Knee pain is one of the most common complaints of otherwise healthy people. Almost everyone has knee pain or knows someone with it. The knees bear more weight than any other joints, except for the ankles. Because of their extensive range of motion, the knees are subject to considerable wear and tear. Knee pain can be acute (sudden onset and self-limited), or chronic (long-lasting).
Most cases are of the chronic variety. The most common cause of chronic knee pain is osteoarthritis, the kind of arthritis that afflicts most of us as we age. Osteoarthritis is due to the steady wearing away of the smooth and resilient cartilage that caps the ends of our long bones where they meet to form joints and is essential to normal joint function.
Osteoarthritis can begin in those as young as thirty and may progress for many years before symptoms appear. Those with minor knee pain, clicking, ‘giving way’, or ‘trick knees’ are usually experiencing the earliest symptoms of arthritis. Advanced cases can lead to either a bowlegged or knock-kneed appearance. An older person with severely bowed legs has osteoarthritis of the knees. It is actually quite common.
Acute knee pain is usually due to an injury. Injuries may cause damage to cartilage or cause blood in the joint. When acute knee pain is accompanied by significant inflammation and swelling, it may be a case of gout, or rarely, infection. Sometimes acute knee pain represents a temporary flare-up of chronic osteoarthritis, or the superimposed occurrence of pseudogout.
Treatment of acute knee pain depends on the underlying cause. Acute knee pain is treated with painkillers, anti-inflammatory agents, or removal of the abnormal synovial (joint) fluid and injection of medication. Exercise and physical therapy to maintain muscle strength and range of motion should always be employed. Occasionally, if there is severe cartilage damage that fails to improve with medication, arthroscopic surgery is indicated.
Chronic knee pain is treated the same way, but on a long-term basis. Exercise and physical therapy to rebuild atrophied leg muscles are of paramount importance. Without the proper exercise to strengthen supportive musculature, all other treatments are doomed to failure. Sometimes, strong painkillers like codeine or its relatives are employed.
In severe cases that fail to respond to these measures, consideration should be given to surgical replacement of the joint. This is the last ditch treatment and it is always desirable to try and prevent surgery with conservative measures first. The decision to operate should always be made by the patient, and is based on quality of life, activity level, and general health. The decision to operate is not based on "how the x-ray looks".
A newer treatment for osteoarthritis of the knee is injection of hyaluronate (hyaluronic acid). This substance, derived from rooster combs, replaces some of the lost lubricating and shock absorbing properties of normal cartilage. In carefully selected patients the results can be truly excellent, with few or no side effects. Although results are not guaranteed, some have had such dramatic improvement that they have actually put off surgery.
The most important point is that arthritis of the knees can be markedly improved and sometimes even prevented. The proper use of exercise and medication tailored to the individual patient can prevent needless disability and can help to avoid surgery. Proper exercise instruction to improve knee stability is absolutely essential. A treatment program that neglects exercise instruction is incomplete. The treatment of osteoarthritis is not simply a pill.
The staff of the Arthritis Center's Division of Rheumatology, Osteoporosis, and Pain Management has years of extensive experience in all types of treatment of all types of arthritis. Our capabilities include medication, exercise, physical therapy, injections, and all of the latest modalities, including the experimental when necessary.
If disability is to be avoided, evaluation by our experts as early as possible is essential. We have the necessary expertise, experience, and physical facilities to make your treatment as easy, painless, and effective as possible.