Taking Care of Aging Knees
By Dennis A Phelps, MD
More and more people are staying active as they age. This is healthy, but playing team sports, jogging or doing other high-impact activities that repeatedly pound, twist and turn the knees can stress aging joints. Highly active, middle-aged patients may develop painful knees as a result of osteoarthritis (OA)—a painful condition occurring when the cartilage lining on the ends of bones gradually wears away.
Most knee osteoarthritis sufferers are over age 55 and/or obese and/or have a family history of OA. Younger, highly active people may also develop OA if their knee(s) suffered a significant injury. Symptoms include knee pain when standing or going up and down stairs. Additionally, affected knees may buckle and give way, lock in place, or become stiff and swollen.
Increasingly, patients with knee osteoarthritis are asking for total knee replacement surgery as a result of friends’ recommendations, advertising or news reports about its success. While total knee replacement may be appropriate in some cases, many highly active patients in their 40s and 50s often refuse to change their lifestyles to extend the life of their natural knees.
Patients often hope for a complete end to their symptoms without making any changes in their activities. In reality, orthopedic surgeons use a complex medical process to determine whether total knee replacement is appropriate for a patient—considering age, activity demands and other factors. In addition, long-term results of joint replacement are less certain in younger patients.
Alternative knee surgeries aimed to relieve pain and restore function include two minimally-invasive procedures called partial knee resurfacing (PKR) and knee arthroscopy. PKR restores only the part of the knee that is damaged by arthritis. In addition, a PKR implant is smaller than a total knee implant and does not disturb the knee’s healthy tissues. With respect to arthroscopic surgery, a small camera inserted into the knee joint via an arthroscopic tube allows an orthopaedic surgeon to thoroughly evaluate and “clean out” the knee joint.
For middle-aged people, the earlier an orthopedist diagnoses knee osteoarthritis, the more likely conservative treatment may help. If in its early stages, your doctor may recommend low-impact activities and other non-operative treatments that can delay or eliminate the need for surgery. In some cases, activity modification may be the only treatment a patient needs. Even when surgery is needed, patients still have to modify their activities to preserve the replaced joint.
Moderate physical activity lessens joint pain and improves flexibility and function. Knee OA sufferers should continue exercising, but change the forms of their activities. They should stop doing high-impact activities that twist and turn the joints and start doing smooth, low-impact activities that are easier on the joints. High-impact activities include running, tennis, racquetball, basketball, and softball. Low-impact activities include stretching, swimming, water aerobics, cycling, walking, and playing golf.
Other options that may extend the life of natural knees include medications, steroid injections, physical therapy and mechanical aids.
Typical medications prescribed are non-steroidal anti-inflammatory drugs (NSAIDs) which help reduce inflammation. Certain dietary supplements may also help. Glucosamine stimulates formation and repair of articular cartilage, and chondroitin sulfate prevents cartilage from degrading. Please note that these compounds may cause negative interactions with other medications or excessive bleeding during surgery. Always consult a doctor before taking dietary supplements.
In terms of injections, an orthopedist may inject the knee joint with strong anti-inflammatory medications called corticosteroids. This can relieve pain and swelling for several months. Another type of knee injection is part of a joint fluid replacement therapy called visco supplementation. It utilizes a substance called hyaluronic acid and is usually a series of three injections.
In conjunction with other treatments, an orthopedist may recommend a fitness program including physical/occupational therapy to improve joint flexibility, increase range of motion, strengthen muscle, bone and cartilage tissues and reduce pain. Icing the affected joint for short periods, several times a day may also help. If supportive or assistive devices are needed, a mechanical aid such as an elastic bandage, splint, brace, cane, crutches or walker may be ordered.
In summary, degenerative knee osteoarthritis represents a spectrum of disease and severity. If you believe that you are experiencing symptoms, see an orthopedic surgeon for diagnosis and treatment. He/she will consider your comprehensive medical history; perform a physical examination and possibly order tests and/or imaging studies before recommending a course of treatment. As noted, there are a variety of treatment options short of surgery that can help extend the life of your natural knees.
Author Dennis A Phelps, MD, is a Total Joint Specialist with the Colorado Springs Orthopaedic Group
