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If knee pain is keeping you from the things you love, you and your doctor may decide it is time for knee replacement surgery. While there are many important factors to consider, keep in mind that surgical treatments are designed to reduce pain and restore function.
Why does my knee hurt?
To understand why your knee hurts, it is important to understand how a healthy knee joint works. The knee is the joint in the body where the lower end of the thigh bone (femur), the upper end of the shin bone (tibia) and the knee cap (patella) meet. In a healthy joint, these bones are cushioned with cartilage and a thin lining called the synovial membrane to reduce friction and absorb shock.
Osteoarthritis (OA) is the most common type of arthritis and it can affect any joint in the body. However, OA is most common in knees and hips. When OA affects the knee joint, the cartilage cushioning the bones softens and wears away, causing the bones to rub against one another. This bone-on-bone contact causes pain and stiffness that can increase over time.
Early diagnosis of arthritis* may help to tailor the treatment of your joint health. Only a physician can determine if you have arthritis, based on:
- The overall pattern of symptoms
- Medical history
- Physical exam
- X-rays and other imaging techniques
- Lab tests
The good news about arthritis in the knee is that it can be treated. Here are some signs that it might be time to talk to your doctor:
- Pain persists or recurs over time
- Pain worsens after exercise or other weight-bearing activities
- Pain prevents you from sleeping
- Stiff or swollen knees
- Difficulty walking or climbing stairs
*Arthritis is a disease that typically worsens over time, so it is common for treatment to involve more than one approach and to change over time. For some people, lifestyle changes, medications and walking aids help alleviate the pain. For others, knee replacement surgery may be the only long-term solution. Together, you and your doctor can determine the best treatment options for you.
Nonsurgical treatments for knee pain
When it comes to relieving knee pain, there are many different treatment options. For some people, early intervention treatments like the ones below may help restore knee function and reduce pain.
- Heat/cold therapies – The use of heat or cold over joints may provide short-term relief from pain and stiffness. Cold packs can help reduce inflammation and swelling and may be useful for flare-ups. Heat can aid in relaxing muscles and increasing circulation.
- Low-impact exercise – Low-impact exercise, such as joint and muscle exercises, can improve strength and flexibility. A common myth is that exercise will “wear out” joints, however, when done properly, varied intensity levels of exercise, such as walking or jogging, may help to reduce pain and improve function or movement.
- Weight management – Weight loss helps to ease pain by reducing the amount of stress on your joints. One research study suggested that for each pound of body weight lost, there was a four pound reduction in knee joint stress among overweight and obese people with osteoarthritis of the knee.
- Physical and occupational therapy – Physical therapists can work with you to create a personalised exercise program and show you how to use therapeutic heat and massages to potentially reduce pain. In addition, occupational therapists can introduce you to beneficial devices, such as those used to elevate chairs or toilet-seats.
- Assistive devices – You can protect your knees by using a cane or other walking aid to keep from putting excess stress on them. Shoe inserts called orthotics are designed to support, align and improve the function of your foot. In turn, they may reduce the pressure on your knees.
- Bracing – Different types of braces may help reduce knee pain and improve function and mobility.A “support” brace supports the entire load on your knee. An “unloader” supports the weight on only one side of the knee, when only one side of the knee is damaged.
- Medication – Both prescription and over-the-counter medications can be used to treat the symptoms of osteoarthritis and control pain. Commonly used medications include, but are not limited to, aspirin-free pain relievers, anti-inflammatory drugs, corticosteroids, disease modifying drugs, and sleep medications when pain prevents or interferes with sleep. It is important to talk to your doctor about all medications and dietary supplements you are considering taking, even those available without a prescription.
- Injections – Knee injections, either corticosteroid or hyaluronic may be used in patients whose osteoarthritis knee pain does not respond to medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or simple pain relievers such as acetaminophen. Synovial fluid acts as a lubricant and shock absorber to help your knee joints move smoothly. In the early stages of osteoarthritis, synovial fluid can begin to lose some of its hyaluronic acid content and joints can become painful. Be sure to consult your doctor to discuss the best treatment plan for you.
Surgical treatments for knee pain
If nonsurgical treatments fail to relieve your pain and loss of mobility, your doctor may recommend a surgical procedure.
- Arthroscopy – Often the first surgical treatment for knee osteoarthritis is arthroscopy, a surgical procedure used to see, diagnose and treat problems inside the joint. Arthroscopy typically involves inserting a small camera into the knee joint through an incision and then treating identifiable problems
- Partial knee replacement – For some people with osteoarthritis, the joint damage is limited to only one portion of their knee. When this is the case, your surgeon may prescribe uni-compartmental knee replacement. This partial knee replacement procedure preserves the healthy side of your knee. Only one side of the joint – the diseased portion – is replaced, leaving the healthy portion untouched.
- Total knee replacement – A total knee replacement is typically considered when the surfaces on both sides of the bones are significantly damaged. In total knee replacement surgery, the surface of the thigh bone (femur) is replaced with a metal implant designed to fit the curve of the bone. The surface of the shin bone (tibia) is typically replaced with a flat implant piece and a smooth polyethylene piece that serves as cartilage. The polyethylene implant is designed to allow the new knee to glide smoothly, much like natural cartilage.