Advanced Knee Care

Knee Surgeon and Specialist Stefan D. Tarlow, M.D.

Total Knee Replacement: Causes, What To Expect, and Recovery

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If chronic pain, severe damage, or instability keeps you from the quality of life you want, a knee replacement might be the solution. Total knee replacement surgery, or knee arthroplasty, is common for those who find non-surgical therapy and solutions unhelpful. Here is a rundown on all you need to know.

Common Causes

Arthritic pain is the most common cause of knee arthroplasty surgery. This includes Degenerative arthritis (or Osteoarthritis), Traumatic arthritis, and rarely Rheumatoid arthritis. Osteoarthritis is most common cause of knee arthritis and is most often seen in patients over 50. Knee arthritis leads to the death of the cells that cover the bone. This tissue is also known as articular cartilage. When the articular cartilage degenerates, the bones press against each other, generating knee pain, stiffness, limpness, and angular deformity. Traumatic OA follows after a severe knee injury such as fracture, ACL tear, or meniscal tear. This is more prevalent in younger patients and produces symptoms in people as young as 30. These knee injuries damage the articular cartilage, like in Degenerative OA, igniting intense knee pain and activity limitation. Rheumatoid arthritis is a less common disease in which your immune system attacks the knee joint lining. This also causes the cartilage to wear away from the bone and causes severe deformity and pain. Luckily medical management has made significant progress, and rheumatoid patients rarely come to knee replacement.

Who Ends Up Getting the Surgery?

There are specific criteria (or indications) for total knee replacement surgery(including but not limited to symptoms, physical findings, X-ray changes, body weight, smoking status, and diabetes status). Surgery recommendations are based on these factors and the person’s functional status with activities of daily living (including desired activities, work requirements, and severe knee pain). A shared decision for surgery comes from the patient, the family, and the surgeon. Knee replacement surgery is only recommended for people with severe pain, which reduces their quality of life. Included are limiting everyday work and recreational activities. Most patients with advanced knee OA notice angular knee deformities like knee-bowing and limited bend-ing. Most have failed non-surgical treatments like medications, injections, physical therapy, and bracing.

What To Expect During Total Knee Replacement?

The Knee MD of Phoenix Dr. Tarlow diagnosing a knee X-ray

Before knee replacement surgery, your surgeon will evaluate your tests, x-rays, and medical history to ensure this is your best decision. In addition, other surgical details will be explored. Once your consultation is complete, finish all tasks given to you to ensure the best possible outcome for your recovery after the surgery. Don’t forget to modify your home and create an assistance plan for the first few weeks.

Robotic Technology with the Stryker Mako Robot has improved patient outcomes. The surgery is performed in about 90 minutes at an ambulatory surgery center (most patients do not need to go to a hospital). There is no overnight stay. You will walk without a walker and drive within a week or two.

At the Ambulatory Surgery Center

Knee replacement surgery is more tolerable with multimodal pain management, including pre-surgical pain medications, an adductor canal block, a short-acting spinal, and a light general anesthetic. Your surgical team will consult on whether to use general or spinal anesthesia. Most patients awake comfortably, and the intense transient surgical pain doesn’t hit until the next day. In addition, prophylactic intravenous and into-the-knee antibiotics are employed to reduce the risk of a knee infection.

During Surgery

The incision is about 8 inches long. Your surgeon maps the surface of your knee to validate the virtual model of your knee created from the pre-op CT scan. The surgeon completes the complex plan, which allows for accurate and “natural” placement of the knee implants. The robotic arm is brought into the surgical field, and the damaged surfaces are precisely removed. The implants are attached to your bone, usually using bone ingrowth technology. The implant position is validated, and the incision is closed. This operation typically takes a surgical team 1 1/2 hours to complete.

After Surgery

After the knee replacement surgery, you’ll be taken to a recovery room. Typically patients stay for 90 minutes, then are discharged home. People can walk full weight bearing with a walker on the same day. Home medications include pain management medications and baby aspirin for blood clot prevention.

male physiotherapist checking woman's knee mobility

Photo created by freepik – www.freepik.com

How Does Recovery Look?

