Treatment Options for Knee Pain. Anatomy of the Knee Made up of three bones: Made up of three bones: Femur (thigh bone) Femur (thigh bone) Tibia (lower

Treatment Options Treatment Options for Knee Painfor Knee Pain

Anatomy of the KneeAnatomy of the Knee

Made up of three Made up of three bones: bones: Femur (thigh bone)Femur (thigh bone) Tibia (lower leg Tibia (lower leg

bone) bone) Patella (kneecap)Patella (kneecap)

Source: www.AllAboutArthritis.com , 2003

Knee JointKnee Joint

•Healthy knee joint •Arthritic knee joint

Causes of Knee PainCauses of Knee Pain

Osteoarthritis (wear Osteoarthritis (wear and tear)and tear)

Rheumatoid arthritisRheumatoid arthritis Post-traumatic arthritis Post-traumatic arthritis

caused by: caused by: FracturesFractures Ligament injuriesLigament injuries Meniscus tearsMeniscus tears


Symptoms of Knee ArthritisSymptoms of Knee Arthritis

PainPain During activityDuring activity At rest or sleepingAt rest or sleeping

Swelling and tightnessSwelling and tightness Bone spursBone spurs Grinding sound during movementGrinding sound during movement Stiffness and decreased range of Stiffness and decreased range of

motionmotion


Diagnosing Knee ArthritisDiagnosing Knee Arthritis

Physical examinationPhysical examination Medical history reviewMedical history review X-RaysX-Rays Blood testsBlood tests


How Can My Life ChangeHow Can My Life Change with Treatment? with Treatment?

A return to A return to mobilitymobility

Regaining a Regaining a sense of your sense of your former lifestyleformer lifestyle

Reduce or Reduce or eliminate paineliminate pain

Non-Surgical Treatment Options for Non-Surgical Treatment Options for Knee Knee

Pain: Over-the-Counter MedicationsPain: Over-the-Counter Medications

Nonsteroidal Anti-Inflammatory Drugs Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)(NSAIDS) Usually first drug used to treat arthritisUsually first drug used to treat arthritis Can reduce pain, swelling and rednessCan reduce pain, swelling and redness Relief can take several monthsRelief can take several months Examples:Examples:

ibuprofen (ibuprofen (AdvilAdvil®®, Motrin, Motrin®®)) naproxen (naproxen (AleveAleve®®))

AspirinAspirin Reduce joint pain and inflammationReduce joint pain and inflammation Form of NSAIDsForm of NSAIDs


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Knee Pain: Over-the-Counter

MedicationsMedications

AcetaminophenAcetaminophen Reduces painReduces pain Lowers feverLowers fever Does not reduce inflammation of Does not reduce inflammation of

arthritisarthritis Examples:Examples:

TylenolTylenol®® DatrilDatril®® Extra Strength Extra Strength TempraTempra®®


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Knee Pain: Prescription MedicationsKnee Pain: Prescription Medications

NSAIDS NSAIDS Most popular type for osteoarthritis treatmentMost popular type for osteoarthritis treatment Includes ibuprofen (Includes ibuprofen (MotrinMotrin®®), ), naproxen sodium naproxen sodium

((AnaproxAnaprox®®)), oxaprozin , oxaprozin (Daypro(Daypro®®)), sulindac , sulindac (Clinoril(Clinoril®®) ) , etc. , etc.

AnalgesicsAnalgesics Provide pain relief, but do not reduce Provide pain relief, but do not reduce

inflammationinflammation Includes Acetaminophen with codeine (TylenolIncludes Acetaminophen with codeine (Tylenol®®

with Codeine), Oxycodone (OxyContinwith Codeine), Oxycodone (OxyContin®®, , RoxicodoneRoxicodone®®), Hydrocodone with acetaminophen ), Hydrocodone with acetaminophen (Vicodin(Vicodin®®, Dolacet, Dolacet®®), etc.), etc.


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Knee Pain: Prescription MedicationsKnee Pain: Prescription Medications

Biological Response ModifiersBiological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the jointsTreat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (RemicadeIncludes: Infliximab (Remicade®®), Etanercept (Enbrel ), Etanercept (Enbrel ®®))

Glucocorticoids or CorticosteroidsGlucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammationTreat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (CortefIncludes: cortisone, hydrocortisone (Cortef®®, Hydrocortone, Hydrocortone®®), ),

Prednisolone (PrelonePrednisolone (Prelone®®) ) DMARDSDMARDS

Treat rheumatoid arthritis; slow joint destructionTreat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (DepenIncludes: methotrexate, injectable gold, penicillamine (Depen®®), ),

Azathioprine (ImuranAzathioprine (Imuran®®), etc.), etc.


