Knee Replacement Updates: Part 1 of 3
There’s good news for those in need of a knee replacement. New advances have led to equally viable options for two very different patient populations: the younger, active person and the older, less medically stable individual.
Knee or hip joint replacement has had a very positive impact on lifestyle and overall health for more than 7 million Americans -- a number expected to increase substantially with the aging baby boomer population.
We’ll look closely at this topic for the next three weeks, starting today with a discussion of knee arthritis and treatment options, including knee replacement. Part 2, on Jan. 19, will offer a self-assessment to determine if you are ready or eligible for a new knee. Part 3, on Jan. 26, will present the benefits and complications of a new knee and will specifically examine a new option in this field -- partial or unicompartment knee replacement.
Arthritis of the Knee
I have been advising my patients to exercise, keep active and walk as long as they can to stay mobile and healthy. Still, seniors often tell me that activities that require prolonged walking are limited by knee pain from arthritis. But knee joint arthritis is not a death sentence to an active lifestyle.
The three most common forms of arthritis of the knee are:
- Osteoarthritis, also known as degenerative arthritis, is the most common. It is usually a gradual, slow and progressive process of wear and tear to the cartilage in the knee joint that eventually wears down to the bony joint surface. It is most often found in middle-aged and older people and in weight-bearing joints such as the hip, knee and ankle.
- Rheumatoid arthritis is a form of inflammatory arthritis that can affect many joints. It is very destructive to the cartilage, joint and tissues surrounding the joint. It can occur at any age and usually affects both knees.
- Post-traumatic arthritis can occur after a trauma or injury to the knee. It is a form of osteoarthritis that is triggered years after a fracture, ligament or cartilage injury.
Symptoms of arthritis
- Pain: Usually occurs gradually. However, a sudden onset can occur, especially associated with a sudden twist or fall. Pain is often worse in the morning and improves with movement. Changes in the weather or barometric pressure can cause pain associated with arthritis.
- Swelling: Can occur after an increase activity at the end of the day.
- Stiffness: More noticeable in the morning and improves with movement. However, overuse also can create more pain and swelling and lead to stiffness.
- Weakness: From disuse associated with pain; can lead to occasional buckling of the knee when walking or climbing steps.
- Loss of function: Associated with pain, swelling, weakness and stiffness, which limits walking, climbing stairs and other activity.
Treatment for Arthritis
Conservative Treatment:
In the early stages, your treatment will be a conservative, nonsurgical approach. You and your family physician, orthopedic surgeon or rheumatologist will decide which choices are best.
- Anti-inflammatory medications: aspirin, acetaminophen or ibuprofen to reduce pain and swelling in the joint.
- Orthopedic physical therapy: heat, cold, ultrasound, electrical stimulation, joint mobilization, range-of-motion exercises, strengthening exercises, partial weight-bearing aerobic exercises.
- Activity modifications: eat well and lose weight; doubles tennis instead of singles; sitting or lying leg exercises instead of standing; walk instead of run; soft-bed treadmill instead of hard surfaces; avoid squatting, kneeling and bending.
- Supportive devices: knee sleeves, light bracing, good running shoes for exercise and walking, quality supportive shoes for work/dress.
Conservative, But More Aggressive Treatment:
- Corticosteroids: stronger anti-inflammatory medications that are injected directly into the knee joint.
- Viscosupplementation: a synthetic fluid injected into the knee joint, designed to imitate the joint fluid of the knee and promote healing and mobility.
- Glucosamine and chondroitin: supplements taken orally to control the pain of osteoarthritis and promote healing.
- Rheumatoid medications: specifically designed for this disease.
Surgical Treatment:
When conservative measures no longer succeed in controlling pain and deformity or improving strength and function, more aggressive treatment may be necessary.
- Arthroscopic surgery uses a scope to clean and repair damaged tissues inside the knee joint.
- Osteotomy surgery cuts one of the knee bones to realign the joint for less wear and tear.
- Cartilage grafting is performed on rare occasions, usually at teaching facilities, when young, healthy cartilage with minor damage needs to be repaired.
- Total or partial knee replacement of severely damaged joint surfaces with metal or plastic.
SOURCES: Rothman Institute, Philadelphia; American Academy of Orthopaedic Surgeons; Biomet Inc.
Medical reviewer: Harry Schmaltz, M.D., orthopedic surgeon and joint replacement specialist, certified Oxford Unicompartmental Knee replacement surgeon, Scranton Orthopaedic Specialists, PC.
PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice and an associate professor of clinical medicine at Commonwealth Medical College. His column appears every Monday in the Scranton Times-Tribune. Email: drpmackarey@msn.com.