You can shower the next day. You will have an office check-up in a week. Patients have a full weight bearing with a walker for 1-2 weeks and driving in a week or two. Around the 3-6 weeks mark, most patients can resume their day-to-day activities, including housekeeping, driving, shopping, and low-impact activities like walking or swimming. Physical therapy for 6-8 weeks helps speed the recovery.

Full recovery:

Most patients return to regular physical activities; the knee should look normal with its scar. Your knee replacement surgery is successful with the proper care and professional help!

Patient Satisfaction Quite High for Unicompartmental Knee Replacement (Makoplasty)

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An article published in the Journal of Arthroplasty compares patient satisfaction rates at 2 years after surgery for both Total Knee Replacement and Unicompartmental Knee Replacement (also termed Makoplasty or partial knee replacement).

This study confirmed that Unicompartmental Knee Replacement patients have higher satisfaction scores (86 % vs 71 %) than Total Knee Replacement patients.  The reasons for this include better range of motion, more natural feeling knee, less stiffness, and less serious complications for patients receiving a Unicompartmental Knee Replacement.  Additionally, Total Knee Replacement is a more invasive surgery with longer healing times.

For many patients there can be a choice between which type of knee replacement you can have.  Make a thoughtful decision based on your specific clinical information and discuss the options with your surgeon.  Choose wisely.

Minimally Invasive Total Knee Replacement

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minimally invasive TKR

One of the most common orthopedic procedures is total knee replacement. This minimally invasive procedure is also known as arthroplasty. It is used to replace worn or damaged surfaces of the knees. Basically, an implant is placed as a replacement for the knee surfaces to increase mobility, relieve pain and help the patient return to his/her normal everyday activities.

Minimally Invasive vs. Traditional Approach

The main goal of total knee replacement procedure is to relieve the pain, restore the health and function of the, and to eventually help the patient return to daily activities. In this procedure, the damaged bone and cartilage are removed from the surface of the knee and replaced with artificial ones.

The traditional approach involves full surgery. It takes longer and leaves a long vertical incision in the center of the operated. Now minimally invasive knee replacement is gaining more popularity over the traditional approach. This is because, as the term suggests, the technique is less-invasive and faster. I also uses a shorter incision; hence, speeding recovery and reducing postoperative complications.

While both traditional and minimally invasive total knee replacement have more or less the same results; minimally invasive promises a faster recovery and lesser risk for complications. The only problem is that unlike traditional approach, minimally invasive procedure is not for everyone. You need to discuss with your surgeon first if you are a good candidate for the said procedure.

Minimally Invasive Knee Replacement

In minimally invasive TKR, the artificial implants used are the same as the ones used in traditional approach. However, the surgical instruments used for the removal of the damaged cartilage and bones and for the placement of the implants are different and more specialized. This is because in minimally invasive procedure, the incision is shorter, about 4 to 6 inches only, compared to the 10-inch incision in traditional surgery. This means less tissue disturbance and faster recovery. Additionally, the technique used in opening the knee is also less invasive, avoiding trauma and reducing risk for infection and other complications.

Among the benefits of minimally invasive knee replacement procedure are quicker and less painful recovery, rapid return to normal daily activities and lesser damage to soft tissues. It also means less stay at the hospital.

As already mentioned, not all people are a good candidate to undergo minimally invasive total knee replacement. If you wish to know if you are a candidate or not, and if you wish to know more about minimally invasive knee replacement; contact an orthopedic surgeon. Make an appointment with Dr. Tarlow today.

Warning Signs That You May Need Knee Replacement Surgery

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Signs You Need Knee Surgery

This past year, there have been more than 600,000 total knee replacements performed by surgeons in the United States alone. And this number is expected to continually rise for the years to come. This says that despite the long rehabilitation and recovery process of the procedure, more and more people trust the effectiveness and benefit of the knee replacement surgery. But when do you know that you may already need to undergo knee replacement surgery? The answer is both personal and practical.

Sometimes, people wait for things to become unbearable and too much before they decide to get knee replacement surgery. Well, this is more or less a normal response because surgery is a big deal to most people. People prefer minimally invasive and other non-surgical options to treat their knee problem. But there are cases where the only and best option left is to undergo total or partial knee replacement. And there are warning signs for this.

