Activity -- many patients with arthritis feel that they should rest or stay off of the affected hip or knee. Actually this may be the worst thing a patient can do. Activity, either exercise or walking, helps keep muscles strong around the arthritic hip or knee. These strengthened muscles decrease force across the abnormal joints and help decrease pain. Patients with arthritis should stay as active as possible with pain being their limiting factor. Patients who are unable to walk because of pain can still utilize exercise bicycles, cross-country skiing machines, and swim to maintain muscle tone. Light weight lifting has also been recommended for the older population to maintain strength, balance, and prevent potentially serious falls.

Medications -- there are many different types of medications available for the treatment of arthritis. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used for sometime to decrease inflammation and pain from arthritis. This class of drugs which includes Naprosyn, Feldene, Relafen, and Daypro are quite effective but have a side effect of stomach upset, or potential ulcer disease. A newer class of anti-inflammatories is the COX-2 inhibitors. These drugs act by a different pathway and have less incidence of ulcer disease. Celebrex and Vioxx are the two newest agents of this class available today. Tylenol is also quite effective in the treatment of arthritis, but patients need to be aware that overuseage can result in liver damage. Use of Tylenol with multiple other medications needs to be reviewed by the patient's medical doctor as well. Glucosamine and chondroitin sulfate have also gained popularity. Their mechanism appears to be related to the growth of new cartilage cells in the arthritic joint. Further evaluation of this class of medication will determine whether long-term benefits are evident.

Weight loss -- upon arising from a chair or climbing stairs, between 3 to 7 times body weight is placed across the hip or knee joint. In the obese patient this can be up to one ton of force across an already arthritic joint. Increased stress on the arthritic joint results in accelerated wear of the articular cartilage. This may hasten the need for surgical treatment. Weight loss is very difficult, but quite important for the arthritic patient, and needs to be monitored by a physician who specializes in this area. Numerous fad diets are popular at this time, but caloric intake restriction and exercise can obtain consistent weight loss.

Arthroscopy -- looking into the knee joint, and less commonly the hip joint, with a small operating telescope may be helpful in the diagnosis and treatment of arthritis. Treatment of cartilage tears, or shaving the worn articular cartilage may be helpful in decreasing the pain of arthritis. The procedure is done under local anesthetic and the patient can go home later that day. Crutches may be required for a few days after surgery. The surgeon can evaluate all compartments of the joint and give the patient a better idea of the severity of their disease and their prognosis. Newer techniques of cartilage transplantation and cartilage growth are on the horizon as viable alternatives in the treatment of arthritis.

Osteotomy -- removing a wedge of bone to redirect forces across the normal portion of the arthritic joint had been used for many years with varying success. These procedures can be technically difficult and are for temporary relief only. Patients commonly experience 8 to 10 years of pain relief before further surgery is necessary. Your surgeon should be consulted to see if this as an option for the treatment of your arthritis. After osteotomy total joint replacement can still be done.

Total joint replacement -- replacing the arthritic surface with a metal and plastic artificial hip or knee is very successful in the treatment of arthritis. Pain relief is reported to be good to excellent in 95 percent of patients undergoing this surgery. Replacements are now lasting 15 years routinely in long-term studies. Investigators have shown that the results of replacement are better when the surgeon performs at least ten of the surgeries per year. The popularity of joint replacement centers where hundreds are performed annually has increased the success rate further. Patients contemplating joint replacement surgery should question their surgeon regarding long-term published results of the prosthesis they will receive and the volume of surgeries he performs.