Has walking and standing become more difficult? Is it a difficult chore to go up and down the stairs? Do you have a feeling of knee giving way? Do you feel and hear noises with the movement of your knee? Does your knee look like it is getting more curved and bumpy? Do you have difficulties sleeping because of the knee pain?
If you answer yes to the above questions, then you may be suffering from a natural wear and tear of your knees. The knee joints are made up of bones, ligaments, cartilage, and meniscus. The cartilage is a lining of the bones and the meniscus is the shock absorber in the joints. The cartilage in our knees is like tires on a car. As we drive our cars, the tires wear out. Obviously, depending on the quality of the tires, and how we drive the car and take care of the tires, it will wear slower or faster. Our knee cartilage also wears out as we get older. This is called wear and tear arthritis or osteoarthritis. The quality of the cartilage is based on our genetics. Our level of activities has a large impact on the rate of the wear of our knee cartilage. Generally, high impact activities such as running and jumping can lead to an earlier wear. Therefore, low impact exercises, such as biking, swimming, elliptical machines, and stair steppers are more preferred cardiovascular exercises. Finally, our body weight also impacts the rate of the cartilage wear. The ratio of our body weight to the stress across our lower extremities is 3:1. That is for every one kilogram of weight gain, we increase the stress on our knees by 3 kilograms.
Most of the times, the knee pain from wear and tear occurs gradually. On occasions, we can get a tear of our meniscus, which may result in a more sudden pain. These tears occurs because our meniscus thins out as we get older. Normal daily activities that require planting and rotating of our legs, such as getting in and out of a car or getting in and out of a bed, can cause a tear of our meniscus. Obviously, force full injuries such as a fall can also result in a tear of the meniscus.
If you are suffering from any of the above symptoms, you should consult your physician or orthopedic specialist. Your doctor will ask about your history and will do a complete examination of your lower extremities. The first diagnostic study to obtain is a weight bearing x-ray of your knee. This will allow your doctor to determine if the space between your knee bones are narrowed, which means you have arthritis. If the x-ray results are negative, then your doctor may decide to order a MRI to rule out meniscus tear.
Regardless of whether you have arthritis or a torn meniscus, the initial treatment is conservative. This includes activity modification, physical therapy, oral anti-inflammatory medications, and weight loss. Your doctor may also recommend steroid or viscosupplement gel injections, that may give you temporary relief of your symptoms. If you continue to be symptomatic, and have limitations of activities of daily living, then your doctor may recommend surgery.
The surgery for meniscus tear is a short outpatient procedure, called arthroscopy. It is done through two small incision, through which your surgeon will trim the area of the meniscus that is torn. You can start walking on the same day, using crutches for support, and return to your normal activities within 4-6 weeks.
The knee arthritis is usually treated with a total knee replacement. This is a surgery that takes about an hour, and the surgeon will remove the arthritic areas of the knee. By making different cuts on the bones, your surgeon will place metal caps on the bones and a plastic spacer in between. You will be able to stand and walk with the help of a physical therapist and use of a walking aid on the same day of surgery. You will need to stay at the hospital for 1-2 days. The full recovery can take between 3-6 months.
If you want more information or would like to make an appointment, please contact Dr. Kevin at GMC Orthopedic Department.
Dr. Kevin Shamlou
Orthopedic & Spine Surgeon