Ain't that a 'pain in the knee'

Many patients present to Memorial Satilla Specialists-Orthopedic Surgery with knee pain. One of the more frequent diagnoses we make is knee arthritis. Otherwise known as osteoarthritis, it is one of the most common reasons for disability.

More than 85 percent of the population above the age of 75 is afflicted with some level of osteoarthritis. The typical complaints are pain and swelling in the knee, producing both painful motion and a decrease in joint mobility. This can occur from a traumatic injury or from ‘wear and tear’ over one’s lifetime.

The knee, which is the largest joint in the body, is subject to three to five times the force of body weight during normal gait. With additional weight, such as with obesity, or when carrying heavy loads, this force is increased exponentially across the knee. The knee normally has joint fluid, a meniscus, and cartilage that are meant to protect the joint surfaces and provide painless motion. When these mechanisms are disrupted, the cartilage wears down, similar to the tire tread on a new tire, and both pain and stiffness result until a critical point is reached.

Osteoarthritis is a chronic disease, and treatment is aimed at improving the symptoms in order to improve function and quality of life. Currently there are many treatment options for knee arthritis. The majority of treatments are non-operative, aimed at treating the symptoms of the disease.

When a patient presents to us with knee pain, X-rays are commonly taken along with a history and physical exam to determine the cause of pain. Once the diagnosis of arthritis is established, an appropriate treatment plan is put in place based on the American Academy of Orthopedic Surgeons clinical practice guidelines.

Non-operative Treatments

Education and awareness of the patient’s symptoms helps them become proactive in their care plan. Symptoms can often be reduced by refraining from activities that aggravate pain.

Physical therapy is a powerful tool to improve joint function. Therapists are trained in many treatment options that can reduce pain levels and prevent further deterioration of a joint, including exercise plans that allow other muscles to compensate and improve balance, strength, and range of motion. Avoiding painful activities ultimately leads to decreased strength and muscle atrophy which worsens the symptoms in the long term. A well prescribed exercise program can help prevent this from occurring. Aqua therapy is another option that may decrease the load across a joint by neutralizing the force of gravity with water.

Weight loss helps reduce force across the joint and can lead to decreased pain. Studies have shown weight loss, through diet changes and exercise, improves symptoms in knee arthritis by reducing pain, increasing walking distance, improving stair climb time, and overall self-reported function.

Knee bracing: Many patients with advanced arthritis will notice a curvature to their legs which can produce an unstable joint. The goal of a knee brace is to improve stability in the knee. While the brace won’t correct any curvature, a knee brace can help reduce pain in instances of arthritis flare-ups.

Assistive devices – A cane, typically used on the opposite side of the arthritis, or a walker, can help decrease load across a joint and therefore improve both pain and balance.

Cryotherapy – Decreasing the temperature of skin and muscle may reduce pain and the incidence of muscle spasms. We typically recommend this after surgery as one of the ways to reduce post-surgical pain. Brief sessions of twenty minutes of an ice pack followed by rest work well for many patients.

Acupuncture – This treatment method uses thin needles inserted into the skin at certain points in the body in order to reduce pain. It may provide temporary relief from arthritis. A certified acupuncture practitioner has to perform the procedure.

Denervation therapy – Aimed at reducing pain across a joint by using heat or chemicals to reduce the pain sensations nerves carry, this treatment may provide short term relief from osteoarthritis.

Medication – Anti-inflammatories are a broad class of medications that decrease inflammation in the body, and therefore reduce pain. NSAIDs, a class of drugs with anti-inflammatory properties, have been shown in multiple studies to provide relief of the symptoms of pain in patients with arthritis, at least for short terms. It is important to talk to your physician to see which medication may work for you.

Injections – Cortisone injected directly into the joint may provide temporary relief of pain and swelling. These medications can only be injected at certain intervals so as not to cause harm. Visco-supplementation injections are synthetic medications designed to mimic the joint’s natural lubricating fluid. Your doctor will be able to educate you about the risks and benefits of these medications. It is important to speak with your doctor to see if they are an option for you. PRP and stem cells injections are aimed at reducing pain and inflammation within the joint, but there is currently limited evidence to support this treatment option. These injections are not typically covered by insurance.

When non-operative treatments fail, surgery may be needed. Total knee replacement provides reliable pain relief, increased motion, and an overall increase in function of the knee joint, allowing for improvement in quality of life. Total knee replacement is a reasonable option for patients who continue to have debilitating pain or a decrease in function even after trying non-operative treatments.

Memorial Satilla Health Orthopedic Surgery is located at 305 Pineview Drive, Waycross. To make an appointment or for more information about the services we provide, visit the Memorial Health Satilla Specialists website or call 912-283-8444.