Feed: The Arthritic Knee - AggScore: 72.7
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Unfortunately, for many people it will eventually get to the stage where there only thing that is going to help is a total knee replacement ( also called a total knee arthroplasty).
It is not uncommon for there to be a waiting period between when the decision is made and when the operation occurs. This may be a matter of weeks or, in the case of public health systems, many months.
Once you have agreed to a knee replacement your next question should be: What can I do between now and the surgery?
1) Remain as active as possible: Don't cease all painful activity while you wait. Continue as best you can despite the pain. Decreased activity can lead to loss of muscle strength and increased knee stiffness.
2) Work those quads: The stronger your quadriceps muscle, the easier it will be for you to recover from the surgery. Even if your wait is only a few weeks, improvements can be made.
3) Educate yourself about Deep Venous Thrombosis, a potential complication of surgery. Learn what you need to do to decrease your risk. This link goes to my article on DVT
4) Prepare your house: Remove trip hazards such as rugs. Remove clutter. Do any jobs that will be difficult after your operation.
5) Practice Crutches: If you have never used crutches before, consider learning how to uses them BEFORE your operation. Try stairs with crutches with and without a rail.
These are all simple, easy things to do and they can make your recovery much more pleasant. Don't waste the time before your operation - use it to your advantage.
Date Published: Nov 03, 2009 - 8:56 pm
What is the point of replacing only half of the knee?
There has been a change in attitude amongst surgeons in the last few decades. The old, aggressive surgical practices of big operations with big incisions has been replaced by minimally invasive techniques and a philosophy of doing the smallest amount possible to achieve a result.
A good example of this is cartilage tears in the knee. The old way was a large incision and complete removal of the meniscus. Today only the torn part is removed and this is done as a day case via key hole surgery.
Knee replacements are the same. Surgeons began to ask: "Why are we replacing the whole knee when only one compartment is worn?"
Due to the angulation that occurs in arthritis - either bow-legged or knock-kneed - all of the weight goes on the worn half of the knee while the other half gets a rest. This means it is often in very good condition.
Half knee replacements are only suitable if there is a good enough surface on the less worn side of the knee.
One of the advantages of unicompartmental knee replacements is that you can still have a full knee replacement later. It is more difficult to perform but not as troublesome as a revision total knee replacement.
There have been some concerns over the lifespan of half knee replacements. It has been argued that their shorter life is a result of them being used on much younger people who demand more from the implant.
There are many factors to consider, so discuss your personal medical history with your consultant to see if a unicompartmental knee is the right choice for you.
Date Published: Oct 20, 2009 - 5:48 pm
Although not always the case, most people who have had both a knee and hip replacement report that the knee is the more painful.
There are a few reasons for this, the main one being the location of the incision.
There are multiple ways of approaching a hip replacement but all of them result in the incision being 'out of the way'. A knee replacement has the incision straight down the front of the knee. This has an effect on the rehabilitation.
To prevent the knee from stiffening, the knee must be quickly exercised. This means bending the knee and stretching the skin around the incision. This is responsible for a lot of the post-operative pain. After a hip replacement, you are not required to do movements that stretch the scar, in fact you are told to avoid them.
This is why I tell people you can be a little lazy and do OK after a hip replacement, but to get a good result from a knee replacement, you are going to have to work. The pain is something that gets in the way but should be seen as a temporary obstacle to years of pain free walking.
You should be going into a knee replacement operation focused and motivated. It will be a few weeks of toil for the greater good. I have always found that those who have put up with the pain of an arthritic knee for years manage with ease. At least this pain is because of an operation that is going to help. That is much easier to deal with than the pain of arthritis that gains you nothing.
There are a few reasons for this, the main one being the location of the incision.
There are multiple ways of approaching a hip replacement but all of them result in the incision being 'out of the way'. A knee replacement has the incision straight down the front of the knee. This has an effect on the rehabilitation.
To prevent the knee from stiffening, the knee must be quickly exercised. This means bending the knee and stretching the skin around the incision. This is responsible for a lot of the post-operative pain. After a hip replacement, you are not required to do movements that stretch the scar, in fact you are told to avoid them.
This is why I tell people you can be a little lazy and do OK after a hip replacement, but to get a good result from a knee replacement, you are going to have to work. The pain is something that gets in the way but should be seen as a temporary obstacle to years of pain free walking.
You should be going into a knee replacement operation focused and motivated. It will be a few weeks of toil for the greater good. I have always found that those who have put up with the pain of an arthritic knee for years manage with ease. At least this pain is because of an operation that is going to help. That is much easier to deal with than the pain of arthritis that gains you nothing.
Date Published: Oct 12, 2009 - 3:10 am
As the evidence mounts that Glucosamine and Chondroitin are not going to help everyone, are there other supplements out there that may help relieve the pain of knee arthritis?