Signs You Need Knee Surgery

  • Severe pain in the knee and the surrounding area, which already affects your daily activities.
  • Knee pain is still present even when you are resting, feeling moderate to severe pain day or night.
  • Knee swelling and inflammation that no longer respond to medications.
  • Knee stiffness.
  • Bowing out of the leg.
  • Taking NSAIDs no longer provide relief for the pain.

If you feel and experience these warning signs, immediately go to the surgeon and ask for an advice. Chances are, it is high time that you undergo knee replacement surgery before things get from bad to worse.

These are serious signs. These signify that you must not delay because things are surely starting to get worse. The best warning that you must really heed is when the surgeon himself has advised you to undergo surgery as soon as possible. If you don’t heed such warning signs, you may suffer from any of these repercussions.

  • Weakened muscles and ligaments in the knee.
  • Deformities of the area outside the knee joints.
  • Limited mobility due to loss of functionality and chronic pain.
  • Continued degeneration of the knee joints which leads to various complications.
  • Reduced success rate of surgery in the future.

There is no hard and fast rule as t when you should need knee replacement surgery. The best advice is that coming from a reliable, experienced surgeon. Factors like medical conditions, age, weight and lifestyle also play a vital role on whether you should undergo knee replacement or not, or when.

Contact a Surgeon

But if you already suffer from any of the mentioned warning signs, the best thing to do is not to delay. Immediately seek help from a qualified professional. If you decide to get a Makoplasty knee replacement surgery, don’t hesitate to come straight to TarlowKnee. We provide advanced knee care in Arizona.

Contact us to schedule an appointment.

TKR Surgery Fact: Do Both Knees End Up Being Replaced?

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total knee replacement

Not all who have knee problems need to undergo knee replacement. Most of the time, only patients with severe destruction of the knee joint or osteoarthritis end up having their knee replaced. The procedure is medically known as Total Knee Replacement surgery. In this procedure, the defective knee will be replaced with an artificial one. The diseased or injured joint will be replaced with plastic and metal parts which function normally and last long enough for the patient to enjoy doing normal activities again.

Total Knee Replacement is a popular procedure not only for osteoarthritis patients, but also to those who have devastatingly injured their knee. Despite the success and innovativeness of this procedure, some people are still wary of its effects. Some patients are still concerned about the pros and cons of Total Knee Replacement.

But it is not only this that they are worried about. There are reports that say once you have undergone TKR on your one knee, you will likely undergo another procedure on your other knee. Patients raise concern that once you have had one knee replaced, there is a high chance that your other knee will need replacement too. So the question that needs to be answered is this: do both knees end up being replaced? Is this a fact or just a myth? Let us find out if there is any truth to this.

To answer the question, let us take a look into a particular study conducted on the subject. A population study spanning 40 years was conducted. This question was addressed to the TKR candidates: if you had one knee replaced, what are the chances that the other knee will also be replaced through Total Knee Replacement surgery? Based on the data studied, the general finding is this: there is 45% chance that the other knee will be replaced within 11 years after the first knee replacement. In the study, the data of 2,000 total knee patients, spanning from 1969 to 2008, were analyzed. The results show that out of the 2,000 patients who underwent one knee replacement, 809 had their other knee replaced within 11 years after the initial knee replacement procedure. In fact, most of the patients underwent the second knee replacement surgery within 10 years.

Now going back to the question, the answer is yes, it is a TKR surgery fact that both knees could end up being replaced. But this does not mean that TKR as a procedure is not working. It just goes to show that once one knee has encountered an injury or another problem that needs surgery; there is higher chance that the other knee will also encounter the same fate. Still, this does not take away the fact that TKR is an innovative and important procedure. And if you indeed end up having your other knee replaced too with an artificial one, you can still count on the procedure just as you had during the first surgery. As long as it is done right and by the right professional, there is really nothing to worry about.

If you wish to know more facts about Total Knee Surgery or if you need to consult anything about your knee problems or injury, contact Dr. Tarlow at Advanced Knee Care. Make an appointment with us and we will help you with your knee issues.

