Have you been suffering from arthritis in your knees? Have you tried prescription pain medications, braces, shots, and physical therapy? Has your doctor told you it’s time for surgery?
You are not alone!
Though arthritis occurs most often in those over age 65, the CDC estimates that over 54 million Americans over the age of 18 live with an arthritis diagnosis. Because Americans are living longer, they project this number will rise, possibly to 78 million people by the year 2040.
Arthritis can take many forms, including:
- Osteoarthritis – This is the most common form. It occurs when the cartilage and bones within a joint begin to break down. This type of arthritis usually develops slowly and worsens over time.
- Rheumatoid Arthritis – This type is an autoimmune disease that causes inflammation as the body attacks its own joints. RA typically manifests in more than one joint at a time and can also affect other parts of the body, such as the lungs, heart, and eyes.
- Fibromyalgia – This tends to occur in tandem with RA, but can occur on its own.
- Lupus – This is also an inflammatory disease of the autoimmune system. It causes the body to attack itself in different areas, including the joints.
- Gout – This type of joint pain will affect one joint at a time, typically flaring with periods of remission. Repeated attacks of gout will change the joint over time. A build-up of uric acid in the joints causes this condition.
- Juvenile Arthritis – This is a type of rheumatoid arthritis that affects children. While some achieve remission as they age, any damage done to the joints does not heal.
If you’ve been diagnosed with osteoarthritis of the knee, you’re suffering from the most common, age-related form of arthritis. The CDC estimates that it affects 30 million Americans. Osteoarthritis occurs due to wear and tear of the joint over time, which is why it is more prevalent in the older population. Contributing factors include:
- Overuse of the joint
- Increased age – Risk for OA increases with age.
- Gender – It is more prevalent in women than men, especially after age 50.
- Obesity – Extra weight stresses the joints, particularly the hips and knees.
- Genetics – A family history of OA increases a person’s risk.
- Race – Certain Asian populations show a reduced risk of OA.
Treating OA depends on the amount it affects the joint. OA of the knee progresses through five stages, as outlined by the Illinois Bone & Joint Institute. These include:
- Stage 0 – This is a normal knee with no damage.
- Stage 1/Minor – This knee may show a minimal development of bone spur growth, but pain is unlikely. Treatment depends on your personal risk factors for OA and may include supplementation with glucosamine and chondroitin.
- Stage 2/Mild – Imaging of this knee will show continued bone spur growth while spacing and cartilage between the bones of the joint remains normal. At this stage, most people start feeling pain or stiffness in the joint. Breakdown of the cartilage begins. Treatment includes OTC or prescription pain medications, physical therapy to strengthen muscles around the joint, and braces or shoe inserts.
- Stage 3/Moderate – Bone spur growth continues and space between the bones diminishes as the cartilage continues to break down. Inflammation increases causing stiffness and pain, as well as popping or grinding sounds in the knee. Doctors may recommend injections of hyaluronic acid into the knee to relieve pain.
- Stage 4/Severe – Spacing in the joint deteriorates as the cartilage wears away. Inflammation becomes chronic and friction between the bones causes significant pain and disability. Because there is no cure for OA, your doctor may recommend knee replacement surgery as the best treatment option.
Surgery to replace damaged joints, such as hips or knees, is common, with an estimated 600,000 knee replacement surgeries done in the United States every year. Despite the frequency, it can still be a frightening option to consider. Aside from the normal risks associated with any surgery, other possible concerns associated with knee replacement include:
- loosening or wearing of the prosthetic parts
- continued pain or stiffness
- subsequent replacement of the joint in the future
Common fears surrounding knee replacement surgery involve the amount of pain, the time for recovery, infection, and how long the joint will last post-surgery. The American Association of Hip and Knee Surgeons discusses these issues on its website. According to the AAHKS:
- While patients report pain from knee replacement as worse than hip replacement, medications and rapid rehabilitation therapy have lessened their severity. Physical therapy can reduce pain by teaching you how to correctly use assistive devices such as canes, showing you how to properly move during recovery to prevent pain and increase healing, and prescribing specific exercises for the knee that will reduce inflammation and increase the range of motion. Learning and doing these exercises pre-surgery makes post-replacement rehab less painful as well. Improving mobility and muscle function before surgery makes it easier to do the exercises during rehab. Be sure to choose a Physical Therapist experienced in treating people with a knee replacement to prevent unneeded or incorrect therapy.
- Recovery can take 3-6 months, though it typically takes one year to regain full strength and mobility of the joint. Physical therapy usually lasts 3 months before resuming most normal activities.
- Driving can occur 4-6 weeks post-surgery, though this varies with the use of narcotic pain medications.
- Returning to work depends on the type of job you have and the demand put upon the joint. Some people return to work in 6-8 weeks, while others may need 3 months.
- Joint replacement longevity estimates are between 15-20 years. Ninety to Ninety-Five percent of joints last 10 years. Eighty to Eight-Five percent last 20 years.
- According to the American Academy of Orthopaedic Surgeons, infection rates after knee replacement are approximately 1 in 100 people. Infections can occur at the time of surgery or years after. Some people are at a higher risk of infection, such as those with diabetes, vascular or circulatory diseases, and obesity. Efforts to prevent infection include the use of pre and post-op antibiotics, reduced procedure time, and proper sterilization of all tools and equipment.
Ultimately, the decision to have knee replacement surgery rests with you. The Arthritis Foundation recommends weighing the pros and cons of the surgery before making a final decision. Do the possibilities for less pain and better mobility outweigh the concerns over pain and recovery time? When considering knee replacement, they offer the following tips:
- Explore Your Options: Try everything else first before resorting to surgery. Engaging in Physical Therapy before surgery can improve mobility and lessen pain. Many PT sessions work to strengthen the muscles around the joints, improve posture and balance, and teach you proper ways to move your body during certain activities. A Physical Therapist can also make recommendations regarding cold and hot therapies as well as braces or shoe inserts to reduce stress on the joints.
- Know that Surgery is Not a Cure: It is still important to maintain a healthy weight, exercise the joint, and take medications as directed by your doctor.
- Know Your Odds: The younger you are at the time of replacement, the higher the risk you may need to do it again in the future.
- Consider Partial Replacement: Discuss your knee’s condition with your doctor and determine which parts need replacing. Replacement of specific parts instead of the entire joint is a possibility.
- Find an Experienced Surgeon: Discuss the surgery with a doctor who has experience and knowledge in joint replacement for the best information.
For some, knee replacement surgery is a scary thing to consider. Pursuing Physical Therapy before resorting to surgery can delay the necessity for replacement. Using PT before and after surgery gives your joint better longevity and functionality. Discuss the details with your doctor and choose the option that will benefit you the most. For more information on how Physical Therapy can benefit osteoarthritis in the knee, please contact us. Cawley Physical Therapy and Rehabilitation commit to giving every patient personal, comprehensive, and skilled services.
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