Are you waiting for your surgery to be rescheduled?
We are doing a lot of waiting at the minute, waiting to see when things will return to normal, waiting to see family and friends, waiting for a vaccine. Life has been put on pause but our pains, problems and illness haven't and may even be exacerbated by lack of physiotherapy, ability to exercise and delays in ongoing investigations.
6.3 million orthopaedic surgeries have been cancelled worldwide in a 12 week period due to Covid 19. Within the NHS 516,000 elective surgeries will have been cancelled. Even if the NHS increased capacity by 20% it would take 11 months to clear the backlog and that doesn't account for the further 43,000 cancellations for each extra week of closed theatres.
There is going to be a long wait for orthopaedic surgeries so what can we do to improve these patients quality of life and decrease pain while they wait.
Physiotherapy
It is very well documented that all grades of osteoarthritis can achieve improvements in pain and function with physiotherapy. Physiotherapists have a unique skill set to help you manage your pain both physically and mentally and will work with on your specific goals you want to achieve to make your life better. As no 2 people are the same neither is your physiotherapy treatment. Some clinics have opened and are offering hands on treatment and some are treating via phone or webcam.
Independent physiotherapy clinics would appreciate your support right now with high rates and no income over the past 12 weeks they are keen to get back at it.
Find a physio near you https://www.csp.org.uk/public-patient/find-physiotherapist/find-physio.
With elective surgeries not happening it’s important to note that there are several alternatives to surgery with impressive evidence to back them up. Speak to your physiotherapist to get advice on whether they could help you.
Apps
Escape pain is a fantastic national program that has an online platform to help you manage your pain with educational content and exercise videos.
Jointfully arthritis is an app that allows you to track your activity, medication, mood and weight which can then be shared with your Dr.
https://apps.apple.com/gb/app/jointfully-osteoarthritis/id1068422271
Injections
In recent years there have been lots of new advancements in intra articular injections for treatment of OA.
Platelet Rich Plasma (PRP) have some good evidence in those under 60 with a healthy BMI and mild OA. PRPs low cost and high safety have led to its acceptance in the medical community.
Hyaluronic Acid (HA) can be beneficial for those over 60 with a high BMI but it has a higher cost and only medium term pain relief.
Corticosteroid (CS) has been the go to for the past decade, it gives short term relief and so some patients may require multiple, maximum 3 per year. There is some evidence today CS can cause joint scarring but others dispute this. It is not recommended that you have a CS injection 1 year prior to surgery.
Injections are a great option for pain relief and should be used alongside physiotherapy and a home exercise program. There are some contraindications to the use of injections which may mean you are unable to receive this as a treatment choice.
APOS Therapy
APOS therapy is a foot worn device used for less than an hour a day which can re educate your muscles and re align your body. It has a large number of studies to prove it is highly effective at reducing pain and improving function for osteoarthritic conditions of the hip and knee. All of this can be easily installed into your normal everyday life.
https://www.apostherapy.co.uk/
Brace
Bracing is a cost effective method of treating unicompartmental knee osteoarthritis while awaiting surgery. One of its biggest downfalls has been due to poor patient compliance of wearing them because of those uncomfortable and bulky they were. The top end of the brace market is the new Unloader one X by Ossur. It is sporty, quick and easy to put on and light making it comfortable to wear. If you want something to help with pain while you continue to do the activities you enjoy, check them out.
https://www.ossur.com/en-gb/bracing-and-supports/knee/unloader-one-x
Vitrue Remote
We have just secured an Innovate UK grant to develop technology to help during the Covid 19 pandemic. We are working on ways we can help make remote assessments more meaningful and efficient and to help patients waiting for surgery - so watch this space (and get in touch if you'd like to get your clinic early access!).
While you're waiting try some of our physiotherapist recommended exercises.
https://www.vitruehealth.com/blog/ or some of the treatments mentioned above.
The NHS has lots of online advice and exercises you can try too. https://www.nhs.uk/conditions/osteoarthritis/treatment/
References