Sex Life after Knee Replacement

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tarlow knee sexual functionKnee problems such as osteoarthritis affect millions of Americans every year. Aside from this fact, many people are not that aware that there is a correlation between knee problem and sexual function. Based on a research presented at the annual meeting of American Academy of Orthopaedic Surgeons (AAOS), osteoarthritis of the knee limits sexual activity.

In a survey of Knee Replacement patients, several patients were observed. These patients have undergone knee replacement surgery two years prior. The results and findings of such survey were published in the Journal of Arthroplasty. Before knee replacement, 45% of the patients with knee arthritis said that before knee replacement, their sexual frequency and/or quality was limited. They cited knee pain and limited knee flexions as the major factors that make having sexual activity challenging. After they have undergone knee surgery, 72% of the patients said that they were no longer limited by the aforementioned factors. Postoperatively, patients were able to resume sexual activity at an average of 2 ½ months (ranging from 0-18 months) after the knee replacement operation.

In another study, patients under the age of 70 with a mean age of 57.7 years agreed to participate. The study required them to answer and fill out questionnaires prior their scheduled for primary total knee replacement. They were also asked again six months and then one year after surgery. Out of the 147 patients, 78 of which are women and 68 are men, 65% participated in and completed the three surveys. The result of said study contains the following findings and generalizations:

  • 67% of the patients reported physical problems and limitations regarding sexual activity prior to the surgery. The common problems include stiffness, pain, reduced libido and inability to attain proper sexual position.
  • 91% of the patients answered that they experienced psychological issues related to their knee problem or osteoarthritis. The issues include low sexual self image and diminished sense of general well-being.
  • 90% of the TKR patients reported that they experienced improved overall sexual function after the surgery. More women reported improvement more than men. 42% reported improvement in libido; 41% said that their intercourse frequency has increased; 41% also said that they have increased intercourse duration; 84% of the patients reported that their general well-being improvement; and 55% attested that their sexual self image developed. Only 16% of the patients said that the surgery did not significantly affected their sexual function, particularly due to fear that the replacement joint might get damaged.

Sexual function is also a vital part of one’s life. It is only justifiable to include sexuality and sexual activity in the evaluation of the outcome of total knee replacement and other knee surgery. Sexual experience is part of one’s overall health and lifestyle, which is why it is great to note that knee surgery has something to offer as regards one’s overall sexual function.

But there must be a balance between sexual function and taking care of the knee replacement. This is better discussed personally with your surgeon or knee professional. If you need to learn more about knee surgery or if you want to undergo the same, contact Tarlow Knee. Make an appointment with us today.

Total Knee Replacement Fact: Obesity Puts Patients at Risk

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obesity and total knee replacement

Much is said about Total Knee Replacement. While many agree that it is a perfectly safe procedure, there are those who say that the surgery can be risky. One of the most common factors that increase the risk for knee replacement is obesity. There is a circulating belief that people who are obese are not fit to undergo TKR. There is higher risk for complications for patients who are obese, they say. How true is this and if so, what are the possible serious complications? Let us find out.

Let us take a closer look into this study conducted by Mayo Clinic which was published in 2016. The study seeks to the address the following question: Is Total Knee Replacement a more risky procedure in patients with high body mass index (BMI)? Luckily, this was answered in the same study.

The study used and reviewed the data of 22,000 patients who underwent Total Knee Replacement. The average BMI of the patients is 31. Out of the 22,000 patients included in the study, 5,500 have a BMI above 35. Based on the results of the study, there was an increased rate of repeat knee surgery (including revision total knee replacement surgery) as well a striking increase of knee joint infection, a serious complications in the morbidly obese group (BMI 35-40).

Complications arose following the Total Knee Replacement among the patients belonging to this group. This answers the question as to the complications that obese patients might encounter after undergoing TKR.

However, in the same study, it has been noted that the risk for complication can be minimized by delaying surgery until obesity and other modifiable risk factors are reversed. While obese patients are at risk for complications when undergoing the procedure, the case is not totally hopeless. In fact, the case can be remedied and these patients can still continue with their treatment with less risk. The risks can be minimized through best practices. This calls for experienced and reliable professionals. If the surgeons employ best practices and proven strategies, they can maximize patient outcomes and surgical success, as well as minimize risk for serious complications among obese patients. In other words, the key to lowering or totally eliminating the risk for such patients during and following TKR is to have the procedure conducted only by trusted and proven professionals.

