Erik Bowman, MD, on treating knee and hip arthritis

Does your hip or knee feel stiff or painful? Are you experiencing a dull, aching pain in your groin, outer thigh, knee or buttock? The cause may be osteoarthritis (OA), or “wear and tear” arthritis, which is the most common form of hip and knee arthritis. Luckily, with today’s medical advances there’s absolutely no reason to live with OA pain or sacrifice your active lifestyle.

During the BCH lecture, “Innovative treatment for painful hips & knees,” orthopedist Dr. Erik Bowman of BoulderCentre for Orthopedics explored the continuum of treatment options for hip and knee OA, from the non-surgical to the most advanced robotic surgical treatment using Mako robotic-assisted orthopedic surgery. 

_____________________________________________________

Watch "Innovative Treatments for Hip & Knee Arthritis"

_____________________________________________________

Non-surgical treatments

Dr. Bowman began his talk by describing non-surgical treatments for hip and knee arthritis such as the following:

• Lifestyle modifications—
  • Modifying your weight - “Women with BMI of more than 30 are four times as likely to develop arthritis than someone with an average BMI. For men, the risk is five times greater,” Dr. Bowman stated.
  • Exercise - Participating in aerobic, low impact and leg strengthening exercises can help.
  • Diets and supplements - According to Dr. Bowman, evidence shows that low inflammatory diets, turmeric, CBD may decrease some pain through decreasing inflammation but will not affect the progression of arthritis. There's good evidence that collagen, glucosamine and chondroitin do not work.
• Medications—
  Dr. Bowman noted, “It’s important to be aware of the side effects each medication presents to your system and to understand there is moderate evidence that they’ll offer pain relief.”
  
  He added, “There are some disease-modifying drugs being developed. However, it may be 10 to 15 years before they are actualized. Some of these drugs try to relieve pain, others will try to inhibit the breakdown of cartilage or actually repair the cartilage. These will undoubtedly be very expensive, restrictive and potentially not covered by insurance.”
  
  Dr. Bowman’s review of the medications patients most often inquire about included:
  • Acetaminophen (Tylenol) - He warned that this provides little pain relief and, over the long term, will affect your liver.
  • Non-steroidal anti-inflammatories/NSAIDs (Advil, Motrin, Aleve, naproxen, Voltaren cream) - Dr. Bowman claimed there’s moderate evidence that these are effective for inflammation and pain relief. However, they are more effective in early stages of OA. “As your arthritis advances to a bone-on-bone state, these medications are no longer effective,” he stated.
  • Cox-1 Inhibitors (Celebrex, celecoxib) - these are newer pain relievers.
  • Tramadol – Dr. Bowman said this is an opioid-like medication, with fewer side effects, but it can result in addiction and is prescribed judiciously.
• Therapy—
  • Physical therapy - Dr. Bowman explained, “Physical therapy is different from exercise; it offers muscular balance and neuromuscular control.”
  • Hydrotherapy - “This an excellent option, especially for heavier patients,” said Dr. Bowman.
  • Stretching - Improves range of motion, particularly in early stages of arthritis. However, it can make your pain worse if your stretch past your limit.
  • Chiropractic therapy - This type of therapy may offer temporary relief, according to Dr. Bowman.
  • Acupuncture - Provides temporary relief for those who are in a lot of pain.
• Braces—
  • Dr. Bowman’s favorite is the “supportive sleeve.” He stated that it provides some support. "However, I am not a fan of braces with bars on the side because the dial, which is a part of this type of brace, can put pressure on your joint and increase your pain."
• Injections—
  “Most are not beneficial once you have advanced to bone-on-bone OA,” said Dr. Bowman. They include:
  • Corticosteroids – These are the most popular and conventional anti-inflammatory injections used to control pain. They are relatively well-tolerated and “buys time” for patients whose joint isn’t quite ready for total replacement.
  • Visco-supplementation – This is hyaluronic acid and used as a mechanical lubricant. "These are often multiple injections over three weeks. They work if you have some cartilage left. Often insurances require authorization and want to see you have tried therapy and/or cortisone injections first," Dr. Bowman explained.
  • Platelet rich plasma (PRP) - Dr. Bowman said, “We take blood from your arm, spin it down and put it back into your joints in hopes that the proteins will heal the damage. The issue is, if you have no cartilage, there is nothing left to repair or heal. I am suspect of this treatment, and don’t recommend it for arthritis. It costs a lot of money and is not covered by insurance”
  • Stem cells – These injections are extraordinarily expensive. “In short,” said Dr. Bowman, “it doesn’t work.”

Surgical options

Dr. Bowman explained, “Knee and hip replacements have become quite common. In the United States 450,000 knee and 1,000,000 hip replacement surgeries are performed annually.” He added, “These numbers continue to rise each year.”

For patients needing hip or knee surgery, Dr. Bowman performs a wide range of patient-centered approaches, including minimally invasive options.

Total hip replacement

During total hip replacement surgery, the damaged parts of the hip socket and thigh bone are replaced with an artificial hip joint, also known as a prosthesis or implant.

Dr. Bowman uses the front-of-the-hip (anterior) approach to hip replacement. Traditional surgery requires an 8-to-12-inch incision and cutting through muscles at the back of the hip, leaving patients with a long recovery. With the anterior approach, he accesses the hip joint by making a 4-to-5-inch incision at the front of the hip, near the groin, and gently pushes muscles aside rather than cutting them. This leads to a quicker, less painful recovery.

Total knee replacement
Total knee joint replacement is an “open” surgery that replaces the entire damaged portion of the thighbone and shin bone with an artificial knee joint (prosthesis or implant).

Partial knee replacement
Partial knee joint replacement is a surgery performed to remove only the diseased portion of a knee joint and replace it with an implant.

Mako: One system for three procedures

Mako Robotic-Assisted Surgery is Dr. Bowman’s preferred system for hip, knee and partial knee replacements. It provides the information he needs in advance of the surgery to ensure a knee or hip implant is compatible with each patient’s unique anatomy. This means he goes into surgery, ready to execute the plan, and only making minor adjustments intra-operatively to tailor the implant to your anatomy.

Procedures performed with the Mako robotic-assisted surgery system may offer important benefits compared to open surgery, including:

• Significantly less pain
• Less blood loss
• Less scarring
• Shorter surgery recovery time
• Faster return to normal daily activities

Schedule an Appointment

To schedule an appointment with Dr. Bowman, call (303) 449-2730 or visit BoulderCentre for Orthopedics & Spine.

Click here to view/download a PDF of slides shown during the lecture.