Knees Archive

News briefs

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Many older adults have pain from knee osteoarthritis, a condition in which cartilage in the joints wears away. But when is it time for joint replacement? An observational study published March 28, 2017, in The BMJ suggests that a new knee improves quality of life only in certain cases. The study included over 7,400 middle-age and older adults who already had knee arthritis or were at high risk for the condition. Compared with people who didn't have knee replacement, those who had the surgery during the 26-year study period appeared to have a better quality of life afterward. However, the improvements were minimal, except in people who were less physically functional before the surgery because of more severe arthritis symptoms. The authors suggest that the high costs of knee replacement may be justified only in those who are severely affected by arthritis. What if your symptoms aren't severe? As we reported last month, it may be possible to delay or avoid knee surgery by strengthening your leg and core muscles, losing weight, and improving range of motion.

A simple x-ray may be a better and cheaper way to diagnose knee arthritis than an MRI, according to researchers. X-rays are also cheaper than MRIs and quicker to perform. 

It appears that “unloading” shoes are no better at reducing pain or improving function than a good pair of walking shoes, according to a study published online July 12, 2016, by Annals of Internal Medicine. 

These options may help you find relief from constant discomfort.

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Knee pain is one of the top reasons men visit their doctor. While the pain and soreness often can go away with rest, ice, and over-the-counter pain medications, if it becomes too severe or fails to abate in a timely manner, you may need to take further action.

"If your knee pain is not a result of some kind of structural or mechanical issue that requires surgery, or due to osteoarthritis, there are other options that may help eliminate or better control the pain," says Dr. Lars Richardson, a sports medicine orthopedic surgeon with Harvard-affiliated Massachusetts General Hospital.

The idea of having a knee replaced is daunting. But what if both of your knees need repairing? Is one visit to the operating room better than two?

If you are otherwise in good health, it's a conversation worth having with your doctor and rehabilitation team. There are some benefits to replacing both joints during a single surgery (called simultaneous replacement). These include undergoing anesthesia only once, fewer days in the hospital, and only one (albeit prolonged) rehabilitation that lets you resume normal activities sooner than two separate ones. 

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Ask the doctor

Q. I occasionally use a brace on my knee because I have knee arthritis. Am I weakening my knee?

A. The benefit of a brace for knee arthritis is likely in the eye of the beholder. A brace can help improve the ability to perform certain activities, and for some people the compression and warmth of the brace relieves pain. However, medical research has been mixed on the absolute benefits.

If knee pain and swelling are severe an are not getting better, see your primary care doctor for a thorough evalucation. Image: Thinkstock

Arthritis is not the only possible cause of knee pain, swelling, and disability.

Joint replacement is a complex procedure, and finding the right surgeon and hospital can make a big difference in your outcome. In general, you're likely to have a better result and fewer complications if your surgeon performs the operation frequently (at least 100 times per year) and operates in a hospital where these procedures are commonplace. Don't be surprised if this rules out the most convenient hospital for your location.

Your orthopedist, rheumatologist, or primary care physician, or a friend who has undergone successful joint replacement, may be able to recommend a specific surgeon. But keep in mind that your insurer may restrict you to certain specialists or require a larger copayment if you go outside your plan.

Physical therapy is helpful for wear-and-tear knee osteoarthritis, especially if you start doing it early. But injecting a painful knee with an anti-inflammatory steroid medication before starting physical therapy offers no additional benefit, according to a clinical trial in JAMA Internal Medicine.

Studies have shown that physical therapy modestly reduces pain and improves daily functioning in people with knee osteoarthritis. That could mean being able to walk farther with less pain or to continue leisure activities such as gardening. Before you start physical therapy, your doctor may offer to inject the knee with a cocktail of anti-inflammatory steroid medication and an anesthetic. Hypothetically, this could make it easier for you to stick with exercise and therefore lead to better results.

Knee replacements can restore your mobility, but you don't want to get one too soon—or wait too long.