So if you are obese and you have knee problems, don’t consider yourself as a hopeless cause. You can still have your knee issue fixed without having to worry about serious complications following the knee replacement. As already said, it’s just a matter of employing best practices With the right preparation and right measures before, during a and after the procedure, you will have a successful TKR operation. To reiterate, the key to a successful surgery is a reliable, trustworthy and experienced surgeon.

If you are obese and are having doubts whether to continue with the procedure or not, give us a call. You do not have to look further to find the right surgeon who can ensure a successful, risk-free procedure. We know exactly what needs to be done and what’s appropriate for you and your condition. Our surgeon has the right experience, expertise, knowledge, practices and passion for this kind of procedure to work. Make an appointment with us today for a consultation.

Experience Matters: Find the Right Surgeon for Knee Replacement

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Find Knee Replacement surgeon

Being experienced is always an edge. Experience is highly important to the success of any endeavour, especially technical ones like medical procedures and surgeries. Knee surgery like unicompartmental knee replacement is specific and technical, and requires not just skills and expertise, but most importantly practice and experience. This is why it matters that you choose a surgeon with specific experience in performing the above mentioned procedure.

Before we tackle the importance of experience to the success of a knee replacement, let us understand the basics of unicompartmental knee replacement or arthoplasty first. This surgical procedure is also known as partial knee replacement, as opposed to total knee replacement (TKR). This procedure is most commonly used to treat and relieve arthritis affecting the knee. If the knee is not totally damaged but only parts thereof such as the medial, lateral or kneecap; only the damaged knee compartment or parts are replaced. This surgery has shorter recovery period and reduced post-operative pain. However, if the whole knee, that is, all the three compartments are damaged, the best solution is total knee replacement.

Whether it’s partial or total knee replacement, it does not take away the fact that the procedure is highly specialized. Not all surgeons perform these procedures. Only those with the special training and education can perform the same. This explains why there are knees-only surgeons.

Now you have a picture of what it takes to perform unicompartmental knee replacement successfully. Training, background and skills are important. But constant practice and experience are even more important. This is how you test whether the surgeon is better or not, this is what separates a best surgeon from the better or the good. With this, it is helpful if you look into the track record of the surgeon and see how many times has he done this type of surgery and what is his success rate. To be sure, you can go directly to a knees-only surgeon.

Knees-only surgeons are focused on treating knee injuries and other related problems. Their training is highly specialized. But again, not all knees-only surgeons are the same although they may have the same level of training and background. What sets a great doctor apart is his experience. We again emphasize the importance of experience when you choose a surgeon to perform a unicompartmental knee replacement or any knee surgery for that matter. The surest way to a successful procedure and fast recovery is through an experienced knees-only surgeon in Arizona.

If you are in need of one, you don’t need to go far. Contact TarlowKnee today and schedule your appointment.

Knee Arthritis: A Primer

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Facts About Arthritis of the Knee

A 15 year study of middled aged (avg 53 years) of normal body weight (BMI avg 25) from the United Kingdom provides insight on the incidence and severity of symptomatic Knee OsteoArthritis.

These data are gender specific and since this is a normal weight population can not be extrapolated to the obese population. The annual rate at which middle-age women develop knee osteoarthritis (OA) is fairly low, but progression is common when x-ray changes in the joint are already present, a community-based cohort study found.
During 15 years of follow-up there is a 49% lifetime risk of developing symptomatic (not necessarily severe OA of the knee). 51% of normal weight women never develop knee arthritis.

Among the entire cohort, 561 had undergone knee radiography at baseline and then at years 5, 10, and 15.
High body mass index also was associated with an increased incidence, with a nearly 20% greater incidence by year 10 among obese women.

