One of the most common causes of knee pain and loss of mobility is the wearing away of the joint’s cartilage lining. The knee can be damaged by trauma (for example, falls, sports injuries, car accidents) or through disease such as with arthritis. When this happens, the bones rub against each other, causing significant pain and swelling — a condition known as osteoarthritis. Once enough damage has occurred, the knee becomes painful and causes discomfort, limping, instability, giving way, and swelling, resulting in a decrease in the motion and function of the knee joint. In addition, without cartilage there is no shock absorption between the bones in the joint, which allows stress to build up in the bones and contributes to pain.
Cause & Symptoms
Arthritis is the most common form of pain due to general wear and tear. The pain associated with arthritis of the knee usually develops slowly over time, although sudden onset is also possible. Pain may worsen after a period of inactivity, or in the morning. Activities such as walking or kneeling may exacerbate the pain. The knee may become swollen and stiff, and it may become difficult to straighten or bend the knee. The degree of pain and immobility may be affected by changes in the weather.
If you are middle-aged or older and experiencing pain in one or both knees, you may have Osteoarthritis. This is known as a “wear and tear” form of arthritis, caused when the joint cartilage in the knee joint wears away. Osteoarthritis usually develops slowly over time, effecting mostly middle-aged and older patients.
If both knees are experiencing pain, you may have Rheumatoid Arthritis. This is an inflammatory form of arthritis that affects the joint cartilage. It usually affects both knees, and can occur at any age.
If you once suffered a knee injury and now are begining to feel joint pain, you may have Post-traumatic Arthritis – This type of arthritis is can develop after a knee injury.
One of the best ways to reduce wear and tear on your knee is to lose weight. Imagine adding a 100 pound bag of sand to the trunk of a car. Think about how the car sinks lower from this added weight. Over time, the shock absorbers in your car will wear out from carrying this additional weight. Your knees are similar to the shock absorbers in your car. For each pound you lose, you save your knees 5 to 7 pounds of force. By simply losing 5 pounds you can relieve up to 35 pounds of stress on your knees!
Your ProSports physician will assess the tenderness, swelling and range of motion of the knee. X-rays will show if there is significant loss of joint space in the knee, indicating osteoarthritis. An MRI may be necessary to diagnose rheumatoid arthritis of the knee.
Once the knee is damaged to the point that it is painful or that it can no longer move in the way that it is intended, the patient goes to a physician to see if anything can be done to change this situation. There are things that can be done other than knee replacement for people who have problems with their knees. Whether those things are likely to be successful, depends a little bit on the specific individual circumstances.
Non-surgical Treatment Options:
At its early stages, arthritis of the knee may be treated with a variety of non-surgical procedures:
- Minimizing activities that aggravate the arthritis, such as running, jumping and climbing stairs, and incorporating exercises such as swimming and bicycling.
- For overweight patients, a weight loss regimen may help alleviate the symptoms.
- Physical therapy exercises (including water exercises) can help strengthen the leg muscles and increase flexibility.
- Wearing a knee brace or impact-absorbing shoes may help relieve symptoms.
In addition, your ProSports physician may work with you to develop a drug program to help with your condition. This may include anti-inflammatory medications such as aspirin or ibuprofin, steroids or other medications.
Surgical Treatment Options
For advanced stage arthritis that does not respond to nonoperative treatments, your your doctor may recommend surgery. There are surgical procedures that are lesser surgical procedures than total knee replacement such as: osteotomy, arthroscopic debridement, and synovectomy. These surgical procedures should be discussed with you to determine if they are reasonable alternatives in your case. Depending on the stage of your disease or damage, total joint replacement may be the only reasonable surgical procedure. This means that basically the choice is either to proceed with a total joint replacement or simply to wait a little bit longer to see how rapidly your condition deteriorates and to try some other things including medication, limitation of activity, weight reduction, etc.
There are several different options available:
- Arthroscopic surgery allows the surgeon clean out the inside of the joint and repair the torn cartilage.
- Osteotomy cuts the femur (thighbone) or tibia (shinbone) to improve the alignment of the knee.
- Cartilage grafting replaces the damaged cartilage with healthy cartilage. This procedure is useful for patients with limited cartilage damage (due to arthritis or trauma).
- A partial or total knee replacement uses metal or plastic to replace the torn knee cartilage.
If arthritis (or injury) has damaged your knee, and different treatments for your pain haven’t helped you get through your everyday activities comfortably, you may be ready to consider knee replacement surgery.
Knee replacement has been proven over four decades to relieve severe knee pain and restore knee function in the vast majority of patients. In fact, the National Institutes of Health recently concluded that knee replacement surgery is “a safe and cost-effective treatment for alleviating pain and restoring function in patients who do not respond to non-surgical therapies.”
If you have undergone Knee Replacement surgery, the Knee Replacement protocol contains instructions and exercises to help you recover.