participate in routine exercise. The CDC states that physical activity is necessary for healthy joint function and reduced symptoms, including pain and mood. The most important thing to remember is to find exercise routines that are low-impact for your joints. The CDC also recommends starting slow with any exercise and modifying exercises as needed to keep your body comfortable.

What are the best exercises for people with arthritis? According to Medical News Today, simple stretching tops the list. Yoga is just one example of a type of exercise that incorporates stretching and flexibility, helping you increase your body's range of motion. Other activities like walking, water aerobics, and cycling can also be excellent ways to drop pounds, stay active, and improve pain while giving aching joints a break.

That said, you might still experience some pain in your affected joints after exercising. In that case, Mayo Clinic suggests using a cold compress for 20 minutes to reduce swelling or applying heat for 20 minutes to relax the muscles around your joints.

Get injections for joint pain

                                                   ©Anut21ng Stock/Shutterstock

Injections may be a good alternative for people who don't want to take pills to manage their arthritis pain. Steroid injections are among the most common for people with arthritis, particularly those with rheumatoid arthritis and other inflammatory types of this condition. Like pain medications, steroid injections are available in a few forms, including hydrocortisone and triamcinolone. Based on the pain's location, the administrating physician will deliver the shot in a nearby muscle, soft tissue surrounding the joint, or even the joint itself. These shots can provide pain relief for several weeks (per Versus Arthritis).

Viscosupplementation, or a series of hyaluronic acid injections, is another type of pain management that may be appropriate for people with arthritis. This one works especially for osteoarthritis, which causes the breakdown of cartilage in and around a joint. Hyaluronic acid may replace the cartilage in arthritic joints, leading to better pain management. Some viscosupplementation injections may last as long as six months, but you may need to be patient. It could take a couple of weeks before you notice a difference (via John Hopkins Medicine).

Quit smoking as soon as possible

Ditching your smoking habit can change your body in several positive ways, from improving your cardiovascular function to boosting your immune system. What's more, people who live with arthritis might find a light at the end of the tunnel regarding pain management when they put out their last cigarette. Several studies show the relationship between arthritis development and smoking, particularly in cases of rheumatoid arthritis. One published in Clinical Laboratory found that toxic ingredients in cigarettes, like lead and cadmium, were more concentrated in rheumatoid arthritis patients who smoked. Another scientific review from the journal Cells noted that smoking-related periodontitis, also known as gum disease, can also be a risk factor for developing rheumatoid arthritis.

According to medical doctor April Chang-Miller in a Mayo Clinic question-answer post, people who have smoked for 20 years or longer have the greatest risk of developing rheumatoid arthritis. Additionally, smoking may decrease the efficacy of medications used to treat and manage arthritis, which could prevent your pain from subsiding with drugs like it usually would.

Try acupuncture

©Imagen Punto De Luzi/Shutterstock

Acupuncture is a traditional therapy based in Chinese culture that focuses on pain management and healing. Although it doesn't use the principles of Western medicine that may be more familiar to some patients, there is evidence that shows it could work for arthritis pain management.

A scientific review published in Complementary and Alternative Therapies for Inflammatory Diseases explored the potential outcomes of acupuncture on arthritic pain. The studies included in the review ranged from 1974 to 2018 and included single-case studies, randomized control trials, and clinical trials conducted on rheumatoid arthritis patients. Study researchers offered several hypotheses for their subjects' improved pain, including anti-inflammatory effects, antioxidative effects, and immunity-regulating effects associated with acupuncture.

Another controlled trial discovered that arthritis patients who received acupuncture treatment saw more improvements in their self-reported measures of pain (and depression associated with their pain) than patients receiving counselling alone or Western-style arthritis treatments. "There's a lot of research that says when we put an acupuncture needle into the body, a number of physiological mechanisms occurs," explains professor of family and community medicine Brian Berman to the Arthritis Foundation. According to Berman, acupuncture releases pain-relieving endorphins and produces cortisol that controls inflammation, which could then lead to positive results for people with arthritis.

