Tag Archive for: knee replacement

Holding Knee with Arthritis

Torn Meniscus? Is Surgery Worth it?

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It’s estimated that approximately 750,000 arthroscopic knee surgeries are performed every year – the majority of them being due to a torn meniscus.

But at a cost of about $4 billion per year – is this surgery even worth it?

Let’s investigate…

Arthroscopic knee surgery is a minimally invasive procedure that’s commonly done to help “clean out” your knee joint if you’ve got degenerative arthritis, or to clip out pieces of a torn meniscus that might be irritating your knee. The biggest set of pro’s for this procedure is that it’s quick, recovery is fairly minimal, and you will typically experience an immediate relief of pain.

Sounds worth it – right?

Not so fast. There are many cons to this procedure as well, many of which are not realized until it’s too late. So it’s worth a second opinion and considering all of your options before you jump in.

First, as with any surgical procedure, even if it’s minimally invasive, there are risks. Complications include nerve damage, excessive bleeding, infection, reactions to anesthesia, persistent stiffness and swelling, or blood clots. While these risks tend to be rare, they don’t outweigh the other long-term considerations you should be aware of.

Looking to avoid a knee replacement in your future?

Then you’ll definitely want to think twice about getting arthroscopic meniscus surgery. Research tells us that people who undergo arthroscopic knee surgery are likely to have knee arthritis that advances more rapidly – resulting in a total knee replacement that quite possibly could have been avoided. This is because you’re removing vital cushioning and shock absorbing mechanisms (the meniscus) from your knee joint. Plus, a meta-analysis published in Oct 2020 in the Knee Surgery, Sports, Traumatology, Arthroscopy journal revealed a 36% failure rate by year two – and a 13% failure rate by year five for meniscus repairs – resulting in more surgery and eventual knee replacement.

And then there’s the elephant in the room…

It’s more common than you think for knee pain to be coming from somewhere other than your knee, even when your MRI shows a meniscus tear. Knee pain can be caused by problems in your ankle, hip, or back. One study showed that 40% of the time – knee pain comes from a source in your spine – even when you don’t have any back pain. MRI’s add even more confusion to this because degenerative changes, which are normal as we age and very commonly lead to a torn meniscus, make surgeons think your meniscus is the cause of your knee pain when it might not be. The only way to truly determine the cause of your knee pain (in the absence of trauma) is through a proper mechanical exam that involves repeated movement testing to reveal the actual pain generator. 

The truth is – 70-80% of all knee problems can be resolved naturally and without surgery.

An early research study from 2002 by JB Mosely and colleagues, and published in the New England Journal of Medicine, revealed that placebo surgery for advanced knee arthritis was just as effective as actual arthroscopic surgery. Since then, numerous studies have proven similar results. This means that even if you have a torn meniscus or degenerative arthritis in your knee – you can still get better naturally and with conservative treatment. 

So why then – despite all this research – are surgeons still performing arthroscopic knee surgery to repair a torn meniscus?

In some cases it’s just what the surgeon knows, and they haven’t kept up with the research. Other times, it’s due to poor conservative management of knee pain. If you’ve gotten physical therapy and it wasn’t effective, people are led to believe that the physical therapy “didn’t work”. But more often than not, you didn’t get physical therapy from a specialist – someone who understands how to diagnose knee pain properly and get you the customized approach that is required to avoid surgery. 

If you’re young and involved in high-level sports, meniscus surgery is likely worth it for you.

But for most people, especially those over the age of 40, there’s a 70-80% chance you can get full relief of your knee pain, and full restoration of knee function without any type of surgery or procedure. This is not a popular opinion by the way, so be careful who you speak to for a second opinion. But for me, both the research as well as my 22 years of clinical experience tell me that most people (especially those over age 40) can resolve their knee pain naturally and with better long-term results if they avoid arthroscopic knee surgery – even when there’s a meniscus tear.

knee replacement surgery

Three Things to Consider before Knee Replacement Surgery

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Total knee replacement (TKR) surgery has been around for decades, and generally speaking, results are very good. 90% of folks can expect up to a 20 year success rate. The most common reason for a knee replacement is to resolve advanced arthritis.

