How Do You Treat Knee Pain? (podcast)

One of the most common causes of knee pain is arthritis. About 60 to 70% of people suffer from arthritis, which causes pain. Often times, simple things such as getting up in the morning can cause you pain and walking can exacerbate it. Probably most folks are struggling with a condition similar to that.

Other major causes include bursitis. You can get pain on the front of the knee from bursitis.

The meniscus can also play a role. The meniscus is a cushion, a shock absorber between the two bones that can tear or wear out as we age as well.

Then there is something as simple as overuse. You used your knee a lot the day before and the knee is now swollen and painful. Sometimes that will resolve on its own.

Any number of things can cause knee pain and sometimes a simple X-ray and examination can help sort out for you what’s going on.

It depends on what condition you’re facing. It may be as simple as some Tylenol and ibuprofen and some ice and rest. Other things to consider is some low-impact exercise. Bicycling and swimming are great. They can lessen the force on the knee and make it less painful. A step up from that can be injections. Cortisone is a hallmark injection we do. And about 95% of people see some relief from that and it can be prolonged for many months. Other types of injections include hyaluronic acid injections, the gel shots people hear about. They can help manage the pain.

Other things like stem cells and PRP haven’t played as large a role in managing knee pain. Although some people have tried them, there is not a lot of data to support the use of these at this time. Instead, we’re usually using cortisone and gel shots and they can help quite a bit.

PRP stands for platelet rich protein. What happens is they take some of your blood and spin it down and then re-inject it into the location of the pain. The idea is that there are some healing factors associated with that. It has had some promising data in several areas of the body and we’re still looking at it in the knee as far as arthritis goes. But it’s certainly a safe modality to do and it’s an option out there to try.

It is pretty short-lived pain. Most of the time, we use some numbing medicine which kicks in in a minute or two. Most injections take about five seconds. It’s done pretty quick. The first day or two you might be a little sore just from a little bit of swelling feeling in the knee. Often times, ice and a little bit of rest can modify that. Once the cortisone or the gel or what other agent you’re using kicks in, often times the pain improves significantly.

A pretty good percentage of people get significant improvement. With cortisone, 90 to 95% of people will see some degree of improvement, and often profound. For gel shots, it’s a little bit more variable, but the benefit is they tend to last quite a bit longer when they do work. It is similar with PRP or stem cells, if you elect to go that route.

For cortisone shots, if we get a three to four month response, that’s pretty good. You can get them up to four times a year. It is similar for gel shots. We’re looking more for a five to six month response, and those are a two-time a year shot. You can use both of them staggered. Between the two of them, often times we’re getting quite a bit of relief for many months.

We need to see a fair amount of arthritis on an X-ray. When you hear the term bone on bone, that typically refers to that cushion between the bones being gone, and we see that on an X-ray. When folks have that and their symptoms get pretty significant, despite us doing these other things we’ve talked about, then it’s time to consider a joint replacement. For these folks, joint replacements can make a significant difference.

A total knee replacement replaces the whole bearing surface in the knee.

For a partial knee replacement, think of the knee in three compartments. A partial knee replacement would replace one of those compartments. If the rest of the knee is in good condition, you could be a candidate for a partial knee replacement. If the knee shows arthritis throughout the whole entirety of the knee or a significant part, then a total knee replacement is what we would be looking at.

We try to get you up and walking the day of surgery. Most folks only stay one night in the hospital or even go home the same day, depending on their health status.

People are weaning walking aids over the course of a week or two. Hopefully, by about three or four weeks, people are pretty independent.

There is some therapy involved, during which the specific length of time really depends on the person and where your starting point is. But folks are starting to walk right away and then we kind of progress from there. We unrestrict you at three months just to allow a lot of healing time, but people are pretty darn functional prior to that.

Ultimately, I’m looking for a quality of life when I’m treating people. Most of the conversation I have is trying to determine what’s important to the patient and what quality of life they’re trying to get back to.

I try to help them make decisions on the least risky treatments that will help them obtain that quality of life first. Then we progressively increase our treatment strategy from there, depending on their needs and their pain relief.

A lot of my conversation will be targeting what’s important to patients. It’s important for me to hear what their lifestyle is and what they’re looking to get back that they’ve lost as part of their pain.

So, if you’re struggling with knee pain, there are a lot of options out there. Our goal is to get people back to an active lifestyle, particularly here in San Diego where people live a very functional, active lifestyle. That’s our goal here at Scripps. We’re certainly here and happy to see you and talk about your options.