Use hot and cold therapeutics

When joints are really acting up and need quick relief, applying a hot or cold compress can sometimes do the trick, even if the effects are temporary. Arthritis-health notes that cold decreases inflammation by compressing blood vessels and slowing down the movement of fluid that leads to joint inflammation. However, people who use this method should be careful to limit cold therapies to no more than 20 minutes at a time. They should also use a barrier between the skin and the compress to limit skin damage. 

According to Arthritis Foundation, heat makes blood vessels enlarge, allowing oxygen and blood to come to the aid of an injured area of the body, such as painful joints and muscles. Using a warm compress, taking a warm shower, or soaking in a heated bathtub could therefore decrease pain.

So, which method is better for arthritis? Rheumatologist Chad Deal tells Cleveland Clinic that it really depends on the person. Although osteoarthritis typically does better with heat, some people still prefer the relief that cold therapies give them. Therefore, use what works best for you. The most important thing to remember is to stay active through exercise, too. Use hot and cold therapies to loosen up muscles before exercising and soothe pain after exercising.

Add turmeric to your diet

Researchers have long studied the positive effects of turmeric, a spice that's commonly used in Indian cuisine to flavour various dishes, on the body. Several potential health benefits have been discovered in the process, including aiding digestion, controlling allergies, and improving symptoms of liver disease (via National Center for Complementary and Integrative Health).

It could also help people with arthritis manage their pain, especially those with osteoarthritis. According to Mayo Clinic registered dietician nutritionist Katherine Zeratsky, an active ingredient in turmeric known as curcumin is what does the trick. Curcumin is naturally anti-inflammatory, so it could loosen up the joints and relieve some pain.

A 2019 study also comes to a similar conclusion. More than 130 people with knee osteoarthritis participated in the study, taking either curcumin or an NSAID daily. While both led to improvement of pain, participants had fewer side effects when taking curcumin. Also of note is that people taking curcumin averaged a bodyweight loss of 2%, which could further assist in pain management.

Treat yourself to a massage

©Dragana Gordic/Shutterstock

According to the Arthritis Foundation, plenty of research shows that massage could be a valuable part of a pain management regimen for arthritis. Plus, it doubles as self-care, making it even more beneficial from a mental health standpoint. Numerous studies and scientific reviews conducted within the past decade have found positive effects of massage on knee osteoarthritis and hand arthritis for relieving pain and improving mobility. Experts tell Arthritis Foundation that, although research results are clear, exactly how massage helps in this situation remains a mystery. However, it's possible that massage results in a better night of sleep or can alter hormone production, both of which could lead to reduced arthritis symptoms.

The efficacy of massage is still up for debate in the medical world, though, at least until more conclusive research comes about. Still, some experts agree that there's a place for it in the arthritis world. Exercise physiologist Kindle Fisher tells Healthline, "Massage can be beneficial for temporary relief for patients with [rheumatoid arthritis]. A benefit to massage for arthritis patients is that it increases blood flow to certain areas of pain, which helps promote healing and gives a temporary relief." However, Fisher also explains that deep tissue massage isn't the best idea, as the heavier pressure of this technique could actually cause more pain.

As a last resort, consider surgery

While many forms of arthritis treatments and pain management methods exist, the truth is that they don't always work for each and every person. At some point, arthritis pain may stop responding well to other techniques, making surgery something to consider. You and your doctor should decide together when surgery is the right option for you.

Fortunately, several surgery options exist, with some being less invasive than others. Arthroscopy is one of the least invasive surgeries of all, requiring only small incisions and compact tools to reach damaged tissues, cartilage, or ligaments. Other surgeries that can help people with arthritis still manage to avoid total joint replacements, like osteotomies, synovectomies, and arthrodesis (per Arthritis Foundation).

People with advanced stages of arthritis and severe pain or lack of mobility may require a joint replacement. According to the American College of Rheumatology, more than one million knee and hip replacements happen every year. However, this surgery is typically used as a last resort when other non-surgical methods haven't helped a patient.