But what if advanced arthritis isn’t the true cause of your knee problem? Do you really need a knee replacement?

Only 15% of patients with evidence of knee osteoarthritis (OA) actually have symptoms. That means the other 85% don’t have any pain at all. These results are consistent for other joints as well. Signs of degenerating joints, bone spurs, and even meniscus tears all occur normally as you age. While some of the time these things can be the cause of your knee pain – more often than not it’s something else – or a combination of things – that are fully responsible for your joint pain or dysfunction. Evidence of knee OA shouldn’t be the only factor determining your decision of major knee surgery.

Here are three important things to consider before deciding if a total knee replacement is right for you:

 

1. How severe is your knee pain?

This is one of the most important factors to consider before undergoing major knee surgery. The X-ray might say you’ve got “bone on bone” arthritis and terrible OA – but if your knee pain is fairly tolerable – and you can still do most activities you love – why take the risk of major surgery when you could wait? Even though knee replacement surgeries are quite common and successful – there are still risks and complications.

The most common risk is infection. But you could also end up with blood clots, problems with anesthesia, or an ill-fitting prosthesis that doesn’t function right. Not only that, but people tend to underestimate the 6-12 month recovery that comes afterwards. If your knee pain is severe and intolerable, and you’ve already tried physical therapy, then you’re probably a good candidate for knee replacement, and the potential risks are likely worth the reward for you. But if your pain isn’t that bad yet, it might be a good idea to wait, and get a second opinion. There could be other reasons for your knee pain beyond arthritis. If those factors get addressed, you might find you don’t need surgery at all.

2.  Does your back hurt?

In a recent study by Rosedale, et. al (published in the Journal of Manual and Manipulative Therapy), it was found that over 40% of patients with isolated extremity pain, who did not believe their pain could be originating from their spine, responded to spinal intervention.  What does that mean in plain English? It means that you can have knee pain coming from your lower back and not even know it. Severe knee OA doesn’t come out of nowhere. It gradually progresses over time. But when you have knee pain that comes on for no reason, has good days and bad days, and especially if you have knee pain and back pain at the same time – you must get your spine evaluated before undergoing any type of intervention for your knee.

Luckily most surgeons consider knee replacement as a last resort. But if your spine is causing your knee pain and you miss it – you’ll end up down the path of failed knee treatment after failed knee treatment. Then suddenly it will seem as if you’re at your last resort, especially if you’re over 50 and have (normal) evidence of knee OA on your X-ray.  Always get your spine checked by a mechanical pain expert when your knee hurts. It will help you avoid years of mis-guided knee treatment, and could save you from an unnecessary knee replacement.

3. How stiff is your knee?

Typically, with severe or advanced OA of the knee, you’re going to have pretty restricted mobility. And any efforts to improve that mobility will be minimally effective and likely make your knee worse. But if your knee is not consistently stiff, only seems to get tight in certain situations, or perhaps it feels better after you stretch and mobilize it – you may want to think twice before getting it replaced. That’s because sometimes mobility restrictions in your knee can be caused by something other than arthritis – like a small tear in your tissue that gets “caught” in your joint. If you know how to move your knee joint in just the right way – you can actually remove this restriction. Not only will your knee move normally again, but your pain will go away too. This is really hard to figure out on your own. It even gets missed by a lot of medical professionals if they aren’t expertly trained in diagnosing mechanical pain. And it definitely doesn’t get picked up by an X-ray or MRI.

If your knee is not terribly stiff 100% of the time, and you’re tolerating most of your favorite activities – the best thing to do is get a second opinion from a trained mechanical pain expert. Because what you might be missing is highly specialized and specific mobility treatment for your knee. Once your knee mobility is fully and properly restored, you might find you no longer need a knee replacement, or at the very least can put it off another 10 years.

To be clear, I’m not saying you shouldn’t get a knee replacement.

I’m saying there’s a chance you don’t need one and it’s important to explore that. I’ve seen so many cases over the course of my career where people didn’t need a knee replacement – but got one because the X-ray or MRI “said so” – and then continued to suffer for years afterwards.

Are you looking for help with knee pain now?

