The Joint Effort Podcast

Arthritis Relief Without The Operating Room

• Dr. Noelle DiGioia Guthrie & Tiffany Belculfine, PA • Episode 5

Share episode

Can Arthritis Be Treated Without Surgery?

Pain doesn’t get the final say. We lay out a practical, step-by-step plan to manage knee and hip arthritis without rushing to the operating room, then explain how to know when surgery is the right move. From smarter movement to targeted procedures, we show how small, consistent steps can reduce pain and restore confidence.

We start with everyday levers you can pull right now: adjusting high-impact workouts, building strength in the quads, hamstrings, glutes, and core, and using regular motion to nourish joints. Then we dig into medications that actually help inflammation, why opioids miss the mark for osteoarthritis, and how to judge whether your training is helping or harming based on how you feel hours and days later. Clear, realistic guidance replaces guesswork.

Next, we compare injections you’ve heard about—and some you haven’t. Steroid shots for short-term flare control, hyaluronic acid to improve lubrication, and PRP for a biologic anti-inflammatory boost each have a role depending on your goals and health profile. We also spotlight cryoanalgesia, an in-office nerve-cooling technique that can dial down knee pain, bridge the gap before surgery, or ease worries about post-op discomfort. Finally, we map out the decision points for joint replacement: imaging that shows bone-on-bone changes, a good-faith run at conservative care, and the most important factor—your readiness to commit to recovery when daily life is too limited by pain.

You’ll also hear how our team model links wellness and surgical care so you never feel stuck between options. Whether you want to delay surgery with a strong plan or prepare for a safer, smoother recovery, you’ll leave with next steps that fit real life. If this conversation helps, follow the show, share it with someone who needs clarity, and leave a quick review so more people can find practical arthritis guidance.

To learn more about The Bone and Joint Center at Magee-Womens Hospital visit: https://www.pghbjc.com
Dr. Noelle DiGioia Guthrie
300 Halket St.
Pittsburgh, PA, 15213
412-683-7272

To learn more about The Wellness Center for Bone and Joint Health visit: https://www.boneandjointhealth.org
Tiffany Belculfine
300 Halket St., Suite 1601
Pittsburgh, PA, 15213
412-641-8594

SPEAKER_00:

Welcome to the Joint Effort Podcast, where mobility meets reality and your future self says thank you. Your hosts, Dr. Noel DeJoya Guthrie of the Ponent Joint Center of Mickey Women's Hospital, and Tiffany Belkaf, physician assistant at the Wellness Center of Bonent Joint House, serving adults across Western Bad Space. If your needs are like bubble rap, your head's arguing putting on stop with your side eye stairs. You're in the right place. Every day, they'll break it down and build you back up with a personalized plan for real life. The show is information without a substitute. Now, let's get you moving. Here are Dr. Noelle and Tiffany.

SPEAKER_03:

Surgery is not always the first step. Discover the many ways arthritis can be managed conservatively. Welcome everyone. Julie Schwenzer, co-host and producer in the studio with Tiffany Belcofine, physician assistant at the Wellness Center for Bone and Joint Health, and Dr. Noelle DeJoya Guthrie of the Bone and Joint Center at McGee Women's Hospital. Ladies, it's great to be back with you.

SPEAKER_01:

Yes, thank you.

SPEAKER_03:

Thank you. Good to see you again. Thank you. So, Dr. Noelle, this one's for you. Can arthritis be treated without surgery?

SPEAKER_02:

