The Degenerative Knee

KneeBrought To You By Coordinated Health

By Maureen Sangiorgio~

Nick Fredericks, 57, knows a lot about knee injuries. “I worked construction jobs, was an avid skier, and played all kinds of contact sports, so I really mistreated my knees,” he says. “I had my first knee surgery when I was only 18 following a skiing competition. Since then, I’ve had three more surgeries. Now I’ve got arthritis in that knee. My surgeon says I’ve got one of the worst knees he’s ever seen that’s still working.”

Nick is not alone. “Studies show 70% of adults will suffer from arthritis at some point in their lives,” says Emil DiIorio, M.D., Founder and Medical Director of Coordinated Health. “Osteoarthritis, or OA, is the most common form of arthritis. It’s marked by a gradual breakdown of cartilage in the joints which leads to pain, stiffness, and swelling. The earlier stages of OA often begin before middle age.” Osteoarthritis of the knee is a degeneration of the smooth surface covering the ends of the femur and tibia, the bones that form the knee joint. This painful condition is one of the five leading causes of disability among men and women, according to the American Academy of Orthopaedic Surgeons. “The primary reasons we treat OA of the knee are to reduce pain, allow for better movement and function, and improve the quality of our patients’ lives,” says Dr. DiIorio.

Whether or not you need surgery, physical therapy is the key to helping you resume your normal function and get back to living a pain-free life.

Osteoarthritis of the knee often has an earlier onset in knees that have experienced trauma, infection, or injury. Risk factors for OA of the knee include heredity, obesity, advancing age, gender (more women than men suffer from OA of the knee), previous injury, repetitive stress injuries, and participation in high-impact sports. Your doctor can diagnose OA of the knee by obtaining a complete medical history and x-rays. “Osteoarthritis is classified into four grades, with Grade 1 being the least severe, and Grade IV, which is the most severe form of the disease,” explains Carl Weiss Jr, M.D., an orthopedic surgeon at Coordinated Health who performed three of Nick’s surgeries.

Treatment Options Abound

There are several conservative treatment options for you to consider before resorting to surgery. Treatment is performed for several reasons: to relieve symptoms, slow the degenerative process, and to improve quality of life. “The treatment we offer depends on the severity of your osteoarthritis,” says Dr. Weiss. “Patients with lower grades of OA generally respond well to conservative treatment. Keep in mind that OA is never cured. We can only treat symptoms.”

“When we evaluate your knee, we’re going to be looking for swelling, range of motion, alignment, location of pain and or tenderness, muscle strength, and any injuries to the knee,” says Dr. Weiss. “We also use x-rays to pinpoint the location and severity of the condition.”

Treatment of your OA depends on the severity of the condition.  Conservative treatment options include the following choices:

Cortisone injections: Cortisone is a powerful anti-inflammatory that is injected directly into the knee joint. Injections are done to control inflammation and are most often done in conjunction with physical therapy (PT). Injections are typically done at least three months apart. Repeating cortisone injections too frequently can actually speed up the degenerative process. Relief can last several months to several years depending on the severity of your OA.

Oral Anti-inflammatories: These are often used in conjunction with PT and cortisone injections.

Viscosupplementation:  A series of injections into the knee designed to lubricate the joint surfaces by replacing the synovial fluid that is normally found in the knee joint. As OA develops, the knee gets less lubrication and is more likely to be injured from the stress and strain of normal daily activities. Once the series is complete, it can take up to six weeks to begin feeling relief from symptoms.  Relief can last for a period of weeks, months, or even years depending on the severity of your OA.

“If a patient has a higher grade OA or has failed conservative treatment options, we then consider a surgical procedure called an arthroscopy,” says Dr. DiIorio. “With this procedure, we examine inside the knee joint using a small camera inserted there through a small incision. An arthroscopy is done to smooth the surfaces of the joint where the OA is located. In essence, the procedure vacuums and polishes the joint surfaces of the knee. While in the knee, we can also address any other problems that contribute to a patient’s symptoms, such as a meniscal tear.”

Following surgery, some patients return to work several days later. “If your job requires a lot of bending, kneeling, squatting, or climbing, your return to work will take a little longer than someone with a sedentary job,” notes Dr. Weiss.

Whether or not you need surgery, physical therapy (PT) is the key to helping you resume your normal function and get back to living a pain-free life.

Self-Help Tips

You cannot stop the degenerative process in your knee, but you can slow the progress by following these tips:

Step on the scale. “People don’t realize it, but you put about seven times your body weight across your knee every time you get up and down from a seated position, or go up and down steps,” notes Dr. Weiss. “If you lose as little as five to ten pounds, it can go a long way in reducing the stress on your knees.”

Work that knee. “The goal here is to improve and maintain the range of motion and strength of your knee,” says Dr. Weiss. “Stretch the muscles surrounding your knee and maintain the strength of your quads, hamstrings, glutes, and calf muscles.”

“Whether you choose conservative or surgical treatment, it’s important for you, as a patient, to realize the integral role you play in your own treatment,” notes Dr. DiIorio. “Just as Coordinated Health works as a team to get you back to 100%, form your own team with family and friends, so you can have the smoothest, healthiest recovery possible.”

Maureen Sangiorgio is an award-winning consumer health writer based in Macungie, PA.
Amanda Boyce, ATC, CSCS, of Coordinated Health contributed to this article.
Coordinated Health is an integrated musculoskeletal healthcare delivery network with six locations in Allentown, Bethlehem, Easton, Brodheadsville and East Stroudsburg.
Look for The Art of Medicine television show premiering Saturdays at 5:00 pm and Mondays at 11:30 am in March on Channel 69.

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