What every knee pain sufferer should know

What is arthritis?
The bones that form the knee — the tibia (shin bone) and femur (thigh bone) — have cartilage on the ends of them. Cartilage allows the bones to glide over each other, rather than grind. Arthritis occurs when the cartilage of these bones wears out, causing pain. Eventually, this deterioration can become “bone on bone.”

Most arthritis is caused by normal wear and tear, and we call that osteoarthritis. This is part of the aging process and can be partially inherited. There are immune conditions that can also cause arthritis, such as rheumatoid or psoriatic arthritis, but infection, trauma, and avascular necrosis (bone tissue dies) can also cause rapidly progressive arthritis.

Diagnosing arthritis
First, I listen to each patient carefully about the nature of their pain. I examine patients and take an X-ray, which help me confirm if arthritis is the source of their pain. When an exam, medical history and X-rays do not give a perfect picture of what is going on, I sometimes order an MRI for confirmation. That is because there are other potential causes of knee pain:

•    Bursitis or tendinitis — inflammation of the bursa sacs or tendons around the knee
•    An injury, such as a sprain or strain of the ligaments, or tear of the meniscus
•    A pinched nerve in the back, which can cause pain in the knee and down the leg, often with weakness, numbness, or tingling

It is possible to have one or more of these conditions in addition to arthritis.

Non-surgical treatment options
Arthritis is not dangerous; it is just painful. Don’t worry about making it worse, you should continue to exercise and remain active.

Medications: To manage pain, the most effective treatments are anti-inflammatory medications. Some medications are over the counter, such as ibuprofen, but I prefer to give prescription strength versions that only need to be taken once per day.

Knee strengthening program: This can be done through physical therapy or at home. For exercises that you can do at home, visit HipKneeInfo.org. This information comes from the American Association of Hip and Knee Surgeons and is highly reputable.

Cortisone (steroid) injections: These work the same way that medications do. They reduce inflammation and typically relieve pain for three months.

Other injections: These are often referred to as gel shots, chicken fat shots or lubricant shots, and are composed of hyaluronic acid. We do not have convincing evidence that these injections work, but some patients get relief from them.

CAUTION: Stay away from stem cell injections or treatment options that are not covered by insurance. These are proven to be ineffective and extremely expensive.

Weight loss: Losing weight takes pressure off the knees and greatly reduces pain. Talk to your doctor about your weight-loss options since exercise may be difficult for someone with arthritis pain.

Walking assists: No one likes a cane, but they work! To get further with less pain, patients can also try walking sticks or trekking/hiking poles for a more stylish look.

When to consider knee joint replacement surgery
If pain interferes with daily activities or won’t allow the patient to do things they like to do, surgery may be an option. For example, if going to the grocery store sounds unpleasant, and leaning on the grocery cart is necessary to make it down the aisles, it could be time to consider knee replacement.

When the patient has tried non-surgical treatments that have failed, and pain is either increasing or happens every day, patients often consult an orthopedic surgeon.

If the patient’s knee is severely crooked, it is time to seek surgical treatment before it is too late to make a correction.

Knee replacement (arthroplasty)
Knee joint replacement surgery is a very predictable and successful operation. For some patients, a partial knee replacement is the better option, but these may need to be redone later.

A total or partial knee replacement, when performed correctly, makes a huge difference in quality of life.

When to delay or not have surgery
If a patient has no support system in place for recovery, is feeling pressured, or has other health concerns that make surgery riskier, it may be best to delay or not have surgery.

Preparing for knee replacement surgery 
Patients are referred to our pre-op SOS clinic (surgical optimization services) that will obtain updated bloodwork and clearances from their doctors. The clinic also provides excellent education about recovery and will make sure patients have everything they need. Patients must quit smoking and make sure their diabetes is controlled to reduce the risk of infection.

On the day of surgery: Patients will be up and walking around just a couple hours afterward and most will go home that day. People are often surprised by how little pain they have immediately following surgery, and they are off the strong pain medication within a few days.

Recovery from surgery
Patients must use a walker for two weeks following surgery to prevent a fall. Patients will also need to complete six weeks of physical therapy to help regain motion in the knee.

Patients with a desk job typically can return to work four weeks following surgery. If patients have a labor-intensive job, this may be closer to eight weeks.

By three months, the knee will be fully healed, and patients have returned to all normal activities without difficulty.

Common questions

Q: Why are knee replacements said to be so much better these days?
A: Part of the reason is the improvement in the design of joint replacements. We have also made advances in the speed and precision of the surgery, allowing patients to recover quicker. Finally, improved pain control after surgery helps patients leave the same day and return to their lives.

Q: What is the artificial knee made of?
A: The top part (femur) is made of a cobalt and chromium alloy, and the tibia component is made of titanium. The plastic liner in between is made of polyethylene, which allows for smooth motion.

Q: How long will the artificial knee last?
A: With the new materials, implants no longer wear out, and the replacement is expected to last the lifetime of the patient. Some replacements need to be re-done, but this is very rare.

Q: Do you use robots?
A: Robots are a valuable tool, and I use robots for certain situations. Trinity Health Grand Rapids has a Mako robot, and patients can ask their surgeon if that is an option. Whether the patient has robotic-assisted surgery or not, it will not affect the outcome.

Don’t let joint pain slow you down. 
Without treatment, knee arthritis pain will typically get worse. The good news is that there are a range of treatments to help patients feel better and get moving again, from medication to physical therapy to knee replacement surgery. Which option is right for you?

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Read one patient’s story about her knee replacement surgery.