Clinical Publications

2021

Comorbidities do not limit improvement in pain and physical function after total knee arthroplasty in patients with knee osteoarthritis: the BEST-Knee prospective cohort study. King LK, Waugh EJ, Jones CA, Bohm E, Dunbar M, Woodhouse L, Noseworthy T, Marshall DA, Hawker GA; BEST-Knee Study Team. BMJ Open. 2021 Jun 18;11(6):e047061.

Prospective randomized trial of continuous femoral nerve block with posterior capsular injection versus periarticular injection for analgesia in primary total knee arthroplasty. Aragola S, Arenson B, Tenenbein M, Bohm E, Jacobsohn E, Turgeon T. Can J Surg. 2021 Apr 28;64(3):E265-E272.

The Relationship between Patient-Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One Year. Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B, Noseworthy T, Woodhouse LJ, Peter F, Dick D, Powell J, Paul P, Marshall DA; BEST-Knee Study Team. Arthritis Care Res (Hoboken). 2021 Jan 18.

BEST-Knee Study Team. Patients’ Preoperative Expectations of Total Knee Arthroplasty and Satisfaction With Outcomes at One Year: A Prospective Cohort Study. Hawker GA, Conner-Spady BL, Bohm E, Dunbar MJ, Jones CA, Ravi B, Noseworthy T, Dick D, Powell J, Paul P, Marshall DA; Arthritis Rheumatol. 2021 Feb;73(2):223-231.

2020

Examination of total hip and knee arthroplasty tissues. Cormier K, Shahid MK, Fischer G, Bohm E. Can J Surg. 2020 Nov-Dec;63(6):E537-E541.

Canadian Collaborative Study on Hip Fractures. Variation in surgical demand and time to hip fracture repair: a Canadian database study. Sheehan KJ, Sobolev B, Guy P, Kim JD, Kuramoto L, Beaupre L, Levy AR, Morin SN, Sutherland JM, Harvey EJ; BMC Health Serv Res. 2020 Oct 10;20(1):935.

Survivorship of constrained polyethylene inserts in primary total knee replacements. Stockwell KD, Gascoyne TC, Singh M, Turgeon TR. Knee. 2020 Oct;27(5):1343-1348.

BEST-Knee Team. Are medical comorbidities contributing to the use of opioid analgesics in patients with knee osteoarthritis? King LK, Marshall DA, Jones CA, Woodhouse LJ, Ravi B, Faris PD, Hawker GA; Osteoarthritis Cartilage. 2020 Aug;28(8):1030-1037.

Lewis PL, Tudor F, Lorimer M, McKie J, Bohm E, Robertsson O, Makela KT, Haapakoski J, Furnes O, Bartz-Johannessen C, Nelissen RGHH, Van Steenbergen LN, Fithian DC, Prentice HA. Short-term Revision Risk of Patellofemoral Arthroplasty Is High: An Analysis from Eight Large Arthroplasty Registries. Clin Orthop Relat Res. 2020 Jun;478(6):1222-1231.

Patient expectations and satisfaction 6 and 12 months following total hip and knee replacement. Conner-Spady BL, Bohm E, Loucks L, Dunbar MJ, Marshall DA, Noseworthy TW. Qual Life Res. 2020 Mar;29(3):705-719.

BEST-Knee Research Team. Use of Recommended Non-surgical Knee Osteoarthritis Management in Patients prior to Total Knee Arthroplasty: A Cross-sectional Study. King LK, Marshall DA, Faris P, Woodhouse LJ, Jones CA, Noseworthy T, Bohm E, Dunbar MJ, Hawker GA; J Rheumatol. 2020 Aug 1;47(8):1253-1260.

Guided-motion hinged knee replacement prosthesis: early survival rate and postoperative patient function and satisfaction. Perrin DL, Turgeon TR. Can J Surg. 2020 May 1;63(3):E196-E201.

Midterm Results of a Contemporary, Porous-Coated Acetabular System in Patients Undergoing Primary Total Hip Replacement for Degenerative Hip Disease: A Prospective, Multicenter Study. Wilson IR, Turgeon TR, Gascoyne TC, Della Valle CJ, McCalden RW. J Arthroplasty. 2020 Jul;35(7):1862-1867.

Accelerated surgery versus standard care in hip fracture (HIP ATTACK): an international, randomised, controlled trial. HIP ATTACK Investigators. Lancet. 2020 Feb 29;395(10225):698-708.

