Knee pain is one of the most conditions I see in the office. Sometimes the pain starts after a fall or injury and the source of the pain is usually associated with the trauma that occurred very recently. For others, the pain begins slowly and steadily and worsens after a period of increased activity. Carefully listening to the patient and performing a physical examination can lead to the correct diagnosis most of the time. X-rays are taken and quickly can all but confirm the most common cause of knee pain that I see, arthritis!
What is arthritis?
Arthritis is not a normal part of aging. There are many risk factors to developing arthritis and age is one of them, but one should not expect to develop arthritis with old age. I have several patients who are in their 90s with no signs of arthritis. Increased weight and obesity are also risk factors for arthritis. With walking, 2-3 times a person’s body weight is transmitting through the knee. For a person who is overweight, losing 30 pounds is a reduction of 60-90 pounds of force through the knee which makes a big difference. Another risk factor is a previous history of injury or fracture. This kind of arthritis is termed post traumatic arthritis. Arthritis can come from autoimmune conditions such as rheumatoid arthritis or psoriatic arthritis. Some patients have an infection in their knee which is termed septic arthritis.
How is arthritis treated?
The treatment for knee arthritis is based around decreasing a patient’s pain to increase their function. The most proven treatment with the longest lasting benefits is weight reduction for a patient who is overweight. Not only does this result in decreased pain from arthritis but it results in other more system wide improvements to cardiovascular health and the body in general. Physical therapy is a great treatment that can improve knee function and also help with weight loss. By strengthening a patient’s muscles around the knee, less force will be focused on the bones and cartilage. Medications are an effective treatment for arthritis and usually focus around a class of medicines called NSAIDs. These include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), meloxicam (Mobic), and others. The great thing about these medications is that they will both improve your pain and decrease your inflammation. Acetaminophen (Tylenol) is also good for those who cannot take NSAIDs due to other medical conditions however it only has pain relief effects and does not decrease inflammation.
What about injectable treatments?
There are many injections which have been used successfully for knee pain. No injection will regrow the cartilage that has been lost in the knee but the goal is to decrease pain and increase function for the patient. The most common injection is a cortisone or steroid injection. This medication acts to decrease inflammation in the knee and can prove effective for many months. There are gel injections which act to improve how the bones in your knee slide past each other. Another option is platelet rich plasma. For this injection, a patient’s blood is drawn and spun in a centrifuge for several minutes. The patient’s own anti-inflammatory factors are then harvested from this mixture and injected back into the knee.
How do I know if I need a knee replacement?
If all the above treatments have been tried and you are unable to achieve relief and unable to participate in the activities you enjoy, then it is time to consider a replacement. This is not a decision that should be taken lightly as there are significant risks associated with a surgery of this kind. You will need to see your primary care physician to make sure that you are healthy enough to proceed with surgery. For patients who are healthy and have failed other treatments, a knee replacement is a great option to return to the activities that bring them happiness.
How do I know which option to start with?
Only you and your doctor can make this determination together. I have seen x-rays that show terrible arthritis and quite frequently the patient is comfortable with minimal pain. This patient will have a different treatment than someone who has severe pain regardless of what that patient’s x-rays show. It truly is a conversation with input from both the patient and the physician to come up with the best treatment plan. If you have knee pain, make an appointment to see what options are available to you to start getting back to the activities you enjoy.
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