TREATMENT OPTIONS FOR SEVERE KNEE PAIN

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Michael O. Williams, MD FAAOSEdmond Orthopedic Group

How the knee works

Anatomy of the knee

• Largest joint in body

• Referred to as a hinge joint because it allows the knee to flex & extend; while hinges can only bend and straighten, the knee has the ability to rotate (turn) & translate (glide)

• 3 bones• Tibia• Femur• Patella

Common Causes of Knee Pain?

It’s estimated 70 million people in the U.S. have some form of arthritis.1 Osteoarthritis is one of the most common types. Osteoarthritis

• Wear and tear that deteriorates the “cushion” in the joints

• Traumatic injury to joint surface i.e. fracture or internal derangement such as meniscus tear that leads to loss of joint space

Rheumatoid Arthritis

• An autoimmune disease that attacks the lining of joints, causing swelling, possibly throbbing painand deformity

1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website. <http://www.ama-assn.org/amednews/2005/05/02/hlsc0502.htm>, 2005.

What causes arthritis pain?

Healthy knee The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain

Diseased knee (osteoarthritis) Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling

Assessing Knee Joint Pain• Does the knee hurt one or more days per week?

• Does the pain interfere with sleep?

• Is it painful for to walk more than a block?

• Are pain medications no longer working?

• Is knee pain limiting participation in activities(e.g. family vacations or other functions)?

• Has inactivity from knee pain caused weight gain?

Little or no pain

Excruciating, debilitating pain

Assessing Knee Pain• Rate the pain on a scale of 1 to 5

• For most people, the tipping point is about 4 or 5— that’s when the pain becomes too difficult and they turn to a surgeon for relief1

1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study.

Assessing Knee Pain

Check patient’s mobility

If performing any of the movements below, it may be time to consider some type of medical intervention

Walk Bend at thehips and

knees

Pretend to drive: push the gas/brake

Pretend to golf: swing a club

How can the pain be treated?

Water therapy• Soaking, ice packs, hot packs

Exercise & physical therapy• Also good for weight loss

Medications• Analgesics (non-steroidal anti-

inflammatories)• Corticosteroids (short term)

Injections• Corticosteroids or

hyaluronic acid preparations(e.g., ORTHOVISC, HYALGAN, EUFLEXXA, SYNVISC, SUPARTZ)

Total Knee Replacement

Implants replace damaged surfaces

Helps relieve pain and restore mobility

Approximately 580,000 knee replacements are performed each year in the U.S.1

One study has shown that ten years after surgery, 99.6% of patients still depend on their SIGMA® Knees with fixed bearing option in their daily lives2

1. American Association of Orthopaedic Surgeons. Total Knee Replacement – Your Orthopaedic Connection. http://orthoinfo.aaos.org/topic.cfm?topic=a00389 Accessed April, 2011.

2. Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty Vol.23, No.2, 2008: 175-181.

Femoral component

Tibial component

What is knee replacement?

A surgical procedure that removes and replaces diseased joint surfaces with implants

Femoral component

Tibial component

Patellar component

Polyethylene insert

How does TKA work?

• Diseased areas at top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped

• Femoral component covers the thigh bone (femur)

• Tibial component covers the shin bone (tibia)

• Polyethylene insert placed between femoral and tibial components

• Patellar component replaces the

kneecap (patella)

Healthy knee Knee replacement

How does TKA work?

Total Knee Arthroplasty

TKA come in a wide range of shapes, sizes and materials and can be individualized to the patient

Most TKA systems come in enough sizes to essentially custom fit the implants to the individual knee

TKAs are available in both fixed bearing designs and mobile bearing designs

Fixed Bearing Knees

• Most widely used type of knee replacement in the U.S. today1

• Designed to enhance stability of the joint

• New designs and advanced materials - Helps reduce wear

1. IMS Health

Fixed Bearing Knees

Rotating Platform KneesDesigned to rotate as it bends, imitating your natural knee movement

• The surfaces of the knee joint roll and glide against each other as you bend. In other words, your knee naturally rotates as it bends

• Designed for patients who want to remain active since it minimizes implant wear, compared to traditional knee replacements1

• One study has shown after 20 years, 97% of patients still depend on their rotating platform knees in their daily lives2

1. McNulty, D. et al. “In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2).” 2003.2. Buechel F., et al. “Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements.” Clinical Orthopaedics and Related Research July 2001: 41-50.

When should TKA be done?

Assess pain and ability to function• Is the knee pain severe? (4-5 of 5)• Has the pain and loss of function affected quality of life?• Is it difficult to sleep or perform basic functions (walking,

driving, climbing stairs)? • Does medication no longer provide relief?

Consult your physician Early diagnosis and treatment are important1

• Delaying may lower your quality of life2

Osteoarthritis is degenerative—it won’t get better and may get worse

1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728. 2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis

of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330.

Summary The leading cause of knee pain is osteoarthritis

Osteoarthritis is degenerative – it won’t get better and may get worse

Early diagnosis and treatment for total knee replacement are important1

An Arthritis Foundation® study shows total knee replacement has a 90-95% rate of patient satisfaction2

The newer total knees come in a wide range of shapes, sizes and materials, and have improved longevity over past designs

Arthritis Foundation® is a trademark of The Arthritis Foundation, Inc.

1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-17282. The Arthritis Foundation. <http://arthitis.org/research/Bulletin/vol5no11/Printable.htm>, 2006.

Questions