2019

Improving the quality of care with a single-entry model of referral for total joint replacement: a preimplementation/postimplementation evaluation. Damani Z, Bohm E, Quan H, Noseworthy T, MacKean G, Loucks L, Marshall DA. BMJ Open. 2019 Dec 23;9(12):e028373.

A double-blind randomized controlled trial of total knee replacement using patient-specific cutting block instrumentation versus standard instrumentation. Turgeon TR, Cameron B, Burnell CD, Hedden DR, Bohm ER. Can J Surg. 2019 Dec 1;62(6):460-467.

Does oxidized zirconium make a difference? Midterm cohort survivorship of symmetric posterior condyle posterior-stabilized total knee arthroplasty. Demcoe AR, Bohm ER, Hedden DR, Burnell CD, Turgeon TR. Can J Surg. 2019 Apr 1;62(2):118-122.

Differential item functioning of the SF-12 in a population-based regional joint replacement registry. Yadegari I, Bohm E, Ayilara OF, Zhang L, Sawatzky R, Sajobi TT, Lix LM. Health Qual Life Outcomes. 2019 Jul 2;17(1):114.

Impact of missing data on bias and precision when estimating change in patient-reported outcomes from a clinical registry. Ayilara OF, Zhang L, Sajobi TT, Sawatzky R, Bohm E, Lix LM. Health Qual Life Outcomes. 2019 Jun 20;17(1):106.

Orthopaedic registries with patient-reported outcome measures. Wilson I, Bohm E, Lübbeke A, Lyman S, Overgaard S, Rolfson O, W-Dahl A, Wilkinson M, Dunbar M. EFORT Open Rev. 2019 Jun 3;4(6):357-367.

Hip fracture care in Manitoba, Canada and New York State, United States: an analysis of administrative data. Cram P, Lix LM, Bohm E, Yan L, Roos L, Matelski J, Gandhi R, Landon B, Leslie WD. CMAJ Open. 2019 Feb 11;7(1):E55-E62.

Clinical and radiographic outcomes of a hybrid fixation revision total knee arthroplasty system at short to mid-term follow-up. Stockwell KD, Malleck S, Gascoyne TC, Turgeon TR. Knee. 2019 Jan;26(1):240-249.

Hip and Knee Section, Treatment, Two-Stage Exchange Spacer-Related: Proceedings of International Consensus on Orthopedic Infections. Abdel MP, Barreira P, Battenberg A, Berry DJ, Blevins K, Font-Vizcarra L, Frommelt L, Goswami K, Greiner J, Janz V, Kendoff DO, Limberg AK, Manrique J, Moretti B, Murylev V, O’Byrne J, Petrie MJ, Porteous A, Saleri S, Sandiford NA, Sharma V, Shubnyakov I, Sporer S, Squire MW, Stockley I, Tibbo ME, Turgeon T, Varshneya A, Wellman S, Zahar A. J Arthroplasty. 2019 Feb;34(2S):S427-S438.

2018

The assessment of the stability of the tibial component of a novel knee arthroplasty system using radiostereometric analysis. Turgeon TR, Gascoyne TC, Laende EK, Dunbar MJ, Bohm ER, Richardson CG. Bone Joint J. 2018 Dec;100-B(12):1579-1584.

Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians. Gagliardi AR, Ducey A, Lehoux P, Turgeon T, Kolbunik J, Ross S, Trbovich P, Easty A, Bell C, Urbach DR. BMC Med Inform Decis Mak. 2017 Dec 22;17(1):178.

Factors influencing the reporting of adverse medical device events: qualitative interviews with physicians about higher risk implantable devices. Gagliardi AR, Ducey A, Lehoux P, Turgeon T, Ross S, Trbovich P, Easty A, Bell C, Urbach D. BMJ Qual Saf. 2018 Mar;27(3):190-198.

Canadian Collaborative Study of Hip Fractures. Operationalising a conceptual framework for a contiguous hospitalisation episode to study associations between surgical timing and death after first hip fracture: a Canadian observational study. Sheehan KJ, Levy AR, Sobolev B, Guy P, Tang M, Kuramoto L, Sutherland JM, Beaupre L, Morin SN, Harvey E, Bradley N; BMJ Open. 2018 Dec 6;8(12):e020372.