Before going into a few options I repeat my advice that:
1) It doesn't matter what studies on other people have shown, if it works for you, go for it.
BUT
2) If it doesn't work for you after a reasonable period of time, save your money. (If a product is going to help, you should know within 3 months).
So, what else is out there?
Firstly there is Cetyl Myristoleate, also known (thankfully) as CM8. This can be bought combined with glucosamine in tablet form. There has been research into the effect of CM8 and there have been some positive findings. More research is currently in the pipeline so hopefully more positive results to follow. It is likely it will help some but not all arthritis sufferers so it is worth a try but remember - you are only giving a supplement 3 months to prove itself.
CM8 can be bought online under the trade name Flexcin
The second alternative is a natural product based on the Mediterranean diet. Researchers have long studied people from the area due to their lower rates of heart disease and stroke. What many are unaware of is that they also have healthier joints for their age. There are supplements available that take key components of the Mediterranean diet and combine in one tablet. These do not contain any Glucosamine or Chrondroitin are are extremely unlikely to have any side effects. Some will promise results in days but the usual couple of months is sensible to accurately judge if a product is going to be of benefit to you. Natural Joint Supplement is one such product.
Despite plenty of conflicting evidence about the effectiveness of supplements I continue to see people who swear by them. Finding a non-pharmacological supplement that helps your arthritis is of great benefit but natural variation plays a role - you may be one of the lucky ones, you may not. My advice is to sensibly try out a few supplements giving them 3 months (and 3 months only) to show they work for you. Do not take multiple supplements simultaneously - if it works you won't know which one is beneficial and which one is not.
Only continue past 3 months if there is a measurable improvement in your symptoms. If you are not sure after 3 months, stop taking the supplement and see if your symptoms increase over the coming weeks, if they do, you know it was working.
Good luck!
Date Published: Sep 23, 2009 - 11:32 pm
That depends....
The incentive is the cost.
You can pick up braces online much cheaper than you can elsewhere. Sizing isn't a problem as online retailers instruct you on what measurements are required to pick the correct size.
You can pick up braces online much cheaper than you can elsewhere. Sizing isn't a problem as online retailers instruct you on what measurements are required to pick the correct size.
For simple braces like pull on sleeves and the classical hinged knee brace, their simplicity makes then well suited to online sales.
More complicated items such as the new generation of offloading brace are more difficult to pull out of a box and work out straight away. Often you may be able to find a physical therapist with some experience of these braces to give you a hand.
Customer service at online retailers are used to enquiries and are also a good place to start.
Customer service at online retailers are used to enquiries and are also a good place to start.
When you buy a brace from a regular store the extra price covers things such as fitting and face to face instructions. You need to weight up the savings versus the loss of the extra service when buying online.
If a shop doesn't offer fitting then you will be much better off buying on the internet. The Brace Shop is a good place to get an idea of what is available.
Date Published: Sep 20, 2009 - 5:11 am
The big problem with exercising for severe arthritis is that everything hurts and seems to make things worse. You quickly become discouraged and give up. Sound familiar?
If you have very bad arthritis and all of the normal exercises done in weight bearing aggravate your knee, it is time to take a step back.
The following exercise should not be the starting point for everyone. You should start with the best exercises you can manage. The following will be too easy for some and they would get quicker results with tougher exercises.
For those in a lot of pain.......
There are 2 things you can do to exercise and remove some of the strain from you knees.
- Do non-weight bearing exercise
- Do exercises that involve little or no movement of the knee.
Your starting exercise is The Straight Leg Raise.
Technique:
- Lie on your back
- Bend the opposite knee up a little and rest the foot down. This is your starting position. One leg up, one leg out straight.
- Lift your leg up into the air keeping it as straight as possible. Slowly lower the leg back down in a controlled manner. Do not let it flop.
- Repeat
Below is a video of the straight leg raise. If you have arthritis in both knees you are unlikely to be able to bend the non-exercising knee this much. Just find a comfortable position. You also do not need to lift your leg this high. This instructional video is for knee replacement surgery but the exercise is valid for non-operated knees as well. These exercises should not increase your usual knee pain. You will hopefully get the tired ache of fatigued muscles but that it sit.
Date Published: Sep 03, 2009 - 12:25 am
Building up the quadriceps muscles protects the knee joint, slows the progression of osteoarthritis, and can decrease pain.
Squats are one of the more popular quads exercises but many people try them and quickly stop when the cause an increase in pain.
Squats are a common gym exercise but you need to do squats differently if you have osteoarthritis. Like any exercises for arthritis, it is important to do them in a pain free range of motion.
Everyone's knees are different so you may need to do a little trial and error but the following points should help:
- When starting squats you should be doing shallow squats. Very shallow squats. This means your head should drop only 1 or 2 inches throughout the squat. Deep squats puts a lot of pressure on the knee and are nearly guaranteed to cause you pain.