Keep in touch with your doctor

                                                    ©Chinnapong/Shutterstock

Ultimately, it's important to keep up with your medical appointments. Visiting your doctor regularly can help them more efficiently monitor your arthritis and manage your pain. Your primary care physician should be your main point of contact for regular appointments, but they may refer you to a specialist for more in-depth help. Orthopaedists can keep an eye on your musculoskeletal system and may provide injections in arthritic joints to manage pain. Rheumatoid arthritis patients may see a rheumatologist who can help them to manage the inflammation and immune response surrounding their particular arthritis symptoms (via Cleveland Clinic).

Your medical team will determine how often you should visit for consistent care. However, there may be times when you need to schedule an appointment due to changes in or worsening symptoms. WebMD suggests monitoring your symptoms closely and calling your doctor or specialist when something doesn't feel right. For instance, pain that doesn't go away after resting, sustained or increasing pain after a treatment, or red or hot joints could warrant a call to the doctor.

https://www.msn.com/en-us/health/other/what-you-should-be-doing-to-manage-arthritis-pain/ss-AA26ouud#image=1

Sore joints in the summertime? Drink more water

From novanthealth.org

Staying hydrated helps ward off arthritis pain during the hottest and most physically active time of year 

Changes in the weather can aggravate arthritis pain for people living with joint inflammation.

You might think you’re home free in the summer, but that’s not always the case. Even though swelling and stiffness are felt most during the winter, arthritis can flare up even in the hottest months. And while studies have not conclusively connected joint pain to the weather, the Arthritis Foundation finds that humidity and temperature do affect how our bodies feel overall.

Dr. Edward Blocker

But arthritis — which affects about 60 million adults and 200,000 children in the U.S. — has less to do with climate and more with our level of physical activity, said orthopaedic surgeon Dr. Edward Blocker of Novant Health Orthopedics & Sports Medicine - Beaufort.

Nicer weather means the risk of injuries like falls and sprains goes up, especially for older adults. But when approached with care, regular exercise can reduce joint pain while strengthening your heart and helping you maintain a healthy weight.

One key to less pain? Drinking water, and lots of it.

“Because we sweat more when it’s hot and humid, hydrating helps to replenish fluids, lubricate the joints and fight inflammation while staying active,” Blocker said.

Here, he discusses how he helps patients prevent joint pain all year long.

Do people experience more arthritis pain when it’s hotter and more humid outside?

Usually it’s just the opposite. In the colder months, joints get stiffer than usual, but people are generally more active when it’s warmer outside, so that can accentuate joint pain in a different way.

The more active you are the better, because your joints are moving. But it’s important to be careful because humidity is a variable, and I think as the atmospheric pressure declines, some people seem to hurt more. When we sweat, we’re losing water, and dehydration can stiffen the joints.

What types of arthritis do you treat most often?

Every one of us gets some form of arthritis at some point in our lives. Think of your car’s tires: You put 75,000 miles on them, and that rubber is going to wear down. The same goes for wear-and-tear on your joints.

I mostly treat osteoarthritis and rheumatoid arthritis, which are both chronic. Osteoarthritis is most common in older adults and is a degenerative wear-and-tear of the cartilage, the cushion between the bones. As we age, our cartilage wears out and doesn’t have the ability to heal like other body tissues.

Your immune system is supposed to attack viruses and bacteria. But with rheumatoid arthritis, your immune system attacks the cartilage. The less cartilage, the greater the pain. Some people live with both osteoarthritis and rheumatoid arthritis, and the latter can even affect kids.

Can cracking your knuckles cause problems down the road?

It could. When you pop your knuckle there’s a kind of suction phenomenon that happens. The joint of a finger knuckle is a rounded bone sitting inside of a little socket. There’s fluid in the joint, so when you crack your knuckles, it has the effect of a mini jackhammer. That can damage the cartilage, especially if you do it repeatedly. I had a bad habit of popping my big toes, and now I have terrible arthritis in those joints.

When is surgery necessary for arthritis, versus a shot or an over-the-counter remedy?

