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Joint Q&A

by Thomas K. Tkach, MD

Question: Injuries...
It is virtually impossible to eliminate injury in sports activities, but it is possible to reduce the incidence of injuries with proper preparation. First and foremost, is realizing what our aging bodies are capable of and not pushing them beyond that point. Sometimes our ego pushes us to do more than what our body can deliver. Moderation in exercise is very important, but can increase gradually as the body tolerates.
Second, another way injury can be avoided is by proper warm-up and stretching. Preparing the body for exercise/ activity goes a long way in relieving aches and pains and avoiding muscle and tendon damage due to vigorous activity.
Third, using proper equipment for whatever the situation/ activity. This can be protective equipment, proper fitting shoes or even proper soles on the shoes that are required for the task at hand. Most athletic shoes last a year’s time before soles begin to give way. It is important to replace shoes in a timely manner.
Perhaps the most important thing we can do to avoid potential injury is when we begin to feel pain, as with an overuse type of an injury, we should back off the activity causing the pain and rest. Pain is a God-given response to injury letting us know there is a problem. Pain can usually be managed with judicious rest, anti-inflammatory medication and rehabilitation. If these warnings are not heeded, many times further damage, sometimes irreversible damage, can occur.

Question: Manage Joint Injuries & Arthritis...

Arthritis due to joint injuries is managed essentially in a two-tiered fashion. The first level of management is conservative or non-operative measures. If those measures fail, a series of operative options may be required.  Non-operative intervention starts with restriction of activity (at least for a period of time); physical therapy for range of motion and muscle strengthening; and use of anti-inflammatory medication. There are many different types of anti-inflammatory medications (commonly referred to as a Non-Steroidal Anti-Inflammatory Drug/NSAID). For tendinitis and mild arthritis, a rub-on type of a NSAID is useful and can be used in conjunction with oral anti-inflammatory medications.
Braces can also be used to control some of the discomfort of arthritis. They range from simple neoprene knee sleeves and patella stabilization braces to expensive ‘hinged’ knee braces that actually unload the pressure on one side of the joint or the other. Assistive devices such as canes and crutches can also be used, but most young people are unwilling to use them.
Mild pain medicine can also be used as long as it is used judiciously and not on a chronic basis. Most often, non-narcotic pain medicine such as Tramadol is the best choice. It relieves pain on a temporary basis. Another conservative option is an injection into the joint. There are 2 types of injections. One is a steroid injection which is very effective at calming down the inflammatory response inside a joint. This is temporary and can last anywhere from a few days to a few months or longer. The second type of injection is called hyaluronic acid. This injection allows for greater lubrication of the joint and can relieve plain for a period of time. Statistically, approximately 70% of people with these injections receive some degree of relief for somewhere between 6 months to a year. If conservative measures fail, surgical options become a major consideration..
Arthroscopy is frequently used in patients who are having mechanical symptoms in the joint such as popping, catching, locking and swelling. This procedure can sometimes temporarily or even sometimes permanently relieve the problem in the joint. However, if there is a high degree of articular surface damage, arthroscopy is not as effective.
Many young patients will have isolated single compartment arthritis in the knee and in those patients frequently a partial knee replacement may be in order. Hemiarthroplasty is a procedure that resurfaces only one side of the joint, leaving the other two compartments intact. This is a much more conservative bone-saving operation than knee replacement and is frequently used in younger patients with significant arthritic changes trying to preserve as much bone tissue as possible, expecting the need for complete knee replacement maybe 15 years down the road.
The final option, surgically, if the damage is extensive enough, is complete knee replacement, which is where all three compartments of the knee are resurfaced and coated with a metal liner that articulates on a plastic disc. This procedure is extremely effective in relieving chronic arthritis pain of the knee joint.

Question: When is it time for a knee replacement?

The need for knee replacement will be different for every patient. It basically depends on the amount of pain that a patient is experiencing on a daily basis. Some patients can handle more than others and some conservative measures are more effective than others but a good rule of thumb is that when the knee pain is not affected by conservative measures and is severe enough on a daily basis that it only allows a person to walk short distances such as a block or 2 at a time and that if affects activities of daily living such as working and shopping and the pain is unrelenting enough that is disturbs a person’s sleep at night.