Arthritis is a common condition linked to pain and disability. It is regarded as the most common joint disorder in the United States.
Like many other musculoskeletal conditions, there is a lot of misinformation about arthritis management. Most of this misinformation is based on conservative recommendations from back in the day, which are not supported by evidence.
Here are 6 common myths about osteoarthritis.
Myth 1: Osteoarthritis is only wear and tear on the joint.
This is untrue. There is literature supporting that there is an inflammatory cascade that contributes to pathology. Most of this literature is looking at obesity and joint loading. The common thought process is that if someone is obese, the extra bodyweight is causing compression in the knees and hips, contributing to joint space compression/narrowing.
Individuals with a higher BMI tend to have osteoarthritis of the hands, especially the CMC joint of the thumb. We know that a higher BMI is linked to increases in pro-inflammatory cytokines. This information goes against the common thought that extra weight on a joint (like in the knees and hips) is causing osteoarthritis. Therefore, we can draw a conclusion that the pro-inflammatory cytokines are more likely to be related to the onset of osteoarthritis.
Myth 2: Knee replacements are inevitable.
This type of language is detrimental. It implies that everything we do in conservative management will be not helpful in managing pain and limitations related to osteoarthritis.
We know that having healthy lifestyle behaviors, strength training, and conservative management can increase the lifespan of a joint and reduce pain/limitations related to osteoarthritis.
If the arthritic changes, pain, and disability get to a certain level, then joint replacements can improve overall quality of life by addressing these things. It is difficult to know when it is the right time to go for a joint replacement. There are no specific guidelines, but if you have tried conservative management for 6-12 months without any positive impact and your quality of life is suffering, then it may be time.
Myth 3: X-rays tell you everything you need to know.
X-rays cannot be the only one factor used to diagnose arthritis and determine the plan of care. No one modality is the proper way to determine a plan of care.
Repeat x-rays over years showing progressions of joint space narrowing that coincides with symptoms is more reliable. Also, it is possible to have imaging findings of osteoarthritis without any pain or limitations.
X-rays are helpful in the diagnosis, but a full evaluation and monitoring of symptoms is more appropriate to determine the best plan of care.
Myth 4: You cannot kneel after a knee replacement.
People say this all the time. It’s simply not true. This was a conservative recommendation that is no longer supported by the literature. There are no studies out there showing that kneeling after a joint replacement can dislodge the prosthesis.
The inability to kneel can negatively impact quality of life and is the number 1 factor of dissatisfaction after a knee replacement.
Your physical therapist should work with you to gradually expose you to kneeling and kneeling activities to improve your tolerance and confidence with being in this position.
Myth 5: Hyaluronic acid (i.e. Synvisc) is beneficial.
This one is a bit controversial. There are many types of hyaluronic acid injections, with the most common one being Synvisc. The literature on synovial fluid injections is split 50-50. This makes me believe that there is a strong placebo effect going on when it comes to these types of injections.
I wouldn’t necessarily dismiss this type of intervention, but the data is very inconsistent. From experience, most of my clients that undergo hyaluronic acid injections get no benefit even after multiple injections.
Myth 6: Hip precautions reduce risk of dislocations after replacements.
The evidence does not support that hip precautions are beneficial in reducing the risk of hip dislocation. If anything, hip precautions tend to create a fear of movement post-surgery and slow the progression of range of motion.
Corey Hall, PT, DPT