Yes, absolutely. So a big part of my job as an orthopedic surgeon is talking to patients about non-operative measures that can help modulate their pain from arthritis. So um, and we always, you know, we always recommend that should be the first step of anyone is to um explore non-operative measures. I think so. The first step, I it's kind of stepwise process. The first step I always talk to patients about are things like activity modification, not going on five mile runs that hurt your knees, um, diet and nutrition modification, um, self-guided home exercise stretching and strengthening plans. And then that can kind of get a little more intense by going to physical therapy with an actual physical therapist. Um, a lot of what we've talked about on the other side of things, the non-up signs with the wellness center, you know, keeping your bone and joint health by doing exercises on a daily basis. Um, those are kind of the first line of things that we talk about. Um, and then going a little bit more um intervention is talking about injections. So we have a lot of injections that we can offer to patients to help treat their hip and knee arthritis. Um, first and foremost, kind of our tried and true are steroid injections for knees and hips. You can't only get those on a um a certain frequency. Um, that's one option. There's also visco supplementation injections. A lot of patients call these the chicken rooster injections, um, but they serve as to um, and you know, some brand names are eufluxa, sinvisc, which are very commonly uh known among patients, but those serve to uh lubricate your joint. So it's a an injection, one injection for three weeks. Um and then another type of injection that's becoming a little bit more popular are called platelet-rich plasma injections. PRP is the the acronym for it. Um that's basically using your own biological blood to separate your blood and plasma part, and your plasma is really rich in anti-inflammatories growth factors, and we inject that back into your knee or hip. Um, and those are that's like a potent anti-inflammatory. Um so those are some kind of you know basic non-operative means that I talk to a lot of patients about.

SPEAKER_03:

And you mentioned the exercise too, and this is a question we hear a lot actually, is how do you know when your exercise is too aggressive and at what age and you know how to maybe shift the focus, like you mentioned, to stretching and weight training. What's a good time and how do you know?

SPEAKER_02:

Yeah, I mean, I think a big thing with with that question is uh someone's own personal experiences and how they feel after they do a certain exercise. You know, I think your body tells you a lot, and being able to listen to your body is really important. So say you go on a 10 mile run and your knees are pretty sore after that, you know, that's kind of a signal that your body doesn't like that and you need to scale back. Um, you know, and and being active is is great. We never tell patients to just do nothing because arthritis, osteoarthritis particularly, movement is good. It actually you have a synovial lining that makes synovial fluid and actually naturally lubricates your joints the more you move it. Um, but you know, there like you said, there is a fine line between doing too much and you know, not doing anything at all. So I think a lot good way to tell patients that I tell patients is to let your body dictate, you know, what you can and can't do and what makes you feel good or makes you feel bad.

SPEAKER_03:

And is this a point too where you recommend physical therapy?

SPEAKER_02:

Yeah, I mean, I think physical therapy is great because you have an expert person, like a trainer who can sit with you and do like very specific exercises that can help strengthen muscles around your joints. I think that's the biggest thing with therapy is you know, you doing exercises that can strengthen your hamstrings, your quadriceps, your core, your low back that actually help stabilize your joints. Um, and like I said, movement exercises just help your joints as well. So the biggest thing with physical therapy is that this person is trained in this. They they do this day in and day out and can help, you know, give you exercise that you could do at home too.

SPEAKER_03:

And you talked about the medications and the shots. A big question we hear too is do they hurt? And what other medications might help with prevention?

SPEAKER_02:

Yeah, very so another, which I didn't mention, thank you for asking. Um, so best medications you can take for osteoarthritis are anti-inflammatory medications, NSATs. So, you know, based on your medical history, things like Advil, um, uh Neproxin, maloxicam, celibrex, those are big um anti-inflammatories. So a lot of patients are on blood thinners and can't take those kind of medications. So Tylenol can be a good one too. Um, those are kind of the medications that we suggest. A lot of we don't recommend opioid pain medication for our arthritis. That um, you know, that helps with your pain receptors, but it doesn't necessarily help with the inflammation, which is what drives the pain for arthritis. As far as do they hurt injections? Um, they do hurt. I mean, it's a needle going into your knee or your hip. We do, you know, we do a lot of them, so we're very good at them and we we do things. There's a little cold spray we use to help make it feel better, but you know, it's a a quick needle and then some pressure when the fluid goes in. But usually the relief afterwards is better, the better than the pain that the patients experience. So there is another, you know, another procedure I've been doing. Um, it's a little bit newer technology. It's using cryoanalgesia to help with pain relief from arthritis. So it's basically using cold temperatures to kind of numb the sensory nerves that supply the pain to your knee. Um, so it's a procedure that takes about 30 to 45 minutes. Um, we do it in the office, though you're you're able to walk afterwards, but that's kind of another option for patients who are looking to avoid surgery or to prolong the need for surgery.