Usually by the time a patient sees an orthopaedist, they’re beyond taking an Advil every now and then. So the first line of treatment is activity modification, which may involve backing away from sports like running, and transitioning to lower-impact activities like walking, swimming or pickleball.

The next step might be over-the-counter or prescription anti-inflammatories, or a cortisone (steroid) shot to treat the inflammation and manage pain.

We’re born with hyaline cartilage, which wears out as we get older. And because we can’t make it grow back, sometimes that requires a knee replacement — and that’s the final option.

My philosophy is that your knee will tell you when it’s time. Sometimes an X-ray shows severe arthritis, but the patient is having only mild symptoms, so I won’t push for a knee replacement. I’ve never told anybody they need a knee replacement. It becomes self-evident, once you ask them what their life is like. And I believe the physician should listen to the patient.

https://www.novanthealth.org/healthy-headlines/sore-joints-in-the-summertime

More alternatives to knee replacement surgery are emerging

From washingtonpost.com/health

Physicians caution that the treatments aren’t permanent fixes, but they may work well for some 

Years of high school, college and semi-professional football meant Layne Herber’s knees didn’t stand much of a chance.

By the time Herber, 73, retired in 2015, he was relying on periodic cortisone shots and the opioid pain killer hydrocodone to hobble through twice-weekly golf games and walks with his family’s dogs.

“I’d play golf and literally could not walk, but I wasn’t going to give that up,” Herber recalled from his Phoenix-area home.

He was equally adamant that he didn’t want one of the most common elective orthopaedic surgeries in the country: total knee replacement.

Although safe for healthy individuals and the gold standard for patients with knees as damaged as Herber’s, the procedure can be an arduous undertaking that requires up to a year for full recovery. Herber also knew that 20 percent of knee replacement patients are unhappy with their outcome. Even more ominous: A close friend died two weeks after the procedure of complications from an infection he developed because of the surgery.

“I kept putting knee replacement off,” Herber said. “I just didn’t want to go through all of that.”

An estimated 30 million Americans — or more than 11 percent of the adult population — suffer from knee osteoarthritis, the degenerative disease that prompts most knee replacements.

In addition to people like Herber who don’t want to undergo the surgery, many Americans aren’t eligible for it because of health issues, including obesity. For those people, several medical specialties — including reconstructive plastic surgery, interventional radiology, and physical medicine and rehabilitation — have developed clinically recognized treatments designed to bring at least temporary relief.

Physicians said patients suffering from debilitating knee pain should consider the following when weighing which treatment is best for them:

• How quickly do I want to recover?
• How much time do I want to invest in my treatment options?
• How healthy am I overall?
• What is the rate of success of the treatment I’m considering? What’s the likelihood it won’t help?

Reconstructive plastic surgeon Joshua Hustedt examines patient John Kamauff in Hudstedt’s Scottsdale, Arizona, office. (Alvin Chow)

Treating the nerves that signal pain

The medical community remains essentially united that, at least at this juncture, knee replacement is the only permanent cure.

“Knee replacement is the best treatment we have available, but it unfortunately comes at the cost of a long, challenging recovery,” said Osman Ahmed, a vascular and interventional radiologist and professor at UChicago Medicine.

Alternatives, however, may enable a patient “to kick the can down the road until they can reach a time when it’s more advantageous,” noted Anthony Giuffrida, director of interventional spine and pain management at the Cantor Spine Center at the Paley Orthopaedic & Spine Institute in Fort Lauderdale, Florida.

The alternatives include procedures that target and at least temporarily silence the nerves that transmit pain signals emanating from the knee.

Physicians who perform the nerve operations note that they don’t permanently solve the problems of an arthritis-riddled knee joint. The three procedures described below are regarded as invasive, with requisite risks, although the risks are lower than with knee replacement.

Pain exists for a reason — to alert the person experiencing it that something is wrong — so concerns abound about whether an individual could do more damage to a knee after a nerve-related treatment.

