Treatment of the Knee

Simple Measures

Exercise – Non-impact exercise such as walking, swimming and cycling keeps muscle strength and tone. Hip joint stretches to keep the hip supple are beneficial. A consultation with a physiotherapist for education and a home exercise program can be useful.

Walking stick – Using a walking stick in the opposite hand reduces load in the hip and usually increases your walking distance. A strong stick of correct length with a non slip rubber end is best.

Paracetamol – A simple but safe analgesic when used correctly. Often needs to be used 3 or 4 times a day (1000mg / 2 tablets on each occasion). This can be safely used by most people at prolonged periods at these doses.

Natural remedies – Often not proven but some people gain relief from various naturopathic potions, magnets, acupuncture and the like. This affect may be placebo but some plant substances have proven anti-inflammatory effects. You should check the use of these with your local Doctor as some may react with other medicines or be dangerous.

Glucosamine and Chondroitin Sulphate – The most common arthritis remedies at the present time. There is some early evidence that over time they may help to maintain articular cartilage and slow progression of Osteoarthritis. Nothing can ‘put cartilage back’ after Osteoarthritis is established. Some people also report a reduction in arthritis symptoms when taking these substances. Their main side effect is diarrhoea. They should not be taken if you are pregnant or allergic to shellfish.

Fish oils – Have been associated with some improvement in cartilage quality and may be beneficial.

Anti-inflammatories (NSAID’s) – Several types of Non steroidal anti-inflammatories are available. They can be very effective in reducing pain and swelling associated with osteoarthritis. All these medications have potential side effects and are not always tolerated. The most common effects are: exacerbating asthma, stomach upset (ulcers etc), increased blood pressure and ankle swelling.

Weight loss – There is no doubt that if you are above ideal weight, weight loss can have a significant impact in reducing pain from osteoarthritis. Weight loss can also reduce the risk of anaesthetic complications and wound healing. Many people after loosing weight no longer need surgery for their Osteoarthritis. You may be given an ideal weight to attain prior to consideration for surgery. Consulting a dietician may be beneficial.

Injections– Cortisone injections into the knee can be helpful for a couple of months but do not provide long term relief. They have some negative effects and cannot be used repetitively. They may be very helpful in specific circumstances such as to reduce fluid in the joint.

Surgery of the Knee

Surgery is only considered when previous options have been exhausted.

Arthroscopy –In early arthritis pain may be coming from a torn cartilage (meniscus) within the knee. This can be trimmed and debrided. Depending on the progression of the arthritis, the results can be unpredictable but often beneficial.

Osteotomy – This involves cutting the thigh bone (femur) or leg bone (tibia) and changing the alignment of your leg. It is most commonly done for bow legged deformity and mostly for people with arthritis at a younger age (less than 60 years). It has the advantage that there is no replacement in the knee joint to wear out or come loose and does not lead to restrictions in activity. It relies on putting the load through the side of the knee which is not worn out. It is therefore limited to people with arthritis in one half of the knee only. An osteotomy is aimed to provide functional relief for 5-10 years at which time a knee replacement can be performed.

Uni-compartment or half knee replacement – This is an artificial knee, replacing only the worn inner half of the knee. Like the osteotomy the other half of the knee must be in good condition. It is a smaller operation and maintains better bend than a full or total knee replacement but has all the other potential negatives associated with a full knee replacement. Statistically these knees are likely to fail earlier than full knee replacements. I use the Oxford® unicompartmental knee replacement by Biomet. This implant has the longest survival and is the most widely used worldwide.

Patellofemoral joint replacement – PFJ joint replacements is a very good surgical option in younger patients with largely arthritis underneath the kneecap. This is evidence by pain classically going up and down stairs. It is a good option in these patients though may need to be revised in the fullness of time to a total knee replacement. I use the Vanguard® by Biomet.

Total Knee replacement – Involves resurfacing the knee with a metal and plastic artificial joint. It is excellent for relieving pain and stability within the knee. They rarely bend fully usually reaching up to 120 degrees. 2% of knee replacements fail within the first 10 years, some quite early with infection or other complications. The other 98% last between 10 and 20 years. I use the Vanguard® total knee replacement by Biomet.

The wear and loosening rate increases with high levels of physical activity. When they fail a revision procedure or ‘redo’ operation can be performed to put in another knee but in general terms these are not as successful as first time replacements. This is why people are told they are too young for a knee replacement. There is no absolute age cut off but a knee done at an early age will guarantee further surgical procedures in that person’s lifetime and may present difficulties in maintaining mobility into old age. Artificial joints are not suitable for impact or twisting sports such as tennis or running but golf, walking and swimming are encouraged.

Summary

Start with a regular exercise / walking program and good shoe wear. Take simple pain killers and by all means try ‘natural remedies’ if you wish. If and when ‘something needs to be done’ we can guide you through the options available.