Non-Surgical Treatment Options for Non-Surgical Treatment Options for Knee Pain: Injection Therapy Knee Pain: Injection Therapy

Cortisone InjectionsCortisone Injections Helps reduce swelling and Helps reduce swelling and

discomfort from arthritis.discomfort from arthritis. Temporary pain relief.Temporary pain relief. Small risk of infection.Small risk of infection.

Hyaluronic Acid (HA) Hyaluronic Acid (HA) InjectionsInjections Restores lubrication and Restores lubrication and

fluid in the joint.fluid in the joint. Creates a shock absorber Creates a shock absorber

between the bones.between the bones.Source: www.AllAboutArthritis.com , 2003

Non-Surgical Treatment Non-Surgical Treatment Options for Knee PainOptions for Knee Pain

Lifestyle ChangesLifestyle Changes Extra weightExtra weight Exercise important to control weightExercise important to control weight Know what foods to eatKnow what foods to eat

OrthoticsOrthotics Assistive devices (Cane, etc)Assistive devices (Cane, etc)

WalkingWalking BathroomsBathrooms ClimbingClimbing Dressing Dressing


Knee Surgical Treatment Knee Surgical Treatment OptionsOptions

ArthroscopyArthroscopy SynovectomySynovectomy Tibial osteotomyTibial osteotomy Total knee replacement Total knee replacement Uni-compartmental replacementUni-compartmental replacement


ArthroscopyArthroscopy

Removes damaged soft tissue. Removes damaged soft tissue. Less invasive surgery, possibly leading to Less invasive surgery, possibly leading to

shorter recovery times.shorter recovery times. Sustained pain relief varies in advanced Sustained pain relief varies in advanced

osteoarthritis patients.osteoarthritis patients.

Source: www.aaos.org, 2003

Arthroscopic SurgeryArthroscopic Surgery

Small camera Small camera inserted to see inside inserted to see inside the joint.the joint.

Small instruments Small instruments remove any debris remove any debris and smooth cartilage and smooth cartilage surfaces.surfaces.


Arthroscopic Surgery, Arthroscopic Surgery, continuedcontinued

BenefitsBenefits Outpatient surgeryOutpatient surgery Less invasiveLess invasive May reduce recovery timeMay reduce recovery time

Disadvantages Disadvantages Pain relief may be temporaryPain relief may be temporary

Source: www.AAOS.org, 2003

SynovectomySynovectomy

Early stages of rheumatoid Early stages of rheumatoid arthritis.arthritis.

Removes inflamed tissue lining.Removes inflamed tissue lining. Potentially saves joint from further Potentially saves joint from further

damage.damage.


Synovectomy SurgerySynovectomy Surgery

Small incision is made.Small incision is made. Arthroscope is used to inspect the Arthroscope is used to inspect the

joint.joint. Diseased synovium is removed.Diseased synovium is removed. Physical therapy usually required.Physical therapy usually required.


Synovectomy, continuedSynovectomy, continued

BenefitsBenefits Alleviates rheumatoid arthritis pain in the Alleviates rheumatoid arthritis pain in the

jointjoint Joint may be saved from further damage.Joint may be saved from further damage. Synovium could grow back over timeSynovium could grow back over time

DisadvantagesDisadvantages Not a permanent solutionNot a permanent solution


Tibial OsteotomyTibial Osteotomy

Treats a varus or Treats a varus or bowlegged deformitybowlegged deformity

Candidates have:Candidates have: Pain Pain Knee cartilage damage Knee cartilage damage

primarily in one section.primarily in one section. Improperly healed Improperly healed

broken knee.broken knee.


Tibial Osteotomy SurgeryTibial Osteotomy Surgery Incision is made on Incision is made on

both the front and side both the front and side of the knee.of the knee.

Wedge-shaped piece of Wedge-shaped piece of bone is removed.bone is removed.

Edge of cut bone is Edge of cut bone is stapled and held by stapled and held by plates and screws.plates and screws.


