I have osteoarthritis in both knees and have been taking anti-inflammatory drugs and trying to exercise, but the pain is persistent and I can’t walk any distance now.
Can you please advise on alternatives to knee replacement surgery? I am 67 and in good health.
Mr. P. Pope, by email.
It sounds like you’ve definitely spent your time pursuing all the lifestyle measures that can be helpful.
In your longer letter, you say that in addition to taking appropriate exercise, you have maintained a healthy body weight.
Osteoarthritis starts with inflammation and leads to the gradual loss of cushioning cartilage from the tip of the bones that make up the joint [File photo]
This is an essential part of osteoarthritis management as it helps reduce the load on damaged joints.
More recently, you have started using nonsteroidal anti-inflammatory drugs such as naproxen along with pain medications.
Osteoarthritis starts with inflammation and leads to the gradual loss of cushioning cartilage from the tip of the bones that make up the joint.
This loss can be clearly identified by X-rays and MRI scans, which reveal the telltale narrowing of the space between these bones as the cartilage wears out there.
However, other tissues are involved as well – it’s not just wear and tear on the joint. For example, the inflammatory process has led to the formation of cysts in the bone under the worn cartilage.
Additional bone nodules called osteophytes can also grow on bone ends in response to inflammatory damage. MRI scans reveal inflammation and thickening of the synovium, including the membrane lining the joint.
Total knee replacement surgery remains the gold standard when it comes to treating people with severe end-stage osteoarthritis, such as yourself [File photo]
Bone marrow injuries can also build up and soft tissues outside the cartilage, such as ligaments, that attach bones to each other, can be damaged.
In your longer letter, you ask whether cartilage replacement is an option. But since osteoarthritis affects all components of the joint, this is not a cure.
You also mention the possibility of platelet-rich plasma (PRP) therapy, which involves rotating a patient’s own blood to separate the blood cells from the plasma. This plasma is then injected where necessary.
Some studies have shown that this treatment improved pain levels by up to 12 months compared to placebo injections, but there is not enough evidence to recommend it.
Likewise, there is a lack of evidence regarding the benefits of knee stem cell injections.
Total knee replacement surgery remains the gold standard when it comes to treating people with severe end-stage osteoarthritis, such as yourself.
The operation, in which the diseased joint is removed and replaced with a metal joint, resolves pain and improves function.
The results are excellent, although I always tell my patients that it gives you a knee that doesn’t quite meet the standard of one nature that is provided.
An alternative to total knee replacement, depending on your circumstances, is a partial knee replacement – or unicompartmental knee arthroplasty – where only the damaged part of the knee is replaced.
This is a less invasive surgery with a shorter recovery time than a full replacement surgery, and may be more appropriate for some younger patients like yourself.
The ten-year survival rate of partial replacement is more than 90 percent, and this procedure does not rule out a full knee prosthesis later, if advisable.
I must tell you that some form of replacement surgery is currently the only valid path for your degree of osteoarthritis.
My 81-year-old wife has an itchy hairline on her neck. There are small nodules, which are not visible but can be felt. Antifungal cream has not helped. We read your advice often – we never thought we would need it!
Name and address provided.
I suspect your wife has head lice. The term ‘nits’ is often used, referring to the empty egg cartons where head lice hatch. The nit cannot be removed from the hair shaft, which distinguishes it from a spot of dandruff.
Head lice themselves are small and difficult to spot. They are most easily found through a close inspection of the hair and scalp at the back of the head, close to the neck and behind the ears. They prefer this area because of the heat.
Often patients come to me because they have found the nodules you describe instead of the lice – although itching is sometimes the dominant symptom.
Head lice are spread through direct head-to-head contact; they are common among children who catch them at school and deliver them at home to parents and grandparents. Seek help from a person with good eyesight to confirm the diagnosis [File photo]
The nodules are lymph nodes, which are part of our immune system and respond to infection. The nodes become larger due to inflammation caused by bites from the small insects.
Head lice are spread through direct head-to-head contact; they are common among children who catch them at school and deliver them at home to parents and grandparents.
Seek help from a person with good eyesight to confirm the diagnosis.
Talk to a pharmacist about the treatment, which involves combing the hair wet with large amounts of conditioner.
You can also get a lotion containing the insecticide permethrin, for use on the scalp and hair in addition to the wet combing technique.
Write to Dr. Scurr
Send an email to Dr Scurr at [email protected] – please provide your contact details. Dr Scurr cannot engage in personal correspondence. Answers should be taken in a general context and always consult your own GP if you are concerned about your health.
In my opinion … MMR can protect against Covid, so I got the shot
Emerging evidence suggests that certain vaccines not only protect against the disease for which they were developed to fight, but may actually have additional benefits.
We are talking about live attenuated vaccines here. These contain a dose of the virus that has been modified so as not to cause illness. Because of this, the body produces antibodies that fight that infection when we encounter it later.
An example of the additional protection vaccines that may be offered was identified after an outbreak of Covid-19 on the aircraft carrier USS Theodore Roosevelt.
More than 1,000 sailors on board tested positive, but surprisingly, only nine were hospitalized. Among their age group, 14 percent would normally be hospitalized – in this case, more than 140 people.
As it turned out, the crew had recently received an MMR vaccine (measles, mumps, rubella) – all serving military personnel get the shot, regardless of their vaccination history.
Emerging evidence suggests that certain vaccines not only protect against the disease for which they were developed to fight, but may actually have additional benefits. We are talking about live attenuated vaccines here [File photo]
The MMR is made from live attenuated viruses, which may be why so many have been spared a serious illness, mBio magazine reported.
This theory may help explain why children (who have had these vaccines generally more recently than adults) have not been severely affected during the pandemic, so further studies are now being proposed.
Since giving an MMR vaccine to an otherwise healthy adult is safe (although there are exceptions), it can be a sensible precaution for those involved in the healthcare system or at increased risk, even before we have that further evidence.
I just had the vaccine – I was born too long ago to have the shot, and although I had measles from six years and rubella later, I never had mumps – to potentially boost my immunity.