At 15 year followup nearly 30 % of those women with knee arthritis had the disease in both knees.  70 % had symptomatic arthritis in only one knee.
The rate of total knee replacement by year 15 was about 10 %.
The also know risk factors in order of significance are genetics, obesity, female gender, serious knee injury (bone or ligament or meniscus).

Knee Osteoarthritis Treatment Options – AUC from AAOS A Guide

AUC (appropriate use criteria) are meant to augment—not supersede—clinician expertise and experience or patient preference. The scope of this AUC includes nonpharmacologic and pharmacologic interventions for symptomatic OA of the knee as well as surgical procedures less invasive than total or partial knee replacement.
  • The new appropriate use criteria (AUC) on nonarthroplasty treatment of patients with OA of the knee covers 10 different treatment options and more than 500 patient scenarios.
  • A web-based application (www.aaos.org/aucapp) enables clinicians to submit a patient profile based on specific clinical findings and receive feedback on the appropriateness of various treatment options.
  • Although the AUC addresses the most common clinical scenarios, it does not include all of the possible indications, and is not meant to supersede clinician expertise and experience or patient preference.
The full AUC can be found on the website of the American Academy of Orthopedic Surgeons.  Try it yourself.
Open the AUC.  Enter the patient specific information detailing knee pain, knee range of motion, knee stability, knee xray findings, knee aligment (bow legged or knock kneed), meniscal symptoms and patient age.  Enter submit and treatment options categorized as appropriate, may be appropriate and rarely appropriate will be shown.  These options now provide a basis for an intelligent conversation between the patient and the orthopedic surgeon with respect to non surgical and surgical treatment options.

Viscosupplementation for Knee Arthritis

Dr. Tarlow’s opinion – About half of my patients with mild to moderate osteoarthritis of the knee Visco injections report less pain and better function for 6-12 months following a series 3 weekly injections – brand of Visco does not matter in outcome. Patients with severe OA rarely benefit from type of injection.
OA is the death of the articular cartilage cells that cover the bone.

 Here is a summary of the recent literature review:

Hyaluronic acid has little effect on pain, none on function, new review states

Tuesday, June 12, 2012

If the first series of injections help then it is likely a repeat series will be successful. Not all insurers reimburse for this medication – so many patients pay out of pocket for the drug and come to the office for the doctor to inject the drug into their knee.

Another unknown is how and why this medication decreases pain – the mechanism is not clear at this time.

escribe injections of hyaluronic acid, also called viscosupplementation.
There is no evidence to suggest that viscosupplementation results in any relevant reduction in symptoms in patients with knee osteoarthritis, said study co-author Dr. Peter Juni, professor of clinical epidemiology at the University of Bern in Switzerland.
The U.S. Food and Drug Administration in 1997 approved the injections, which are commercially available from several companies and much more costly than pain relievers.
For the study, Juni’s team reviewed 89 studies that compared injections with either a placebo treatment or no treatment. In all, the studies involved more than 12,000 adults aged 50 to 72.
The effect on pain was minimal, and the injections had no effect on functioning, the researchers found.
In some of the studies, the injections reached peak effectiveness at eight weeks, then declined.
“Viscosupplementation therapy for the knee appears to have some transient improvement in a relatively small number of patients for variable periods of time — most often six to 12 months,”
Look at the pros and cons from a patient’s perspective. Many turn to the injections to avoid surgery or medications, which can have their own harmful side effects, he said.
“Some patients, however — particularly patients with earlier stage arthritis — benefitted from viscosupplementation for periods of time sufficient to continue the use of this therapy,” he said.

Diet + Exercise Effective

Report in JAMA September 25, 2013 (Journal of the American Medical Association) concludes Diet and Exercise is Effective in Improving quality of life (diminishing symptoms of pain, improving function/mobility) compared to exercise alone in overweight and obese patients with Osteoarthritis of the knee. Weight loss was greater in the Diet/Exercise group (11 %) compared to Exercise group (2%).