Tibial OsteotomyTibial Osteotomy

BenefitsBenefits Restore knee functionRestore knee function Reduce osteoarthritis painReduce osteoarthritis pain May even stimulate growth of new May even stimulate growth of new

cartilagecartilage

DisadvantagesDisadvantages Results may be temporaryResults may be temporary Cosmetic difference between kneesCosmetic difference between knees


When is Knee Replacement When is Knee Replacement Surgery Right for You?Surgery Right for You?

Experience significant Experience significant pain.pain.

Knee function and Knee function and mobility decreases.mobility decreases.

Uni-compartmental Knee Uni-compartmental Knee ReplacementReplacement

Minimally invasive Minimally invasive surgerysurgery

Removes damaged Removes damaged articular cartilage in articular cartilage in single area of the kneesingle area of the knee

Replaces damaged Replaces damaged component with component with prosthesisprosthesis

Goal is quick:Goal is quick: Return to normal activities.Return to normal activities. Pain reliefPain relief

Source: www.jointreplacement.com , 2003

Benefits of a Uni-compartmental Benefits of a Uni-compartmental Knee ReplacementKnee Replacement

Resolves arthritis painResolves arthritis pain Maintains two-thirds of the Maintains two-thirds of the

natural knee natural knee Minimally invasive Minimally invasive

procedureprocedure Proven procedureProven procedure


After Uni-Compartmental After Uni-Compartmental Knee SurgeryKnee Surgery

Before leaving the hospital, you Before leaving the hospital, you must be able to:must be able to: Get in and out of bed.Get in and out of bed. Walk with crutches or a walker.Walk with crutches or a walker. Do exercises that bend and straighten Do exercises that bend and straighten

the leg.the leg. May be back to regular activity May be back to regular activity

within four to six weeks.within four to six weeks.


Total Knee ReplacementTotal Knee Replacement

TotalTotal knee is knee is affected by arthritis.affected by arthritis.

Reduce knee painReduce knee pain Improve the motionImprove the motion 323,448 total knee 323,448 total knee

replacements in replacements in 2001200111

1. Solucient, Inc. 2001.1. Solucient, Inc. 2001.

Source: www.preservation-uni.com , 2003

Total Knee Replacement Total Knee Replacement ComponentsComponents


Femoral- replaces Femoral- replaces arthritic portion of thigh arthritic portion of thigh bonebone

Tibial- replaces arthritic Tibial- replaces arthritic portion of shin boneportion of shin bone

Tibial insert- replaces Tibial insert- replaces cartilage and acts as cartilage and acts as shock absorbershock absorber

Patella- replaces knee Patella- replaces knee capcap

Total Knee Replacement: Total Knee Replacement: Cemented or CementlessCemented or Cementless

Cemented implant is held in place Cemented implant is held in place by a type of epoxy cement that by a type of epoxy cement that attaches the metal to the bone.attaches the metal to the bone.

Uncemented implant has a fine Uncemented implant has a fine mesh of holes on surface allowing mesh of holes on surface allowing tissue to grow into.tissue to grow into.

Source: www.aaos.org , 2003

Total Knee ReplacementTotal Knee Replacement

Two major types of total knee Two major types of total knee replacement systems:replacement systems: Fixed Bearing- does not allow full Fixed Bearing- does not allow full

range of motion range of motion Rotating Platform Bearing- Rotating Platform Bearing- closely closely

simulates the action of the normal simulates the action of the normal knee jointknee joint


Potential Benefits of Potential Benefits of Fixed Fixed BearingBearing Total Knee Total Knee

ReplacementReplacement

Provides pain relief.Provides pain relief. Restores the motion Restores the motion

of your knee.of your knee. Improves quality of Improves quality of

life.life. Good results in Good results in

appropriate appropriate patients.patients.


Potential Benefits of Potential Benefits of Rotating Rotating PlatformPlatform Total Knee Total Knee

ReplacementReplacement Provides pain relief.Provides pain relief. Restores the motion of Restores the motion of

your knee.your knee. Rotation similar to a Rotation similar to a

normal knee.normal knee. Reduces potential of Reduces potential of

early wear and early wear and loosening.loosening.

Improves quality of life.Improves quality of life.


