"Do I Need a Knee Replacement?"
Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
Does my knee need to be replaced?
Are you experiencing grinding, crunching, catching, and locking in your
knee? Do you have a deep dull ache in your knee all the time? Does the
pain become a sharp stabbing pain with every step? Does your knee swell
or fill with fluid from time to time? Do you have difficulty rising from
a chair or difficulty walking up or down stairs? Is your knee or leg bowing
inward or outward? Do you need a cane, walker, or assistance from someone
else just to get around? Chances are you have a degenerative condition
in your knee and may be a candidate for knee replacement.
Degenerative joint disease (DJD) is a general term simply meaning your
joint has worn out. The way it has worn out can vary from person to person
and type of condition, but the end result is the destruction of articular
cartilage or padding which exists on the ends of the bones. In the case
of the knee joint, the end of the femur and top of the tibia have the
articular cartilage padding which allows the knee joint to bend and flex
smoothly. As the padding wears out the symptoms of catching, grinding,
crunching and locking occurs. This wearing out process is commonly associated
with inflammation causing fluid or swelling. In most cases the padding
does not wear out evenly causing the knee to develop a deformity or bowing.
If the knee wears out more on the outside or is "knock-kneed"
this is a valgus deformity.
More commonly, the knee wears out more on the inside which causes an outward
bowing called a varus deformity. If the deformity becomes severe enough,
it can cause the knee joint to become unstable and one can experience
giving way episodes and even falling. The conditions which lead to DJD
can include osteoarthritis, rheumatoid arthritis, psoriatic arthritis,
gouty arthritis, and post-traumatic arthritis.
Before considering knee replacement surgery there are a number of conservative
or non-surgical methods of treating knee joint DJD which can be tried.
In fact Medicare and some insurances now mandate that these non-surgical
treatments are attempted before knee replacement surgery is approved.
The first step of treatment is oral anti-inflammatory pills called NSAIDS.
These can include over the counter medicines such as Motrin, Advil, and
Aleve. If ineffective stronger prescription NSAIDS can include Voltaren,
Mobic, and Celebrex. If the knee is swelling an effective treatment could
be draining the fluid and injecting cortisone. Another injection alternative
is medicines called viscosupplementation including Synvisc, Hyalgen, or
Suppartz. Other alternatives of treatment can include physical therapy,
bracing, or using an assistive device to walk such as a cane or walker.
When all treatments have failed, then knee placement surgery may be the
best treatment choice. Since its invention in 1968, total knee arthroplasty
or knee replacement has become a well-established method to treat knee
DJD with excellent long term results. First and foremost, the goal of
knee arthroplasty is to alleviate pain. That deep dull achy pain or sharp
stabbing pain with walking is commonly gone shortly after surgery. During
the surgery the worn out joint padding is replaced with metal and plastic
components to allow the knee joint to move and flex more freely which
greatly improves function. Most of the deformities which occur with DJD
can be corrected with knee replacement allowing for a straighter and better
functioning leg. After completing some postoperative physical therapy,
one can shed their walker or cane to get around. To see if you are a candidate,
make an appointment with an orthopaedic surgeon for an evaluation and
X-ray of your knee. In short, knee replacement can give a patient a new
lease on life.
Questions and or comments regarding this week's health column please
contact Michael Dolecki, MD at Bitterroot Orthopedics and Sports Medicine,
a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton,
MT 59840. Working together to build a healthier community!