Knee - Arthritis
Description
Arthritis is inflammation of a joint. The knee can be divided into three compartments: medial (inside), lateral (outside) and patellofemoral (front). Arthritis can be present in one, two or three compartments. Over time, the loss of the smooth covering on the ends of bones (aka - articular cartilage) causes pain and stiffness. This can lead to pain with motion or at rest, swelling, clicking or grinding and a loss of strength. When the cartilage is damaged or decreased, the bones rub together during joint motion, resulting in “bone-on-bone” arthritis. When arthritis becomes severe, inflammation occurs around the joint and extra bone is formed in an attempt to protect the joint, resulting in limited motion and strength.
What are the causes?
The primary cause of arthritis is osteoarthritis (aka – “wear and tear” arthritis). Obesity and genetics are the biggest contributing factors to osteoarthritis. Trauma and other illnesses like rheumatoid arthritis, systemic lupus, septic arthritis and psoriasis can result in degeneration of a joint, leading to symptoms of pain and lack of motion.
What are the symptoms?
Arthritis of the knee causes pain, swelling, stiffness and loss of strength. Pain can be isolated to the medial, lateral or patellofemoral aspects of the joint or be generalized discomfort around the knee. Pain and swelling in the back of the knee may be from a Baker’s Cyst, an area of fluid collection that is caused by arthritis. A 'grinding', 'clicking' or 'locking' sensation may be felt. Loss of motion can become severe, and the patient may have trouble performing tasks, such as walking long distances. Patients suffering from arthritis of the patellofemoral joint will often complain of 'giving way' or buckling of the knee. Patients with patellofemoral arthritis have trouble using stairs, squatting, or standing after prolonged sitting.
How is it diagnosed?
Your surgeon will perform a thorough history and physical exam, which typically includes X-rays. Your surgeon will evaluate the range of motion, stability of the ligament and strength of the muscles surrounding the knee. X-rays may demonstrate decreasing space between the bones (joint space narrowing) and bone spurs (osteophytes) in areas of arthritis. MRI may be helpful to determine if other areas of joint cartilage or the meniscus has damage.
Non-operative
Knee arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. The stronger the supporting muscles, the less the body will need to rely on bony architecture to stabilize the joint. This will lead to less stress across the arthritic area. Your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. Certain nutritional supplements may be beneficial to decrease pain and inflammation. Corticosteroids and Hylauronic acid series injections are the mainstay of non-operative arthritis treatment. Cortisone injections are safe to receive every 3 months and Hyaluronic Acid series, such as synvisc or Euflexxa, are approved to be utilized every 6 months.
Platelet-rich plasma (PRP) injection is another non operative option for treating pain. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. The goal is to promote an anti-inflammatory effect, reduce pain, and stimulate healing. There is also the potential for joint preservation by slowing down arthritic process. Although one injection may help, studies support a series of 2 injections, 1 x Week/2 weeks. Not covered by insurance.
Bone Marrow Concentrate "Stem Cell" Injections is another non operative option for treating pain. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate stem cells, which are then re-injected into the joint. The goals are to change the living micro-environment of the joint to a positive one, and to decrease inflammation and cartilage cell death. Will promote healing of cartilage, will not re-grow cartilage, restore joint space, or remove bone spurs. There is also great potential for joint preservation by slowing down the arthritic process in early stages. Not covered by insurance.
Operative
When non-operative treatment does not relieve symptoms, your surgeon may suggest surgery. Three surgical options are available for knee arthritis.
Minimally-invasive arthroscopy of the knee, or a 'knee scope', may be beneficial to “clean-out” the knee. Although not a cure, this procedure may provide relief in patients suffering mechanical symptoms, such as catching and locking. The entire knee joint, including joint cartilage, meniscus and ligaments can be evaluated during arthroscopy. Knee arthroscopy procedure for severe arthritis has limited benefit.
The definitive treatment for knee arthritis is joint replacement surgery. Dr. Liu will resurface the ends of the bone where the cartilage has worn away, with metal and plastic implants. If the arthritis is localized to a single or two compartments (medial, lateral or patellofemoral), your surgeon will replace only the areas that are affected (unicompartmental or patellofemoral replacement). If the arthritis is present in all three compartments, a total knee replacement is required to alleviate symptoms.
Coming Soon!
Can I shower after surgery?
If you have a bulky dry dressing you can remove it on postop day #3; you may then shower allowing water to run over steri-strips or sutures; towel pat dry and keep clean; NO soaking or submerging operative body part. If you have a waterproof dressing, please leave it on until you follow up in the office. You can shower over the dressing, no soaking or submerging the shoulder
How long do I need to wear the compression stockings?
Dr. Liu wants you to keep the compression stockings on for 3 weeks. Compression stockings are the best way to help the swelling to go down after surgery.
Should I use ice or heat?
Ice can provide analgesic effects and control swelling for the first 3-5 days; after that we recommend ice after exercises or PT.
How do I use an ice machine or CPM?
if either device is part of your recovery, treat this as an assistance to your recovery. Use either as directed, allowing only the machine to move or do the work. Remember, you should not be doing the work or moving the operative body part on your own.
How do I decrease my pain after surgery?
You may take your pain medication as prescribed; if pain continues, you may add ibuprofen or naproxen in between pain medication doses: (8am pain med, 10am ibuprofen 600-800mg or naproxen 500mg, 12p pain med).
Who schedules my first post operative appointment?
You are responsible for scheduling this appointment. This can be done prior to your surgery or within 1-3 days following. Please call the office, at 702-740-5327, provide your date of surgery, and you will be provided your appointment time and date.
When can I drive?
This depends on your surgery. Please wait until your first post op visit to discuss with your provider.
When can I go swimming?
Please wait at least 4 weeks until you submerge your incision into baths or pools. When your incision is submerged, it can open up and increase risk of infection. We ask that you wait 4 weeks when the incision is healed to soak in tubs or pools.
When do I start Physical Therapy?
Physical Therapy will be discussed at your first postoperative visit 10-14 days after surgery.
I have questions that have not been answered.
Please re-read your postoperative instructions handout. If questions remain, please contact the surgery line that has been provided to you on your post surgical handout.