Surgical ProcedureSurgical Procedure

Patient is anesthetized.Patient is anesthetized. Incision is made.Incision is made. Arthritic surface at the end of the Arthritic surface at the end of the

thigh bone or femur is removed.thigh bone or femur is removed. Bone is prepared for a new Bone is prepared for a new

covering.covering. Femoral component is attached.Femoral component is attached.

Source: www.Jointreplacement.com, 2003

Surgical ProcedureSurgical Procedure

Arthritic surface on top Arthritic surface on top of the shin bone is of the shin bone is removed.removed.

A metal tray (tibial A metal tray (tibial tray) is placed on top tray) is placed on top of remaining bone.of remaining bone.

Tibial insert locked Tibial insert locked into tray.into tray.

Incision is closed.Incision is closed.Source: www.Jointreplacement.com, 2003

Preparing for Joint Preparing for Joint Replacement SurgeryReplacement Surgery

Ease anxiety by mentally preparing with:Ease anxiety by mentally preparing with: Breathing exercisesBreathing exercises MeditationMeditation Talking with friends and familyTalking with friends and family

Learn more about knee replacement Learn more about knee replacement surgery:surgery: BrochuresBrochures HandoutsHandouts WebsitesWebsites VideosVideos


The Night Before SurgeryThe Night Before Surgery

Avoid medications, such as “blood Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.).thinners” (aspirin, ibuprofen, etc.).

Do not consume any food or liquid Do not consume any food or liquid after midnight.after midnight.

Make sure you have everything Make sure you have everything you’ll need at the hospital.you’ll need at the hospital.

Ask any questions you may have Ask any questions you may have before surgery.before surgery.


After SurgeryAfter Surgery

Movement of knee determined by Movement of knee determined by doctor.doctor.

Physical therapy is very important Physical therapy is very important to regain mobility and strength.to regain mobility and strength.


A Caregiver’s RoleA Caregiver’s Role

Provide support and show patienceProvide support and show patience Help with needs that the patient Help with needs that the patient

can not do, like:can not do, like: BathingBathing CookingCooking DressingDressing Daily chores (running errands, driving Daily chores (running errands, driving

to appointments, etc.)to appointments, etc.)


Hospital DischargeHospital Discharge You will be released from the hospital as soon You will be released from the hospital as soon

as you can:as you can: Get in and out of bed safely. Get in and out of bed safely. Walk up to 75 feet with your crutches or walker.Walk up to 75 feet with your crutches or walker. Get up and down flight of stairs.Get up and down flight of stairs. Access the bathroom.Access the bathroom. Demonstrate good muscle contraction of the upper Demonstrate good muscle contraction of the upper

thigh muscle.thigh muscle. Hospital stay usually lasts 3 to 4 days.Hospital stay usually lasts 3 to 4 days. May continue physical therapy at a May continue physical therapy at a

rehabilitation center or at home.rehabilitation center or at home.


Recovery in the First WeekRecovery in the First Week

Continued use of your walker or Continued use of your walker or crutches is required.crutches is required.

With a cemented procedure, With a cemented procedure, increase weight on sore leg as increase weight on sore leg as comfortable.comfortable.

With a cementless procedure, place With a cementless procedure, place only the toes down until a follow-up only the toes down until a follow-up x-ray. x-ray.


Recovery in the First MonthRecovery in the First Month

Sutures or staples usually taken out Sutures or staples usually taken out 10-14 days after surgery.10-14 days after surgery.

Do not shower or bathe until the Do not shower or bathe until the sutures or staples are removed.sutures or staples are removed.

Motion exercises should be Motion exercises should be progressing.progressing.


Recovery After Six WeeksRecovery After Six Weeks

Swelling normal for first three to six Swelling normal for first three to six monthsmonths Elevate leg slightly and apply ice. Elevate leg slightly and apply ice.

DrivingDriving 1 to 2 weeks- Left knee replaced and 1 to 2 weeks- Left knee replaced and

automatic transmission. automatic transmission. 6 to 8 weeks- Right knee replaced. 6 to 8 weeks- Right knee replaced.

Return to work in 6 to 8 weeks Return to work in 6 to 8 weeks depending on type of work.depending on type of work.


Questions?Questions?

Thank YouThank You

Documents

Treatment Options for Knee Pain. Anatomy of the Knee Made up of three bones: Made up of three bones: Femur (thigh bone) Femur (thigh bone) Tibia (lower