Knee

Knee Pain

If you have not had any recent injuries, your knee may be painful from tendinitis or arthritis. Tendinitis is an inflammation of the tendons around the knee. Arthritis is a wearing of the cartilage that covers the bony surfaces of your knee. Knee pain due to arthritis is often characterized as frequent aching or long-term soreness. It is worse with walking and may occur even at rest.

Osteoarthritis / Degenerative arthritis

Osteoarthritis (OA) also called degenerative arthritis can affect people from young adulthood to the elderly. Osteoarthritis is basically explained as wear and tear of the joint surface. This wear and tear commonly affects the articular cartilage of the hip and knee joints. The articular cartilage is the smooth white surface that covers the end of bones making the joint smooth with reduced friction for movement. When cartilage layer becomes disrupted and the joint surfaces deteriorate this leads to bone on bone arthritis. Bone on bone arthritis can lead to severe pain in some patients.

The cause of osteoarthritis in the hip and knee is unknown but most experts believe there is some genetic predisposition. In addition to genetics, osteoarthritis can be caused from hip dysplasia (the hip socket does not form properly), knee dysplasia (the knee joint does not form properly), avascular necrosis (disruption of the blood supply to the bone), trauma, bleeding into the joint and infection.

Post-Traumatic Arthritis

Post-traumatic arthritis occurs after a serious injury: dislocation or fracture. The injury causes damage to the cartilage, which can lead to hip or knee pain, stiffness and even arthritis over time. The symptoms basically are the same as those described from OA.

Conservative Treatment of Arthritis

There are many nonoperative treatment options for the pain caused from hip and knee arthritis but it’s important to know none of these modalities will cure the arthritis. Some treatment options include activity modification, physical therapy, the use of an assistive device (cane or walker) and weight loss. Weight loss is very important because your hips carry up to 10 times your body weight. Losing 30lbs can decrease the forces your hips see by 300lbs. Another mainstay treatment option for hip and knee arthritis is anti-inflammatory medicines like motrin, ibuprofen and naproxen. If these medicines fail there are also prescription anti-inflammatories that can be attempted to treat your pain. Some patients can also get some relief from the use of glucosamine/chondroitin sulfate. The long-term benefits from these drugs have not been established. Another option that can be offered is an intra-articular hip or knee injection with cortisone using imaging for the injection. Physical therapy (PT) is another conservative treatment modality. PT can be used to help strengthen the muscle around the hip or knee, stretch the soft tissues and try to control the pain.

Partial Knee Replacement

Your knee arthritis may be limited to one part of your knee and a partial knee replacement may be recommended. Instead of your entire knee joint being replaced by artificial components, only one compartment may be replaced, such as the medical compartment (inside part of the knee joint), the lateral compartment (the outside part of the knee joint), or the patellofemoral compartment (the front of the knee joint).

Total Knee Replacement

For severe arthritis in the knee, you may require total knee replacement surgery, where the entire knee joint is replaced with artificial components. Typically, your surgeon will remove sections of your damaged knee joint, or the ends of your femur (thighbone) and tibia (shin bone). The new femoral and tibial components are placed with a spacer in between to allow for joint motion.

Total Knee Revision

Knee joint revision surgeries may be necessary for younger individuals who demand a lot from their knees or for patients with older knee implants that may have worn down significantly over time through mechanics or by friction. If the implant used in your knee replacement loosens, wears, or becomes infected, the affected knee joint may become swollen and painful. When this occurs, a total knee revision procedure may be recommended to remove the old implant and replace it with new components.