SPEAKER_03:

Are cryotechniques newer? Because we hear about them more often now. Or is this something else?

SPEAKER_02:

The technology is definitely newer. Um, and you know, it hasn't uh gained a ton of popularity within the orthopedic, particularly the, you know, arthritis community quite yet. But I mean, we've been uh we do it for patients who don't want to have our our joint replacement. And also we've been doing it for pre-op total knee patients to help with our post-op pain. Um, because, you know, if you talk within the communities of people needing knee replacements, a lot of the the um scary part of it is the pain afterwards. Um, so this is just another modality we have in our toolbox to help with post-op pain. So, and our patients have been doing really well with it.

SPEAKER_03:

That's great. You guys are so thoughtful when it comes to the pain aspect because I know that's huge. And a last question for you ladies, the big question here is how do you determine when surgery is the best option?

SPEAKER_02:

Yeah, another very good question. And I think, you know, something I discuss with every patient who's gonna have surgery or not gonna have surgery. Um, I always say there's three or four things that go into having surgery or knowing when you're ready for surgery. Number one is your your x-rays have to show that you have end stage or bone-on-bone arthritis. Um, number two, you do have to, you know, try conservative things. We want you to try injections, try the Ayavera treatment to see if we can get you some pain relief. Because a lot of patients can get relief with those modalities, and it also helps prepare you for joint replacement as well, particularly for therapy and stuff like that. Um number, number three, and I think the most important thing is that the patient is ready. Um, joint replacement is elective surgery. So, you know, I will the patient has to be in a good mindset and ready and motivated to have surgery because it is a commitment for sure. Um but those I think, and you know, I think very importantly, and I I say this to patients a lot, maybe on the frustrating side from them, but your body will tell you when you're ready. Your your knees and hips, you know, they will let you know when you can't go play with your grandchildren, you can't go grocery shopping, you can't, you know, go to your holiday um brunch that you have to go to. You they'll they'll tell you. And that's when I think a lot of patients they know they're like, I, you know, my my joints told me when I was ready for sure. Um, so that's also an important, important component.

SPEAKER_01:

Ideally, they would be treated with non-surgical options as much as I can provide before they would go even to have injections with Noelle. Or if they need to, you know, they're maybe planning a surgery, but maybe they need to achieve some weight loss beforehand for a safer outcome for them and to minimize their infection and you know, problem risk afterwards, they would start in the wellness center. But there's a lot of give and take of, you know, okay, you can try this. And, you know, someone may have an injection and then come to the wellness center and then go back for an injection. So we we have a lot of bounce back and forth, but we absolutely all stages, yes.

SPEAKER_02:

Yeah, I think the joint effort, our podcast name really, you know, signifies what we do because we do help each other out a lot on both sides. And it's really nice that we have that aspect of orthopedic care because not a lot of places do. You know, it's you have surgery or you don't have surgery, and if you don't, you kind of fend for yourself as far as, you know, optimizing nutrition, you know, balance, preventing fractures and stuff like that. So it's a definitely a very um unique aspect we have in our our um our bone and joint center here.

SPEAKER_03:

Yes, definitely full service. Well, thank you, ladies. This has been very helpful. You walked us through all these options, and I'm sure the listeners are gonna benefit from it. We hope so. Yeah, thank you. Thank you. We'll see everyone next time on the Joint Effort Podcast.

SPEAKER_00:

That's today's dose of strength, balance, and better movement from the Joint Effort Podcast. Ready for care that fits your life and gets you moving? To schedule an appointment with Dr. Noel for your surgical and injection needs, call 412-683-7272. Or visit PGHBJC.com. Or if you are looking for lifestyle changes that are not surgical, contact Tiffany Belgifine. Call 412-641-8594 or visit boneandjointhealth.org. Healthy bones and happy joints make every day better. Until next time, keep moving, stay steady, and take care of yourself.