Sign up for a discovery visit with one of my specialists to see if we would be a good fit to help you! CLICK HERE to request a Free Discovery with one of my specialists.

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. 

knee pain source

Three Causes of Knee Pain and What to Do

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Knee pain has been the hot topic around our office this week!

With the nicer weather we’ve been having – more people are outside – and their knees are “talking” to them.

Knee pain is the second most common complaint of musculoskeletal pain (back pain is number one) and it impacts one-third of all Americans at one time or another.

Most of our clients are in their 50’s and 60’s and love to ski, run, hike and bike. They worry that knee pain could bring an end to their active lifestyles.

The good news is that eighty percent of ALL knee problems can be resolved without procedures or surgery – but it starts with accurately identifying the root cause.

Here are three of the most common causes of knee pain and what you can do to resolve it.

1. Patellofemoral Knee syndrome

Also known as “runner’s knee”, patellofemoral knee syndrome (PFS) is characterized by pain in the front of your knee – usually just below or behind your knee cap. With PFS, the source of the problem typically has to do with unwanted pressure in the front of your knee… that eventually results in pain.

It’s very tempting to just get a cortisone shot – or take pain pills – to reduce the inflammation caused by this wear and tear. But then you’re only addressing the symptoms…

If you truly want to put an end to PFS, you’ll need to find the cause of this problem.

Typically, it’s poor form and movement habits that are the result of an imbalance somewhere between your hips, quads (front of the thigh), and hamstrings (back of the thigh). When you figure that out, you’ll restore healthy, balanced movement in your knee again – and reduce the aggravation at your knee cap.

2. Iliotibial band syndrome

This is a very common problem that is similar to PFS except that you’ll experience pain on the side of your knee instead of the front. Your iliotibial band (ITB) is a large, thick band of tissue that runs along the side of your thigh to the bottom of your knee. Your ITB is formed from a muscle in your hip called tensor fascia latae (TFL).

When your TFL gets overworked – your ITB suffers – and will result in what often feels like stabbing pain at the side of your knee.

The most common treatment I see for this is foam rolling and massage – and while these are great modalities to relieve your symptoms – they do NOT address the root problem.

You must figure out why your TFL is being stressed and overworked if you really want to get rid of your pain. Typically, it’s due to weak glute muscles, the deep ones designed to stabilize your pelvis. Your TFL is neighbor to your glutes so when they decide to be lazy – your TFL loves to help out – and eventually overdoes it.

When you can get these two groups of muscles working properly together – you’ll put an end to ITB syndrome 🙂

3. Osteoarthritis

Many people find out they have osteoarthritis in their knees and think there’s nothing that can be done. They either have to “live with it” or get surgery to replace their knees.

Not true!

First of all… arthritis is normal and it happens to everyone as they age. What is NOT normal is for you to think you’re helpless because of it.

Arthritis occurs when the protective cartilage that cushions the ends of your bones wears down over time. While there isn’t anything you can do to reverse this process – there is plenty you can do to minimize the symptoms you get because of this condition.

It all comes down to balanced joints and movement.

The more mobility you have – and the more stability you have around your knees – the less symptomatic your arthritis will be.

Some key areas to focus on when you’ve got arthritis in your knees is good core strength, and good flexibility in your hips and ankles. If anything is off in these areas – your knees will want to compensate – which could result in aggravation of arthritic symptoms.

“Motion is lotion” is not just a saying – it works! Especially when it comes to arthritis.

If you’re currently suffering from knee pain, remember that there is a very good chance you fall into the eighty percent of people who can successfully get rid of it completely on their own.

There is no need to rely on pain pills – or think that procedures and surgery are your only options!

If you’re looking for help here in Portsmouth, New Hampshire CLICK HERE to Request a Free Discovery Session. One of our specialist will reach out to you, ask you about everything that’s been going on, and determine if we’re the best people to help you!

Dr. Carrie Jose, Physical Therapist and Pilates expert, owns CJ Physical Therapy & Pilates in Portsmouth and writes for Seacoast Media Group. To request a free copy of her Knee Pain Report CLICK HERE  or to get in touch, email her at [email protected].

