Knee pain is a very common problem. If your knee has been bothering you for a while or keeping you from activities you enjoy, the beginning of a new year is a good time to take action. I encourage you to make the following resolutions:
- Resolve to get the right diagnosis
- Resolve to take action to relieve the pain
- Resolve to live life to the fullest
For some people, strategies such as physical therapy and weight loss may bring much improvement; you will feel like you have a “new” knee. For others with severe arthritis and constant pain, a “new” knee in the form of a joint replacement may be the best option to eliminate the pain once and for all.
There are two types of knee pain. Acute pain is what we experience after a sudden knee injury. When this happens, people are advised to follow the regimen known as RICE: Rest, Ice, Compression and Elevation. You should rest your knee, apply ice on and off, and keep the joint elevated over the level of your heart. You may consider using a compression bandage, as well. However, if the injury is really bad and one cannot put weight on the joint, it is advisable to go to the emergency room or see an orthopedic surgeon sooner rather than later.
The other kind of knee pain is called chronic because it doesn’t go away. It may be worse on some days, but the discomfort is generally ongoing. The most common reason for this type of pain is arthritis, which results from wear and tear.
As the joint damage progresses, it can become increasingly painful, but some simple strategies and good practices could help you feel better. The first step is to see a doctor for the proper diagnosis. Anyone who has pain, stiffness or swelling in or around a joint for more than a couple of weeks is advised to make an appointment with an orthopedic surgeon.
When someone is diagnosed with arthritis, the following strategies may provide some relief:
- Be careful not to overdo physical activities, and avoid any action, such as climbing up and down stairs, that may aggravate an arthritic knee.
- Try to keep your weight down to avoid stress on the joint, or lose weight if you are overweight. Losing weight takes pressure off the knee and may slow the progression of arthritis.
- Take over-the-counter or prescription pain medication, and follow your doctor’s instructions.
- Start physical therapy or an exercise program to strengthen muscles around the joint. Good exercises for people with arthritis include using a stationary exercise bicycle and swimming or even walking in a pool. Exercises should be low-impact.
- Use cold or heat to make a joint feel better. However, if a joint is hot and swollen, make sure you use a cold pack. Put a thin towel under the cold pack. Never put ice directly on your skin.
- Rest a joint until it feels better.
- Use an aid, such as cane, to relieve pressure on your knee when needed.
A doctor may recommend steroid injections into the knee joint to reduce inflammation. This may provide temporary relief, but can only be used on a limited basis. Another procedure called viscosupplementation entails injecting a substance called hyaluronic acid into the knee to provide lubrication. This procedure may benefit people with mild to moderate arthritis, but studies have not shown it to be useful for those with advanced arthritis.
When to Consider Knee Replacement
If someone has severe arthritis and conservative measures no longer help, knee replacement surgery is often the best option for permanent pain relief and restored mobility. Major advances over the past decade have revolutionized the way we perform the surgery, and nobody should live with unrelenting pain.
More than 700,000 knee replacements are performed in the United States each year. Advances in implant design mean a knee replacement could last 25 to 30 years. These days, most major joint replacement centers use regional anesthesia, eliminating the need for general anesthesia. The patient is still asleep during the surgery.
Minimally invasive knee replacement with much smaller incisions generally means less pain and a faster recovery. The procedure entails a three- to four-inch incision instead of the standard 10- to 12-inch incision.
Some patients may qualify for a less extensive surgery called a “unilateral” or partial joint replacement. A smaller incision, less pain after surgery and a quicker recovery are potential advantages of a partial joint replacement. Many patients say your knee feels perfectly natural after the procedure.
For the best outcome, people are advised to carefully choose your orthopedic surgeon. Indeed, when considering any type of surgery, it is extremely important that people do your homework. Individuals should choose a surgeon with extensive experience in the procedure you are having, with whom you feel comfortable, and who takes the time to answer all of your questions. It is also advisable to select a major hospital in which a high number of joint replacement surgeries are performed.
If conservative measures fail to provide arthritis relief, joint replacement can eliminate pain and restore quality of life. For those able to get back to activities they once loved, it can change your lives dramatically.
Dr. Geoffrey Westrich, Orthopedic Surgeon, specializes in knee and knee replacement, including revision surgery and complex cases at Hospital for Special Surgery. He is director of research of the Adult Reconstruction and Joint Replacement Service at HSS.