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When evaluating your treatment options for joint pain, it's good to focus on knee replacement as the last option, not the first.

 

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Including your lifestyle activities into your evaluation of options will help ensure you make the right choices.

Knee Health Treating Whole person Avoiding Surgery Surgical Solutions Faster Recovery

Have you been told you need a knee replacement?

Patients with knee pain report that the number one fear that they have when visiting an orthopedic surgeon is that they will be told that they need a knee replacement. If you or a loved one has been told that knee replacement is necessary, it is important that you review your options and reach a full understanding of what is involved in knee arthritis and understand the non-surgical and the surgical procedures available for addressing arthritis.

Do you really need a total knee replacement?

Not all knee arthritis requires surgery. Anti-inflammatory medications, nutritional supplementation, injection therapy with either steroids or protein that is similar to joint fluid, bracing, and strengthening exercises are all options for reducing knee pain. Even when knee replacement surgery is called for, up to a third of patients who require surgery are eligible for partial knee replacement rather than a total knee replacement. This operation has the advantages of preservation of more of your own bone and cartilage, a faster recovery, greater function, fewer limitations, and, in most cases, greater longevity than a total knee replacement. For most people, knee replacement is the last option, not the first.

Your knee hurts and you’ve been told you have arthritis…. What is arthritis anyway?

First, what is knee arthritis? To understand this, one must first understand a bit about the anatomy of the knee joint. The knee joint is formed at the junction of the end of the thighbone (the femur), the top of the shinbone (the tibia), and the kneecap (also called the patella). The surface of the bones, where they meet within the joint, is normally covered by a smooth, almost rubbery, cushioning material called articular cartilage. The cartilage surfaces are normally lubricated by a viscous protein-filled fluid called joint fluid or synovial fluid. In early arthritis, the surface cartilage begins to wear away, and the joint fluid becomes watery, so that it no longer provides the essential lubrication. As the wear continues, the loss of cartilage becomes complete in some contact areas, leading to a condition known as bone-on-bone contact.

When patches of cartilage are gone, it may feel at though you are driving your knee over a pothole with every step… and in a sense, you are.

These changes are experienced as pain, stiffness, and the feeling that the knee is going to give way. It is as though the knee has become a rusty door hinge, moving in spurts and creaking and groaning (in the knee we call the sound crepitus).

  • Generally, the pain associated with arthritis develops gradually, although sudden onset is also possible.
  • The joint may become stiff and swollen, making it difficult to bend or straighten the knee.
  • Pain and swelling are worse in the morning or after a period of inactivity. Pain may also increase after activities such as walking, stair climbing, or kneeling.
  • The pain may often cause a feeling of weakness in the knee, resulting in a "locking" or "buckling."
  • Many people report that changes in the weather also affect the degree of pain from arthritis.

Cartilage loss typically happens first at the inner sides (called the medial side) of the knees… the sides of the knee which touch together rather than the outside edge. You may notice you become increasingly bowlegged as the inside cartilage of the knee wears away. When caught at this stage (even though there is bone-on-bone contact), arthritis can often be treated with a partial, rather than a total, knee replacement. A partial knee replacement involves resurfacing only the worn part of the joint surface with a metal and plastic implant. By restoring the worn surface, it is possible to straighten the leg, restoring the alignment. European studies have shown that the restoration of normal alignment slows the progress of arthritis in the rest of the knee, delaying, and in some cases, eliminating the eventual need for a total knee altogether.