Opioid Addiction in Adults over 40: a Public Health Emergency

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The COVID-19 pandemic has been top of mind for months. We’ve all experienced some major curveballs this year, and most people have learned a lot about public health and epidemiology along the way. But why now? Why are we finally learning how viruses attack the respiratory system, what it means to be immunocompromised, and the best practices for disinfecting? Maybe it’s because of the unpredictability and common threat associated with this virus. Although some demographics have an increased risk of serious outcomes, anyone can get this novel coronavirus and anyone can become ill. 

Unfortunately, Covid isn’t the only public health crisis facing Americans in 2020.

The opioid epidemic has been in the news for years, but many of us don’t bother to take precautions or educate ourselves because we don’t think opioid addiction can happen to us.   

That couldn’t be further from the truth!

Anyone can become addicted to opioids. Many of the Americans battling addiction right now don’t have a history of drug abuse. Instead, what they have in common is something relatively routine. They deal with chronic pain or they had a surgery, and a physician prescribed them opioids.

According to the US Department of Health and Human Services, “opioid overdoses accounted for more than 42,000 deaths in 2016” and “an estimated 40% of opioid overdose deaths involved a prescription opioid.” Between 2010 and 2016, opiate prescriptions from surgeons rose by over 18 percent (UCI Health). And according to the National Institute on Drug Abuse, approximately 21 to 29 percent of patients who are prescribed opioids by physicians end up misusing them. Eight to 12 percent become addicted (NIDA). And the reality of opioid addiction is sobering. In 2017 alone, over 47,000 people in the United States overdosed on opioids and died. 

In 2017, the opioid epidemic was declared a public health emergency.

A public health emergency is just that — public! The emergent status of this crisis is not limited to one demographic or “type” of person. Although media attention through TV and movies tends to focus on heroin and young people getting high, data from the Substance Abuse and Mental Health Services Administration tells us that 63.4% of the adults who misused prescription opioids in 2015 did so to relieve legitimate physical pain. Chances are, we’ve all felt pain at one time or another that ibuprofen or tylenol alone couldn’t get rid of. Everyone is at risk for opioid addiction because anyone could get in a car accident, or require surgery, or develop arthritis. 

Pain-relieving drugs like Oxycodone, Oxycontin, Vicodin, Percocet, and others can be extremely helpful in some circumstances. But unfortunately, they are often overprescribed thanks to aggressive incentivising and pressure from drug manufacturers. The fact that opioids are so often prescribed after surgery and for patients with chronic pain means that middle aged and older adults are at a higher risk for drug addiction than ever before. In 2016, 14.4 million adults on Medicare (age  65+) had at least one opioid prescription (Consumer Voice). Older adults are also more sensitive to the physical effects of opioids. Side effects such as respiratory depression and cognitive impairment increase in severity as the patient’s age increases, often leading to hospitalizations and even deaths. 

So many clients in our practice fall into this at-risk demographic.

We have countless clients coming to us with severe chronic pain. Some have already had surgeries or been told that surgery is their only route to a pain-free life. Many have considered opioids to treat their back pain. And we are so grateful that we’ve been able to help hundreds of individuals recover from their injuries AND chronic pain without resorting to drugs, surgery, or both!

We promote both physical therapy and Pilates as alternatives to surgery and for preventing painful musculoskeletal problems because they truly work.

We recognize that most knee, back, and other injuries occur because the surrounding muscles are too weak to support those joints and systems properly — and we have the expertise to retrain your body in correct movement. You may think that your regular exercise and stretching is enough, but oftentimes working specific muscle groups leaves others underdeveloped and your body unbalanced as a whole. Our team of specialists is trained to create individualized solutions for your particular needs, because we believe that movement is medicine — when it’s prescribed properly! The idea of a quick fix is tempting — but a quick fix can easily turn into long term opioid addiction, illness, and even death. Taking the time to teach your body how to heal itself is so much more rewarding in the long run.

Want to learn more about how we can work with you to determine the safest, strongest, most effective route to recovery? Just click here to sign up for a FREE Discovery Session with one of our specialists.

 

This article was authored by Katya Engalichev. Katya is a pharmacy technician, EMT, and graduate student who writes for CJ Physical Therapy & Pilates.