Surgical site infection surveillance for elective primary total hip and knee arthroplasty in Winnipeg, Manitoba, Canada. Dyck M, Embil JM, Trepman E, Bohm E. Am J Infect Control. 2019 Feb;47(2):157-163.

The effect of multimorbidity on changes in health-related quality of life following hip and knee arthroplasty. Zhang L, Lix LM, Ayilara O, Sawatzky R, Bohm ER. Bone Joint J. 2018 Sep;100-B(9):1168-1174.

Canadian Collaborative Study of Hip Fractures. Mortality effects of timing alternatives for hip fracture surgery. Sobolev B, Guy P, Sheehan KJ, Kuramoto L, Sutherland JM, Levy AR, Blair JA, Bohm E, Kim JD, Harvey EJ, Morin SN, Beaupre L, Dunbar M, Jaglal S, Waddell J; CMAJ. 2018 Aug 7;190(31):E923-E932.

Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty. Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M, Pelet S, Fisher W, Belzile E, Dolan S, Crowther M, Bohm E, MacDonald SJ, Gofton W, Kim P, Zukor D, Pleasance S, Andreou P, Doucette S, Theriault C, Abianui A, Carrier M, Kovacs MJ, Rodger MA, Coyle D, Wells PS, Vendittoli PA. N Engl J Med. 2018 Feb 22;378(8):699-707.

How do patients trade-off surgeon choice and waiting times for total joint replacement: a discrete choice experiment. Marshall DA, Deal K, Conner-Spady B, Bohm E, Hawker G, Loucks L, MacDonald KV, Noseworthy T. Osteoarthritis Cartilage. 2018 Apr;26(4):522-530.

Comparing the validity and responsiveness of the EQ-5D-5L to the Oxford hip and knee scores and SF-12 in osteoarthritis patients 1 year following total joint replacement. Conner-Spady BL, Marshall DA, Bohm E, Dunbar MJ, Noseworthy TW. Qual Life Res. 2018 May;27(5):1311-1322.

Radiostereometric Analysis of Keeled versus Pegged Glenoid Components in Total Shoulder Arthroplasty: A randomized feasibility study. Gascoyne TC, McRae S, Parashin SL, Leiter JS, Petrak MJ, Bohm ER, MacDonald PB. Can J Surg. 2017. Aug;60(4):273-279.

Insights from the design and implementation of a single-entry model of referral for total joint replacement surgery: Critical success factors and unanticipated consequences. Damani Z, MacKean G, Bohm E, Noseworthy T, Wang JMH, DeMone B, Wright B, Marshall DA. Health Policy. 2018 Feb;122(2):165-174.

2017

Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes. Kreindler SA, Siragusa L, Bohm E, Rudnick W, Metge CJ. Can J Surg. 2017 Sep;60(5):349-354.

Single-entry models (SEMs) for scheduled services: Towards a roadmap for the implementation of recommended practices. Lopatina E, Damani Z, Bohm E, Noseworthy TW, Conner-Spady B, MacKean G, Simpson CS, Marshall DA. Health Policy. 2017 Sep;121(9):963-970.

2016

Trends in revision hip and knee arthroplasty observations after implementation of a regional joint replacement registry. Singh J, Politis A, Loucks L, Hedden DR, Bohm ER. 2016. Can J Surg. Sep;59(5):304-10.

In-Vivo Fracture of a Reverse Total Shoulder Replacement Humeral Tray: A Case Report. MacDonald P, Petrak MJ, Gascoyne TC, Bohm ER. 2016. Proc Inst Mech Eng, Part H. 230(12) 1141-1147.

Failure analysis and mechanical testing of Ti-6Al-4V modular revision hip stems. Nayar P, Bohm ER, Petrak MJ, Caley WF, Cahoon JR. 2016. Canadian Metallurgical Quarterly Aug-16.

2015

Stem-sleeve junction failure of a modular femoral hip stem after primary total hip arthroplasty: a retrieval analysis. Waly, F, Fahad HA, Gascoyne TC, Turgeon TR, Huk O. 2015 Musculoskeletal Journal of Hospital for Special Surgery 9-Jul-15.

In vivo wear performance of cobalt-chromium versus oxidized-zirconium femoral total knee replacements. Gascoyne TC, Teeter MG, Guenther LE, Burnell CD, Bohm ER, Naudie DR. 2015. J Arthroplasty Jan;31(1):137-41.

