WJMC - West Jefferson Medical Center

WJMC - West Jefferson Medical Center

HIP AND KNEE

 

Your knee is the largest joint in your body and one of the most complex. It is also vital to movement. Because you use it so much, it is vulnerable to injury. Because it is made up of so many parts, many different things can go wrong.

Because the knee is so important to movement and maintaining independence, knee pain can be a cause for serious concern. As you age, your body changes and muscle strength and bone density decrease. You become more at risk for a range of bone and joint conditions, such as arthritis or osteoporosis.

Osteoarthritis is the most common form of knee arthritis. It is a slowly progressive degenerative disease in which the joint cartilage gradually wears away. It most often affects middle aged and older people. Osteoarthritis of the knee is a leading cause of disability in the U.S. Although there is no cure, there are many treatment options available to help manage pain and keep you active.

Post – traumatic arthritis can develop after an injury to the knee. It is similar to osteoarthritis and may develop years after a fracture, ligament injury, or meniscus tear.

Rheumatoid Arthritis is an inflammatory type of arthritis that can destroy the joint cartilage. It can occur at any age and generally affects both knees.

Symptoms:

Pain associated with arthritis usually develops gradually, although sudden onset is possible. Many people report that weather changes affect the degree of pain.

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 long 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”.

 

Diagnosis:

  • Physical exam by orthopedic surgeon – gait, range of motion, joint swelling, tenderness.
  • X-rays – shows loss of joint space in the affected knee
  • MRI – magnetic resonance imaging – may be indicated

Non-Surgical Treatment:

The purpose of treatment is to reduce pain, increase function and generally reduce your symptoms. The choice of treatment should be a joint decision between you and your physician.

Nonsurgical treatments fall into four major groups: lifestyle modifications; exercise; supportive devices; other methods.

Lifestyle modifications – can include weight loss, switching from running or jumping exercises to swimming or cycling, and minimizing activities that aggravate the condition.

Exercise – can help increase range of motion and flexibility as well as help strengthen the muscles in the leg. Physical therapy and exercise are often effective in reducing pain and improving function. Your physician or a physical therapist can help develop an individualized exercise program that meets your needs and lifestyle.

Supportive devices – symptomatic relief may be obtained by using supportive devices, such as a cane, wearing energy-absorbing shoes or inserts, or wearing a brace or knee sleeve. An “unloader” brace shifts load away from the affected portion of the knee. A “support” brace helps support the entire knee load.

Other methods – may include heat or ice application, water exercises, liniments or elastic bandages.

Drug Treatment:

There are several types of drugs that can be used in treating arthritis of the knee. Because every patient is unique and because not all people respond the same to medications, your orthopaedic surgeon will develop a program for your specific condition. Medications (including over the counter medications) may interact with other medications you may be taking. Be sure to discuss these issues with your orthopedist or primary care physician.

The types of prescribed medications may include:

Anti-inflammatory – to help reduce joint swelling.

Over the counter pain relievers – to reduce pain.

NSAID’s – nonsteroidal anti-inflammatory drugs – are available in prescription and over the counter forms.

COX-2 inhibitor – special type of NSAID. For moderate to severe pain. You should not take this drug if you are taking an over the counter NSAID. Be sure to tell your doctor if you have had a heart attack, stroke, angina, blood clot or hypertension or if you are sensitive to aspirin, sulfa drugs or other NSAID’s.

Glucosamine and Chondroitin – oral supplements that may relieve pain from osteoarthritis by helping reduce swelling and tenderness. These supplements can interact with other medications, so keep your doctor informed about your use of them. If you decide to take this therapy, it is important not to discontinue too soon. At least two months of continuous use is necessary before the full effect is realized.

Corticosteroids – are powerful anti-inflammatory agents that can be injected into the joint. They are not very helpful if the arthritis affects the mechanics of the joint. They can provide pain relief and reduce inflammation; however, the effects are not long lasting. No more than four injections should be given per joint per year.

Viscosupplementation with Hyaluronic Acid – involves injecting substances into the joint to improve the quality of the joint fluid.

Gold Salt Injections – special treatment used for rheumatoid arthritis.

SURGICAL TREATMENT:

When you and your orthopaedic surgeon determine that surgery is your next best treatment, there are a number of surgical options.

  • Arthroscopy – a procedure using special cameras and equipment to visualize, diagnose and treat problems inside a joint.
  • Osteotomy – the correction of bone deformity by cutting and repositioning the bone.
  • Total or Partial Knee Arthroplasty (joint replacement) – when an arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis.

TOTAL JOINT REPLACEMENT:

The procedure involves removal of the diseased or damaged joint and replacement with a prosthetic joint, made of a combination of metal or plastic materials. Many of the millions who choose this procedure enjoy a full return to their lifestyle before osteoarthritis limited their joint functioning, with only some modest modifications or cautions.

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