By Dr. Fabian Poletti
ONE of the most common phrases I regularly hear from patients over 60 is this: “I’m managing.”
They tell me calmly. Sometimes even proudly.
But when we look more closely, ‘managing’ often means something very sad.
It means no longer walking along the paseo by the beach.
It means hesitating before climbing the stairs to a first-floor bedroom.
It means avoiding longer outings.
It means not lifting a grandchild.
It means shortening walks with the dog.
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It means living cautiously – not freely – because of the pain they are in.
Over time, pain becomes normalised. And here is the uncomfortable truth: Living around pain is not simply a matter of resilience.
The problem is often osteoarthritis, which is described as simple ‘wear and tear’.
That explanation is incomplete. In most patients, osteoarthritis represents the end result of years of low-grade chronic inflammation and is the most common form of arthritis.
This inflammatory process around the joints is influenced by weight, metabolic health, inactivity, sleep quality, stress, previous injuries and genetic predisposition.
It does not affect cartilage alone. Osteoarthritis involves the entire joint organ – cartilage, subchondral bone, ligaments, synovium, capsule, surrounding muscles and, in the knee, the meniscus.
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It is a complex biological condition, not merely mechanical erosion.
By the time daily life becomes restricted, the inflammatory and structural changes have usually been evolving silently for years.
And pain itself is not passive.
When joint pain persists over months or years, the nervous system adapts. Pain pathways become more efficient. Signals amplify. Movements that once caused mild discomfort begin to trigger disproportionate responses. This process is known as chronic sensitisation.
Enduring pain without addressing it does not build strength. It trains the nervous system to remember pain.
The longer this continues, the harder it becomes to reverse – even when the joint is eventually corrected surgically, which is usually my job.
I have seen technically excellent operations followed by slower-than-expected recovery simply because years of inflammation, muscle loss and sensitisation had already taken place beforehand.
The real danger is not only joint damage: It is the gradual shrinking of life.
The good news is that the solution is not simply ‘operate or endure.’
A well-trained orthopaedic surgeon should be able to offer a full spectrum of options – from lifestyle modification and metabolic optimisation, to evidence-based natural anti-inflammatory strategies, to biological and regenerative therapies, to minimally invasive pain procedures, to joint-preserving surgery, and finally to partial or total joint replacement when, and if, necessary.
Reducing low-grade inflammation begins with realistic steps: structured weight optimisation where appropriate, targeted muscle strengthening to protect joint mechanics, improving sleep quality and addressing metabolic imbalance.
Even modest improvements can significantly reduce load across the knee, hip or other joints.
In selected patients, biologic or regenerative therapies may help modulate joint inflammation and maintain function.
These treatments are not miracle cures, and they do not replace surgery when surgery is clearly indicated. However, in properly selected cases, they may reduce symptoms and potentially delay disease progression for years.
Minimally invasive pain procedures – including targeted nerve blocks and radiofrequency nerve ablation – can interrupt persistent pain signalling in specific cases. When performed within a structural understanding of the joint, these techniques can reduce chronic pain amplification and allow patients to rebuild strength and confidence.
In some patients, joint-preserving surgery such as corrective osteotomy can realign the limb, redistribute load and significantly delay the need for joint replacement.
These procedures are particularly valuable when performed at the appropriate stage of disease.
And when the time is right, modern partial and total joint replacements remain among the most successful procedures in contemporary medicine.
With advanced fast-track protocols and refined pain-management strategies, many patients mobilise the same day and recover more rapidly – often with far less discomfort than they expect.
The key is neither rushing into surgery unnecessarily, nor postponing it out of fear.
What concerns me most is not arthritis itself: It is the quiet acceptance of limitation.
That means, not walking by the sea. Not travelling comfortably. Not playing with grandchildren. Not moving freely inside your own home.
Pain should not dictate those choices.
If you are postponing action because you fear surgery, reconsider. There are often multiple strategies available before that step becomes necessary.
If you are adapting year after year, reconsider. And if you are on a waiting list, practise what I call active waiting: control inflammation, preserve muscle strength, optimise bone health where appropriate and prepare your body so that, if surgery becomes necessary, you arrive stronger – not weaker.
Ageing is inevitable. Low grade chronic inflammation is common. Osteoarthritis is widespread.
But silent deterioration is not.
Understanding pain is the first step in controlling it.
Dr Fabian Poletti is a UK fellowship-trained Consultant Orthopaedic and Trauma Surgeon, FRCS (Eng), FEBOT, MSc (Imperial), DIC. He held senior clinical posts at the UK’s NHS and is listed on the GMC Specialist Register. He later served as Chief Physician in Denmark and has extensive experience across both the Spanish public and private healthcare systems. He currently practises in Marbella, Estepona and Gibraltar.
Further information is available at www.drpoletti.com/en , with consultations in Marbella, Estepona and Gibraltar.
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