2014

The effects of patient positioning on the precision of model-based radiostereometric analysis. Gascoyne TC, Morrison JB, Turgeon TR. 2014. J Biomech Jun 3;47(8):1914-7.

Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements. Gascoyne TC, Dyrkacz RM, Turgeon TR, Burnell CD, Wyss UP, Brandt JM. 2014. J Arthroplasty Oct;29(10):2049-52.

A 67-year-old woman with knee pain. Demcoe AR, Bohm ER. 2014. CMAJ. Nov 18;186(17):1311-4.

Patient Factors in Referral Choice for Total Joint Replacement Surgery. 2014 Conner-Spady BL, Marshall, D.A., Bohm, E., Dunbar, M., Loucks, L., Hennigar, A.W., Frank, C., Noseworthy, T.W. Medical Care 52(4): 300-306.

2013

Fatal Cardiomyopathy after revision totally hip replacement for fracture of a ceramic liner. Zywiel MG, Brandt JM, Overgaard CB, Cheung AC, Turgeon TR, Syed KA. 2013. Bone Joint J Jan;95-B(1):31-7.

Does Adding Antibiotics to Cement Reduce the Need for Early Revision in Total Knee Arthroplasty? Bohm E, Zhu N, Gu J, de Guia N, Linton C, Anderson T, Paton D, Dunbar M. Clin Orthop Relat Res. 2013 Jul 25. [Epub ahead of print]

Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Proc Inst Mech Eng H. 2013 Aug;227(8):833-46.

Aspirin versus low-molecular-weight heparin for extended venous thromboembolism prophylaxis after total hip arthroplasty: a randomized trial. Anderson DR, Dunbar MJ, Bohm ER, Belzile E, Kahn SR, Zukor D, Fisher W, Gofton W, Gross P, Pelet S, Crowther M, MacDonald S, Kim P, Pleasance S, Davis N, Andreou P, Wells P, Kovacs M, Rodger MA, Ramsay T, Carrier M, Vendittoli PA. Ann Intern Med. 2013 Jun 4;158(11):800-6.

2012

The Effect of Adding Tobramycin to Simplex P Cement on Femoral Stem Micromotion as Measured by Radiostereometric Analysis: A Two-Year Randomized Controlled Trial, Bohm, E., Petrak, M., Gascoyne, T., Turgeon, T. Acta Orthopaedica, 2012 April;83(2): 115-20. Epub 2012 Jan 17.

The Frank Stinchfield Award: Dislocation in revision THA: Do Large Heads (36 and 40 mm) Result in Reduced Dislocation Rates in a Randomized Clinical Trial? Garbuz, D., Masri, B., Duncan, C., Greidanus, N., Bohm, E., Petrak, M., Della Valle, C.J., Gross, A.E. 2011 Hip Society Proceedings, Clinical Orthopaedics and Related Research, 2012 Feb;470 (2): 351-356.

Re-Hospitalizations, Early Revisions, Infections and Hospital Resource Use in the First Year Following Hip and Knee Replacement Surgery, Bohm, E., Dunbar, M., Frood, J., Johnson, T., Morris, K. The Journal of Arthroplasty, 2012 Feb; 27 (2): 232-237.

Rehospitalizations, early revisions, infections, and hospital resource use in the first year after hip and knee arthroplasties. Bohm ER, Dunbar MJ, Frood JJ, Johnson TM, Morris KA. J Arthroplasty. 2012 Feb;27(2):232-237.

Pay for Performance (P4P): Ingredients for Success – Part 2, Loucks, L., Bohm, E., Canadian Orthopaedic Association Bulletin #95, Winter 2012.

Obesity and Total Knee Arthroplasty – A Weighty Matter, Bohm, E. The British Editorial Society of Bone and Joint Surgery, April 2012

2011

Use of Patient-Reported Outcomes In The Context of Different Levels Of Data. Rolfson, O., Rothwell, A., Sedrakyan, A., Chenok, K., Bohm, E., Bozic, K., Garellick, G. Journal of Bone and Joint Surgery America. 2011 December 21; 93 Suppl 3:66-71.

Randomized Trial of Computer-Assisted Knee Replacement: Impact on Clinical and Radiographic Outcomes, Hiscox, C., Bohm, E., Turgeon, T., Hedden, D., Burnell, C., Journal of Arthroplasty, 2011 Dec: 26(8):1259-64. Epub 2011 May 17.