Details: According to a study published in the Sept. 25 issue of JAMA, diet and exercise may improve quality of life more than exercise alone for overweight and obese adults with knee osteoarthritis (OA). The authors conducted a randomized, single-blind trial of 399 patients who were allocated to one of three groups: diet, exercise, and diet plus exercise. At 18-month follow-up, the authors found that mean weight loss was 11.4 percent for participants in the diet plus exercise cohort, 9.5 percent in the diet group, and 2.0 percent in the exercise group. In addition, knee compressive forces were lower in diet participants compared with exercise participants, and concentrations of IL-6 were lower in diet plus exercise and diet participants compared against exercise participants. Finally, patients in the diet plus exercise group had less pain and better function than those in the diet group or the exercise group, and the diet plus exercise group had better physical health-related quality of life scores than those in the exercise group.

Link to Abstract – https://jama.jamanetwork.com/article.aspx?articleid=1741824.

Dr. T Speaks —– Hello People. There are simple measure that are dramatically effective in helping you treat yourself with medications, injections, or surgery. Make the effort to convert America into a healthier place. This is an easy way to treat a common problem that is effective and will lower health care costs. Take ownership of your own well being.

Physical Activity

Research suggesting that physical activity could help prevent Knee Osteoarthritis has been presented this week at the AVS 62nd International Symposium and Exhibition, in San Jose, CA.

Researchers including Dr. Burris at the University of Delaware found that as the sliding speed increased toward typical walking speeds cartilage thinning was reversed. At slow sliding speeds (less than would occur in a joint at typical walking speeds) cartilage thinning and an increase in friction occurred over time. This may explain why walking or cycling can mitigate knee pain in patients with osteoarthritis of the knee.
A healthy joint surface is composed of 80 % synovial fluid (water and proteins). To investigate whether hydrodynamic pressurization could refill deflated cartilage, the researchers placed larger-than-average cartilage samples against a glass flat to ensure that there would be a wedge. Pressure forced fluid back into the articular cartilage stopping the joint surface from deflating. If movement occurs faster than the fluid can diffuse then continuous knee movement could prevent deflation.
Articular Cartilage is a firm, porous, rubbery material covering the ends of the bones in the knee joint. It reduces friction in the joint and acts as a “shock absorber.” Loss of synovial fluid occurs when articular cartilage is damaged or diseased. Osteoarthritis is a degenerative disease resulting from a reduction in the articular cartilage thickness, leading to an increase in friction, inflammation, pain and deformity of legs.

When cartilage becomes damaged or deteriorates, it limits the knee’s normal movement and can cause significant pain, and eventually the need for knee replacement surgery.

Surface damage to articular cartilage in a knee

Knee Braces

Non Operative Treatment of Knee Pain/Arthritis with BracingAdvanced Knee Care offers a custom bracing service to patients. This service includes a brief physician visit to confirm the diagnosis and need for the brace, a confirmatory x-ray of the knee and a detailed visit with our bracing specialist, Megan. The charge for this screening visit is $50 (insurance will be billed, if applicable).

The concept for this service is that there are many people that can be treated without surgery. A knee brace may be just what is needed to keep one active for years—no surgery required. This treatment is for people with Knee Pain and Knee Arthritis (either in the main joint or in the patellofemoral joint) that do not want a complex or expensive work up by the doctor, have already tried the myriad of other options for knee arthritis (pills, injections, Physical Therapy, Arthroscopic Surgery) and want a streamlined way to purchase a knee brace to help improve their knee function, help them be more active, and help them exercise to stay fit. There are also good bracing applications for runners with knee pain.

Treat Depression

A Korean study published in March, 2011 concludes that depression is linked to knee arthritis symptoms. The authors evaluated 660 patients aged 65 years or older; severity of knee OA was assessed based on radiographs and symptoms and depression was assessed based on interviews and patient questionnaires. The presence of a depressive disorder was associated with increased risk of symptomatic knee OA among patients with a radiographic severity of minimal to moderate OA.

Mental well being and a positive outlook help people cope with and tolerate symptoms of disease. In this study, a person with minimal to moderate Knee Osteoarthritis was more likely to have moderate to severe symptoms, and the reason for the increased dysfunction was thought to be due to poor mental health, not poor physical health.

This is a good lesson for both patients and doctors. Always consider a person’s overall health when formulating treatment plans. In some cases treatment should be directed at the cause of symptoms (treat depression, not knee arthritis) for the best outcome.

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