Knee Pain
Knee Osteoarthritis
Osteoarthritis (OA) is a common problem for many people after middle age. OA is sometimes referred to as degenerative or wear and tear arthritis. OA commonly affects the knee joint. Although OA has no cure, there are ways to treat it so patients have less pain, better movement, and enhanced quality of life.
The main problem in OA is degeneration of the articular cartilage. Articular cartilage is the smooth lining that covers the ends of the leg bones where they meet to form the knee joint. The cartilage gives the joint freedom of movement by decreasing friction.
When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. Small outgrowths called bone spurs may form in the joint.
Years of repeated strain on the knee leading to wear and tear is the most common caue of osteoarthritis in the knee. Other causes include:
Earlier knee injury: Fractures of the joint surfaces, ligament tears, and meniscal injuries can all cause abnormal movement and alignment, leading to wear and tear on the joint surfaces.
Genetics
Obesity: Having a higher body mass puts greater strain on the knee. Losing 10 pounds can reduce the risk of knee osteoarthritis by 50 percent.
Problems in the subchondral bone: Normally, the articular cartilage protects the subchondral bone (the layer of bone just below the articular cartilage). But some medical conditions can make the subchondral bone too hard or too soft, changing how the cartilage normally cushions and absorbs shock in the joint.
Pain, swelling and stiffening of the knee
Pain worsens after activity like walking
Knee osteoarthritis develops slowly over several years, so symptoms gradually worsen.
Early stage: Your knee does fairly well while walking, then after sitting for several minutes your knee becomes stiff and painful
Intermediate stage: As the condition progresses, pain can interfere with simple daily activities
Late stage: The pain can be continuous and even affect sleep patterns
The diagnosis of OA can usually be made on the basis of the initial history and examination.
X-rays can help in the diagnosis and may be the only special test required in the majority of cases. X-rays can also help doctors rule out other problems, since knee pain from OA may be confused with other common causes of knee pain, such as a torn meniscus or kneecap problems. In some cases of early OA, X-rays may not show the expected changes.
Magnetic resonance imaging (MRI) may be ordered to look at the knee more closely. An MRI scan is a special radiological test that uses magnetic waves to create pictures that look like slices of the knee. The MRI scan shows the bones, ligaments, articular cartilage, and menisci. The MRI scan is painless and requires no needles or dye.
If the diagnosis is still unclear, arthroscopy may be necessary to actually look inside the knee and see if the joint surfaces are beginning to show wear and tear. Arthroscopy is a surgical procedure in which a small fiber-optic TV camera is inserted into the knee joint through a very small incision, about one-quarter of an inch long. The surgeon can move the camera around inside the joint while watching the pictures on a TV screen. The structures inside the joint can be poked and pulled with small surgical instruments to see if there is any damage.
OA can't be cured, but therapies are available to ease symptoms and to slow down the degeneration. Recent information shows that mild cases of knee OA may be maintained and in some cases improved without surgery.
Taking pain relievers: Your healthcare provider may recommend taking pain relievers (non-steroidal anti-inflammatory medications, or NSAIDs) to help reduce pain and swelling in your knee. Acetaminophen can be used as an alternative if you cannot tolerate NSAIDs or are allergic.
Glucosamine and chondroitin sulfate: These supplements seem to have nearly the same benefits as anti-inflammatory medicine with fewer side affects. Many doctors feel the research supports these supplements and are encouraging their patients to use them.
Cortison injection: Cortisone is a powerful anti-inflammatory medication, but it has secondary effects that limit its usefulness in the treatment of OA. Multiple injections of cortisone may actually speed up the process of degeneration. Repeated injections also increase the risk of developing a knee joint infection, called septic arthritis. Any time a joint is entered with a needle, there is the possibility of an infection. Most physicians use cortisone sparingly, and avoid multiple injections unless the joint is already in the end stages of degeneration, and the next step is an artificial knee replacement.
Hyaluronic acid injection: Doctors inject three to five doses into the joint over a one-month period. The medicine helps lubricate the joint, ease pain, and improve people's ability to get back to some of the activities they enjoy. These injections are less effective for older adults and severe OA.