Pay for Performance (P4P): A Brief Review of Concepts – Part 1, Loucks, L., Bohm, E. Canadian Orthopaedic Association Bulletin #94, Fall 2011, 31-32.

Paraneoplastic Clostridium septicum infection of a total knee arthroplasty.Burnell CD, Turgeon TR, Hedden DR, Bohm ER. J Arthroplasty. 2011 Jun;26(4):666.

Eliciting patient views on choosing the next available surgeon to reduce waiting times for joint replacement surgery: on the need to consider individual patient preferences and information needs. Conner-Spady B, Marshall D, Bohm E, Dunbar M, Frank C, Hawker G, Noseworthy T. The International Journal of Person Centered Medicine. Volume 1 Issue 2 pp 1-8. (May 2011).

2010

Using population data to measure outcomes of care: the case of hip and knee replacements. Sanmartin C, McGrail K, Dunbar M, Bohm E. Health Rep. 2010 Jun;21(2):23-30.

Experience with Physician Assistants in a Canadian Arthroplasty Program. Bohm, E., Dunbar, M., Pitman, D., Rhule, C., Araneta, J.: (In press, The Canadian Journal of Surgery)

The Bone and Joint Decade in Canada: A Look Back and a Look Forward. Mandzuk, L., McMillan, D., Bohm, E: (In press, The Journal of Orthopaedic Nursing)

Using Population Data to Measure Outcomes of Care: The Case of Hip and Knee Replacements. Sanmartin C, McGrail K, Dunbar MJ and Bohm E. Statistics Canada, Catalogue no. 82-003-XPE-Health Reports, Vol. 21, no 2, June 2010.

2009

Proximally Versus Fully Porous-coated Femoral Stems: A Multicenter Randomized Trial Macdonald, SJ., Rosenzweig, S., Guerin JS., McCalden, RW., Bohm, E., Bourne, RB., Rorabeck, CH., Barrack RL., Clinical Othop Relat Res, 2009 September 24. (Epub ahead of print)

Employment Status and Characteristics of Working Aged Patients Awaiting Hip Replacement Surgery. Bohm E, Canadian Journal of Surgery, 2009, April: 52(2): 142-6

2008

Priority – setting tools for rheumatology disease referrals: a review of the literature. De Coster, C., Fitzgerald, A., Cepoiu, M., and Investigators of the Western Canada Waiting List Project (WCWL), Clinical Rheumatology 2008 Nov; 27(11): 1411-6

Appropriateness of Health Care Interventions: Concepts and Scoping of the Published Literature. Sanmartin, C, Murphy, K., Choptain, N, Connor-Spady, B, Mclaren, L., Bohm E, Dunbar, M, Sanmugasunderam, S, DeCoster, C, McGurran J, Lorenzetti, D, Noseworthy, T, Int J Technol Asess Health Care, Summer 2008; 24 (3): 342-9

The Effect of Total Hip Arthroplasty on Employment. Bohm, E. In press, the Journal of Arthroplasty, 2008, December 22 (Epub ahead of print)

Appropriateness of Health Care Interventions: Concepts and Scoping of the Published Literature. Sanmartin C, Murphy K, Choptain N, Conner-Spady B, Mclaren L, Bohm E, Dunbar M, Sanmugasunderam S, DeCoster C, McGurran J, Lorenzetti, D, Noseworthy T. International Journal of Technology Assessment in Health Care. 24:3 (2008), 342-349.

Unicompartmental Knee Arthritis: High Tibial Osteotomy. Turgeon TR. COA Bulletin, Vol 81: 2008. pp 26-8.

2007

Presence of Medical Comorbidities in Patients with Infected Primary Hip or Knee Replacements Kafai L, Bohm E, Burnell C, and Hedden D. J Arthroplasty 2007 Aug; 22(5) 651-6

Presence of Medical Comorbidities in Patients With Infected Primary Hip or Knee Arthoplasties. Lai K, Bohm ER, Burnell C, Hedden DR. The Journal of Arthroplasty. 2007;22(5):651, Elsevier Inc.

Care Models to Consider. Dunbar M.J, Bohm E, Rumble T: Canadian Orthopaedic Association Bulletin – Winter 2007

2006

Above and Below-the-Elbow Plaster Casts for Distal Forearm Fractures in Children. A Randomized Controlled Trial Bohm E, Bubbar V, Yong Hing K, and Dzus A, J. Bone Joint Surg. Am., Jan 2006; 88: 1 – 8.