- When extending the knees after a squat you should not completely straighten you knee. Again, this is likely to cause aggravation.
- Your aim is to fatigue the muscle without increasing your pain. The muscle is fatigued when it starts to wobble a little.
- Do squats slowly. You will find this harder and fatigue the muscle quicker. Aim to do your squats at roughly the speed you breathe.
- You will usually be able to fatigue the quads in less than a minute. If you have to do more than 30 or 40 to fatigue the muscle, make the squats more difficult. You can do this by doing one legged squats. Keep them shallow and slow and hold onto something for support.
- Since it only takes a minute to do, you can integrate these exercises into your everyday routine. While you boil the kettle, squat. Toast on? Squats. On the phone, waiting for a lift, brushing your teeth - do all of these and you will be building strength without aggravation before you know it. Every time you fatigue you are sending a message to your brain to build more muscle. It doesn't matter how old you are, if you use them more, they get bigger, you use them less, they get smaller.
Date Published: Aug 28, 2009 - 4:42 pm
Osteoarthritis is a chronic condition. That means it is a persistent disease that continues over a long period of time.
Chronic pain will eventually wear anyone down. This is what makes osteoarthritis so enticing to scammers. It is a common condition that has plenty of people desperate for any relief.
Understanding osteoarthritis helps arthritis sufferers avoid becoming a victim of scammers. If you remember the following points you will easily avoid those who prey on people in chronic pain.
- Osteoarthritis is physical wear and tear of the joints
- There is no known supplement or medication capable of re-growing the articular cartilage of the joints.
- Pharmaceutical companies spend millions of dollars researching osteoarthritis as there is a huge market for any effective treatment. If any common plant, mineral, or other concoction was effective, they would be selling it to you and be making a killing.
- The only non-surgical treatments clinically proven to help are not very glamorous. Weight loss, exercise and pain killing medication are (on average) effective but either require hard work or have side effects.
If you are going to spend money spend it on either exercise or information. Apart from surgery, lifestyle modification, exercise and weight loss are the things you can do to decrease your pain. Don't waste money looking for the magic cure. Spend $10 on a book on osteoarthritis and get a gym membership or buy a bike and do something positive to combat your arthritis.
Life wasn't meant to be easy, but you don't have to accept you pain. Empower yourself and get motivated.
Date Published: Aug 26, 2009 - 6:35 am
Another question I am commonly asked is about heat or cold therapy.
Many people are confused as to which to use and why they work.
To correctly use these types of treatments, you need to know why you are using them.
Pain is not the answer I am looking for here, it is the cause of pain that is important.
Inflammation is part of the body's healing process. It is a reaction to tissue damage and is one of the first steps in repairing the damage. Unfortunately, the body often goes overboard and the inflammatory response is excessive leading to increased pain and swelling. Heat encourages inflammation as blood vessels dilate in response to heat. Putting heat on an already inflamed area makes the problem worse.
Cold on the other hand helps to prevent inflammation and can decrease the pain associated with it. This is why any sporting injury is initially treated with ice, and never heat.
So which do I use for my arthritis?
Simple question, not so simple answer.
Inflammation can be a component of osteoarthritic pain, especially after a flare up. For many people though, pain is a result of joint stiffness. Stiffness will respond well to heat and can be made worse by cold. This is why it is common for people to complain more about their arthritis in winter and why retirees live in Florida.
For the majority of people with osteoarthritis of the knee, heat will be the place to start. There will need to be a bit of trial and error but if a hot bath helps, a hot pack will too. If you find that heat makes your knee pain worse, it is likely you have an inflammatory component to your pain and cold is worth a try (combined with anti inflammatories if possible).
once again there is no blanket answer for everyone. You are an individual and your knees are too. Once you have learnt about them however, you will know what works and be able to do whatever you can when your knee pain is bad.
Date Published: Aug 22, 2009 - 7:28 am
The body is a complicated thing. All is often not what it seems to be. Take pain for example.
Pain itself is a many faceted experience. Its perception can be heightened or dampened by our emotional state. Like other forms of sensation, it travels along our nervous system to reach our brains. This is why spinal injured people have no sensation and no pain. If the message doesn't get through, the pain is not felt.
The system of nerves that carry the messages of pain are also susceptible to mistakes. This is known as referred pain.
Our nerves leave our spine and provide sensation to a specific area of the body. This has been mapped out as displayed in the picture on the right, each area corresponding to the level of the spine the nerves come out of.
The L4 dermatome passes over the front of the knee and the back of the knee is covered by S1 and S2.
When the nerve roots are aggravated as they leave the spine, the body can not determine where the pain has come from. The result is pain felt throughout the area covered by that nerve.
This means that if you had a disc bulge in your spine at L4 on the left, you would feel a band of pain from the outside of your left hip sweeping down over the front of your knee.