Physical therapy: You will learn ways to calm pain and symptoms, which might include the use of rest, heat, or topical rubs. You will also be taught how to protect the arthritic knee joint by modifying your activities. Range-of-motion and stretching exercises will be used to improve knee motion.
Walking aids: This may include shock-absorbing insoles, a cane or walker, a knee unloading brace, or a heel wedge
In some cases, surgical treatment of OA may be appropriate.
In cases of advanced OA where surgery is called for, patients may also see a physical therapist before surgery to discuss exercises that will be used just after surgery and to begin practicing using crutches or a walker.
Click on the tabs below to learn about the various surgical procedures for knee OA.
Arthroscopy
Surgeons can use an arthroscope to check the condition of the articular cartilage. They can also clean the joint by removing loose fragments of cartilage. People have reported relief when doctors simply flush the joint with saline solution. A burring tool may be used to roughen spots on the cartilage that are badly worn. This promotes growth of new cartilage called fibrocartilage, which is like scar tissue. This procedure is ofte
Proximal Tibial Osteotomy
Surgery to realign the angles in the lower leg can help shift pressure to the other, healthier side of the knee. The goal is to reduce the pain and delay further degeneration of the medial compartment. In a proximal tibial osteotomy, the upper (proximal) part of the shinbone (tibia) is cut, and the angle of the joint is changed. This converts the extremity from being bowlegged to straight or slightly knock-kneed. By correcting the joint deformity, pressure is taken off the cartilage. A proper joint angle actually allows the cartilage to regrow, a process called regeneration.
This surgical procedure is not always successful. Generally, it will reduce your pain but not eliminate it altogether. The advantage to this approach is that very active people still have their own knee joint, and once the bone heals there are no restrictions on activities.
A proximal tibial osteotomy in the best of circumstances is probably only temporary. It is thought that this operation buys some time before a total knee replacement becomes necessary. The benefits of the operation usually last for five to seven years if successful.
Artificial Knee Replacement
An artificial knee replacement is the ultimate solution for advanced knee OA.
Surgeons prefer not to put a new knee joint in patients younger than 60. This is because younger patients are generally more active and might put too much stress on the joint, causing it to loosen or even crack. A revision surgery to replace a damaged prosthesis is harder to do, has more possible complications, and is usually less successful than a first-time joint replacement surgery.
Physical therapy treatments after surgery depend on the type of surgery performed. Rehabilitation is generally slower and more cautious after knee replacement procedures and certain types of tibial osteotomies. After simple procedures such as arthroscopy, you may begin fairly aggressive exercise therapy immediately.
Therapy treatments usually begin the next day after surgery. Your first few rehabilitation sessions are used to ease pain and swelling, help you begin gentle knee motion and thigh tightening exercises, and get you up and walking safely. You may need to use either a walker or crutches after surgery. Some patients may be instructed to limit how much weight they place on the knee for four to six weeks.
After going home from the hospital, some patients may be seen for a short period of home therapy before beginning outpatient physical therapy. Outpatient treatments are designed to improve knee range of motion and strength and to safely progress your ability to walk and do daily activities.
The therapist's goal is to help you keep your pain under control, maximize knee mobility, and improve muscle strength and control. When you are well under way, regular visits to your therapist's office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.
How using the HeatPulse
and Thermosleeve can help
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat knee osteoarthritis.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
The Thermosleeve and HeatPulse are great hot and cold therapy tools to help you treat knee osteoarthritis.
Thermosleeve uses cold compression to relieve pain and inflammation
HeatPulse provides a heated massage to boost blood flow to your knee, encouraging healing and improving range of motion
You can use Thermosleeve to bring down initial pain and swelling in your knee. Once pain and swelling have calmed, or after the first 72 hours, switch to the HeatPulse to improve flexibility and range of motion, as well as encourage healing.
You can also use the HeatPulse to warm up and loosen your muscles before doing strengthening and stretching exercises. When you have completed the exercises, use the Thermosleeve to calm flare ups of pain and swelling.
Swelling after knee surgery can last for three to six months after surgery. To help reduce inflammation and pain, you can use the Thermosleeve three to four times a day for about 10-20 minutes during the first few days after surgery. After the initial swelling has gone down, you can alternate between the Thermosleeve and the HeatPulse to relax the muscles and ease stiffness.
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