If you suffer from knee pain, you’re not alone. Out of approximately 320 million people living in the United States, more than 40 million suffer some form of arthritis. But there are treatment options that can help, and by understanding the causes of joint pain, patients can be better informed about their own health and care alternatives.
Understanding knee pain
Each year there are over 700,000 knee replacements performed in the United States, and as the “baby boomers” advance in age, these procedures are bound to become more prevalent. Some reports predict this to increase to over 3 million knee replacements by 2030.
Twenty-one million Americans suffer from osteoarthritis. It is the leading cause of joint replacement in the United States. Rheumatoid arthritis is common in women and presents generally between the ages of 20 and 45. Other types of arthritis include post-traumatic arthritis, avascular necrosis and Paget’s disease.
Patients with arthritis may notice pain and stiffness at night or upon first waking in the morning. Increases in activity can also trigger symptoms. Pain from arthritis and joint degeneration can occur suddenly or increase over time, and can be accompanied by swelling. Problems in your spine, nerves or even internal organs can cause knee pain as well. A visit with an orthopaedic doctor can help determine the source of your pain.
Seeing an orthopaedic physician
At your doctor’s visit, you will provide a thorough medical history, likely have X-rays and then receive a physical examination from your orthopaedic doctor. Additional tests may be ordered as needed. To prepare for your visit, you can begin to assemble your medical history. Your doctor will want to know a list of all the medications you are currently taking, information on prior surgeries and/or treatments, prior diagnoses and your family history.
During your physical examination, your doctor will inspect your problem joint, noting the ability to stretch, the range of motion, check for swelling, observe reflexes and the condition of the skin. From the X-ray, your doctor will be able to determine if the joint space has narrowed, or if there are deformities or incorrect alignments. He or she will also check for cysts in the bone, spurs along the edge of the bone or areas of bony thickening called sclerosis.
Managing your care conservatively involves utilizing non-surgical treatment such as physical therapy, medications and injections. Common medications include aspirin-free pain relievers, such as acetaminophen, nonsteroidal anti-inflammatories (NSAIDs) or corticosteroids, which can be in the form of an injection or a pill.
Physical therapy is also helpful, and will include range of motion exercises to help reduce stiffness and keep joints flexible, along with isometric exercises to help build muscle strength. By monitoring your progress, therapists can modify activity during treatment. Your doctor may also recommend braces or assistive devices.
Another type of injection can provide temporary relief by supplementing joint fluid and is called viscosupplementation. Common injection types of this include Hyalgan, Orthovisc, Synvisc, Supartz and Euflexxa.
Arthroscopy is a minimally invasive surgical technique which involves cleaning out the joint with an arthroscopic instrument and a viewing scope. This can often provide relief of symptoms if the pain is related to specific types of cartilage tearing in the knee.
However, when joint pain is severe and interferes with daily activities or with your profession, and you have significant arthritis, joint replacement may be the best treatment option. The decision to proceed with joint replacement surgery should be made by you, your primary care provider and your orthopaedic surgeon. As with any surgery, there are risks involved and conservative care should be exhausted first. If you and your doctors decide joint replacement is the best option for you, weeks before your surgery you will go through a series of preoperative tests and exams to make sure you’re healthy enough for the procedure. This will include blood tests, urinalysis, physical examination, exercises, quitting smoking, and stopping certain medications. Your doctor will discuss dental procedures, skin conditions, if you need to lose weight prior to your procedure, and medications with you.
The total joint replacement procedure will involve your surgeon cutting away the diseased parts of the joint, replacing both ends of the bone with metal and using a plastic piece between the two pieces of metal. These elements will allow your new, prosthetic joint to move like a normal, healthy joint.
Patients should expect and allow for a period of recovery and rehabilitation following knee surgery. It will include physical therapy to regain muscle strength and increase range of motion. Returning to normal activities will take time, and is a decision only you and your surgeon can make because every patient’s experience is different.
However, there are some general guidelines your doctor may give you:
- You'll practice stair-climbing in the hospital and should be able to do this by the time you leave.
- You should have no restrictions on leaving your home as long as your safety and comfort are assured. Just don't tire yourself out; a good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength
- When to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions. Be sure to follow your doctor's or orthopaedic surgeon's advice and recommendations
- After surgery, certain recreational activities are restricted including any sport or activity that requires running or frequent jumping. Exercise that avoids these restrictions are encouraged after the surgery.
Following joint replacement surgery, patients should avoid causing pain to the joint (including pain felt later), avoid jarring the joint (as in running or jumping) and not place the joint in the extremes of its range of motion. Physical activity should be pleasurable, not painful. The longevity of joint replacement can depend on many factors including age, weight, activity level and bone strength. Your surgeon will discuss these factors with you prior to your surgery.
If knee pain has become disabling and conservative treatments have failed, it’s probably time to discuss joint replacement surgery with your orthopaedic surgeon and your primary care provider.
Click here for more information about joint replacement and the Deaconess Joint Replacement Program