“Patients ask me all the time: ‘If I don’t feel it, am I going to hurt myself more?’” said Michelle Poliak-Tunis, a double-board-certified physician in pain management and physical medicine and rehabilitation, and associate professor at the University of Wisconsin. “If you’re going to go jump out of airplanes, maybe. But if you’re going to live day-to-day life, the answer is ‘no.’”

There are indications that the procedures could help slow the mechanical decline in the knee.

“The knee doesn’t degenerate any faster,” Giuffrida said. “If anything, it degenerates more slowly because you’ve regained some range of motion and you’re more active,” which helps to maintain the health and function of supporting muscles, ligaments and tendons.

Many insurance policies cover the procedures, but the physicians interviewed for this article said that coverage is market- and insurer-specific. None of these treatments preclude a patient from having a knee replacement later.

Surgical knee denervation

“Neuromodulation [interrupting nerve pain signals] is the future of pain management,” said Joshua Hustedt, a Phoenix-area double-board-certified reconstructive plastic surgeon and assistant professor of orthopaedics at the University of Arizona College of Medicine-Phoenix. “We’ll go after the pain signal, not replacing the worn-out parts.”

Hustedt has spent the past five years refining a procedure known as surgical knee denervation that was pioneered 30 years ago by A. Lee Dellon, a Johns Hopkins University School of Medicine professor emeritus and globally recognized expert in neuropathy.

During the 45-minute outpatient procedure, performed under either anaesthesia or a local nerve block, Hustedt makes two roughly one-inch incisions on either side of the knee and uses a tiny, endoscopic camera to identify and isolate the four nerves that send pain signals to the knee. He then severs and reattaches them to surrounding leg muscles.

Research conducted by Hustedt and his colleagues found that the process of attaching the sensory nerves to motor nerves triggers a reaction in the brain that tricks the sensory nerves into thinking they are motor nerves, leading them to no longer transmit pain signals.

Sixteen days after Hustedt performed the procedure on Herber, the retiree travelled and played three consecutive days of golf without pain, something he said he could have only dreamed of before the surgery. “My knee is not a perfect knee,” Herber said. “But for what I want, at this stage of the game, it’s perfect for me.”

Hustedt has performed the procedure on about 200 knees, starting in 2020. It’s currently available only at his practice in Arizona, although he has launched a campaign to train surgeons worldwide on how to perform it. Patients may still pursue the original procedure championed by Dellon at most U.S. medical teaching hospitals, Hustedt said.

Nerve denervation is permanent, so it doesn’t need to be repeated, Hustedt said, although more studies like one he co-wrote last summer must be conducted to establish its long-term outcomes.

Radiofrequency ablation

A procedure known as radiofrequency (RFA) ablation was introduced in the 1970s to treat back pain and expanded to knees in 2008. RFA uses radio waves guided by X-rays to find and ablate — or destroy — the nerves that transmit pain signals from the knee.

Patients undergoing the 30-minute procedure are lightly sedated. Unlike nerve denervation, the results aren’t permanent because the nerves eventually regrow and reconnect. Patients report relief for six months to one year, and the procedure may be repeated.

Genicular artery embolization

Doctors have deployed embolization — the blocking of blood vessels — for decades to interrupt the blood supply to tumours and to stop internal bleeding. It has been used only in recent years for knee pain.

As knee cartilage breaks down, it results in the release of inflammatory markers that promote abnormal blood vessel growth in the lining of the knee joint, Ahmed said. These abnormal arteries carry nerves with them, causing more pain and inflammation. Genicular artery embolization (GAE) targets and blocks blood flow to these abnormal arteries.

During the 35-minute-to-45-minute procedure, patients are lightly sedated and an interventional radiologist uses an X-ray to identify the abnormal arteries and then injects them with an agent that blocks those specific vessels.

Research shows the results last for at least one year and as long as four years. Ahmed said he is embarking on a study funded by the National Institutes of Health to further investigate GAE. Earlier indications that the procedure may increase infection risks for patients who later have knee replacement have largely been debunked, Ahmed said.

https://www.washingtonpost.com/health/2025/05/11/knee-arthritis-replacement-nerves-ablation/