Your knee pain could in fact be coming from your back.
Any new leg pain that is associated with back pain, pins and needles, numbness or an increase in pain with coughing or sneezing, should be discussed with your doctor.
A pain in the knee is not always a pain in the knee.
Date Published: Aug 18, 2009 - 4:51 am
The most common place to have osteoarthritis is in the medial compartment. This typically causes pain at the front and inside of the knee joint.
Over time, as the cartilage covering the joint is eroded, the joint space narrows on the inside. This changes the angle of the knee joint causing what is known in medical terminology as a varus deformity. A varus deformity is what is commonly called bow legged.
The deformity starts off very slowly and usually is only noticed after a number of years with an arthritic knee. In the later stages however, the increasing angle of the joint can place even more force on the inside of the knee. This can see the deformity increasing over a matter of months.
Total knee replacement surgery allows the surgeon to correct the angle of the knee. It is not uncommon for a post operative patient to have a straight leg for the first time in decades.
In extreme cases, when the angle is large, normal knee replacements are no longer suitable and a special prosthesis is required. There is also a limit to how much correction a surgeon can achieve. If you notice a rapidly increasing deformity (over a matter of months) you are advised to discuss it with your surgeon.
In most cases it is not the deformity that bothers you but the pain. A large varus deformity is usually very painful and it is this pain that sees you knocking on your surgeons door.
Date Published: Aug 12, 2009 - 11:38 pm
Much less common than medial compartment arthritis, lateral compartment osteoarthritis is no less severe.
Lateral arthritis results in a valgus deformity, or knock knees, in layman's terms.
It is more common is obese people and the valgus deformity combined with excess weight can lead to rapid disease progression.
Treatment includes weight loss, high tibial osteotomy, unicompartmental knee replacement, and total knee replacement.
Lateral compartment arthritis can also be treated with an off-loading knee brace, particularly in the early stages.
Date Published: Aug 07, 2009 - 6:29 am
Here is another good animation on knee arthroscopy by British private health provider BUPA.
It give a good general overview of how key hole surgery is performed in easy to understand terms.
One point to note is that the animiation states that 3 incisions will be made. It is also common for the entire procedure to be completed using only two.
The benefits of key hole surgery are easily seen by the size of the incisions. In years gone by this type of surgery would have required a large incision, often greater than 6 inches long. This of course led to much more pain and patients having longer hospital stays.
Today, the vast majority of knee arthroscopies are day case operations.
It give a good general overview of how key hole surgery is performed in easy to understand terms.
One point to note is that the animiation states that 3 incisions will be made. It is also common for the entire procedure to be completed using only two.
The benefits of key hole surgery are easily seen by the size of the incisions. In years gone by this type of surgery would have required a large incision, often greater than 6 inches long. This of course led to much more pain and patients having longer hospital stays.
Today, the vast majority of knee arthroscopies are day case operations.
Date Published: Aug 04, 2009 - 5:33 pm
Here is a great computer generated animation of the comparison between the normal knee and the osteoarthritic knee.
Date Published: Aug 02, 2009 - 4:55 am
Arthro is a prefix meaning joint. It is from the Greek word for joint, 'arthron'.
The suffix '-oscopy' mean to look inside.
Put together you have 'looking inside a joint'. Occasionally, an arthroscopy is used purely for diagnostic purposes and this literal definition stands true. Usually however, the surgeon does more than just look inside, they take action and address any pathology found. Today, the term arthroscopy refers to any procedure performed using small incisions and an arthroscope.
During an arthroscopy, a camera is placed into the joint via one incision and the tools to perform the surgery via another. Arthroscopy is also known as "key hole surgery" due to the small incision size.
The small incision means less trauma to the joint and quicker recovery times. It is also considerably less painful compared to an open surgical procedure. Most arthroscopies are day cases, with the patient able to return home that night.
The knee is the most common joint to be operated on via arthroscopy. Meniscal tears are the main indication for arthroscopic surgery. They can be trimmed back to a stable base, retaining the healthy meniscus. This has a much better result than the historical treatment of an open total menisectomy.
Because of the small incisions and instruments used, there is a limit to how much can be done via arthroscopy. Despite this, even when a larger incision is required, surgeons now do as much as possible with the arthroscope before resorting to traditional methods.
The many benefits of arthroscopy means that if it is possible to do all that needs to be done, it will be done that way. Less pain and swelling, shorter stay, and decreased risk of infection are the positives, the only limits are what you can achieve through such a tiny incision - often so small it doesn't require stitches, tape may be enough.
Unfortunately you can't do total knee replacement via arthroscopy - you can't fit the prosthesis through a 1/4 inch incision. Who knows what the future holds, but for now arthoscopy is a highly efficient way to do minor orthopaedic surgery.
Date Published: Jul 30, 2009 - 5:11 am