Are Physician Assistants the Answer to Canada’s Orthopaedic Surgeon Shortage? Rumble T, Bohm E, Dunbar M: Canadian Orthopaedic Association Bulletin – December 2006

Pelvic and Femoral Osteotomy in the Treatment of Hip Disease in the Young Adult. Santore RF, Turgeon TR, Phillips WR, Kantor S. In Instructional Course Lectures. Light TR Ed. Vol 55: 2006. pp 131-44.

2005

The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond. Turgeon TR, Phillips W, Kantor SR, Santore RF. Clin Orthop Relat Res. 2005 Dec;441:188-99.

2004

Taking Control of Septic Joints: A Guide to Joint Infections. Jacob T, Embil JM, Hedden D, Bock GW. The Canadian Journal of Continuing Medical Education. 2004;16(5):121-128.

2003

Total Hip Arthroplasty for Patients with Avascular Necrosis of the Femoral Head. Burnell C, Hedden DR. COA Bulletin. 2003.

2001

Curriculum for Residents’ Education. Gross M, Bohm E: Canadian Journal of Surgery, – February 2001

1996

Proprioception in ACL and Reconstructed Knees. MacDonald PB, Hedden DR. AJSM. 1996.

1995

Effects of an Accelerated Rehabilitation Program After ACL Reconstruction. MacDonald PB, Hedden DR. AJSM. 1995.

There are a variety of non-surgical treatment options that should be considered before proceeding with a joint replacement.

Weight Loss

For both the hip and the knee, the forces acting across the joint are a combination of body weight pressing down on the joint and the muscles pulling up to stabilize the joint. As these values combine, the hip and knee experience 3-4 times the body weight in pressure with each step. Loosing excess weight reduces the pressure on damaged joints and can relieve pain.

Physical Therapy

By stretching, strengthening and re-balancing the muscle- forces across the joint, the movement and control of the joint can be improve. Pain can also be improved with therapy in addition to the mobility of the joint.

Acetaminophen

Acetaminophen (Tylenol) containing products can be very useful analgesics in arthritis. Given its low cost and good side effect profile, it is a good first-line drug for treating arthritis. It should be avoided in some patients with a history of liver disease and care should be taken not to exceed the total daily dose of 4gm per day. This is especially true when a patient takes multiple different medications that contain acetaminophen.

NSAIDs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications that block the COX receptors on cells and reduce inflammation which can play a significant role in both osteoarthritis as well as other inflammatory arthridities such and rheumatoid arthritis and lupus. Different versions of this type of drug have different side-effect profiles, but, in general, NSAIDS, when taken for extended periods, can play a role in stomach irritation, ulcers, and bleeding and kidney problems with elevated blood pressure. While these can be very helpful medications, their prolonged use should be done under the guidance of a physician.

Steroid Injections

Steroid injection (often referred to as a “cortisone shot”) is generally performed with a depot version of a corticosteroid that remains within the joint. Once in the joint, the steroid blunts the inflammation within the joint and can reduce the pain of the arthritis. This effect can last from a few days to 6 months. There is a small risk of infection with an injection which can be very debilitating and destructive if it were to happen. The risk of infection is less than 1%. There is no agreed upon number as to how many times an injection can be repeated if the most recent injection had benefit for multiple months. Most agree that multiple injections can be offered, the whether a limit should exist or how high the limit may be is unknown.

Unloader Bracing

As arthritis progresses in the knee and joint space is lost, the leg becomes more bow-legged or knock-kneed. As this collapse occurs, increased load is applied to the already diseased and damaged section of the joint. By applying and unloader brace, the leg can be straightened and the load shifted back onto the more healthy area of cartilage remaining. This can reduce pain and suffering during activities such as walking, shopping and yard-work.

Viscosupplement Injection

Viscosupplement injections inject a purified, viscous fluid into the joint. The injection frequently includes components of normal healthy joint fluid known to be reduced in arthritis. While the exact mechanism of benefit is not known, many patients, especially with early arthritis, can benefit from these injections for a variable period of time.

Walking Aid

Many patients find the use of a cane, walking stick or walker to reduce their pain. By transferring weight to the walking aid, the effected joint can be off-loaded reducing the pain experienced and improving the distance that a patient can walk.