At times, the negative aspects and alternative treatment options to the surgical techniques considered bear the potential for the marketing of a technique to be misinterpreted by medical professionals as an attack on their sphere of expertise. It is hoped that this is not the case and that there is full knowledge of the various knee pain treatments and their relative benefits and risks, for the patients’ welfare is dependent on the decisions made at this time. On completion of this project, it seems that no one has the perfect solution and the choice lies in the value of benefit and risk that an individual places on their knee.
This e-book was simply a sincere investigation to find the truth about options for knee pain sufferers, for we are frustrated that these truths are poorly explained at best at the most crucial decision-making times. While investigating these treatments, it seemed that the information available to patients is poorly skewed to the positive in an unbalanced manner, with insufficient explanation of the negatives.
This e-book is written for anyone who has been told that their knee is worn out because of a medical condition, such as bone-on-bone or having very little of the cushioning meniscus left, and is looking for ways to help their condition. It looks at the available treatments in Singapore, considering in detail the two major surgical options and asking the important questions about the other alternatives that are also available. This is a review of some of the useful tools, such as Total Knee Replacement (TKR), High Tibial Osteotomy (HTO), viscosupplementation, and autologous chondrocyte implantation, for someone with knee pain from a medical condition. A similar article also exists on Medscape for a more general knee pain. The text also aims to weigh the probability of success and the potential risk of complications. With this information, he/she will be able to make a well-informed decision on the best possible treatment. Everything has been written with the advice from a knee specialist in Singapore.
Non-Surgical Treatment Options
Medications The RICE therapy for patello-femoral pain syndrome can be assisted with simple analgesics for pain relief, such as paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen. Although this is recommended, caution should be taken if the symptoms are chronic or patients are in the older population suffering from degenerative ailments to avoid aggravating conditions to the gastrointestinal or renal systems. There has not been specific medication recommended for the treatment of PFPS, due largely to the fact that it is a movement dysfunction syndrome. The cause and effects that take place are similar to other more traumatically induced knee conditions. A specific group of patients to note is the adolescent with PFPS; it is widely believed that this age group will grow out of their PFPS with bodily growth and physical development correcting any muscle imbalances and alignment problems. For these patients, it is perhaps best to treat conservatively with little more than medication and limiting aggravating activities.
Physical therapy exemplifies a key part of the non-surgical approach to treatment for patello-femoral pain syndrome. The specific aims are to improve flexibility and strength. This is carried out on a one-to-one basis with the physiotherapist to aid improvements in range of movement in the knee and stretch the tight muscles located laterally (on the outside) of the hip and thigh. This should then be followed by a steady progression to strengthening the vastus medialis oblique (VMO) muscle to correct any imbalance in strength with the lateral muscles of the thigh, which is often the causative factor in PFPS. Exercise therapy for PFPS patients must be VMO specific, pain-free, and with correct patella alignment in order to be effective. It can be achieved with various forms of exercises, but research has shown positive results for isometric exercises while progressing to a functional-based regime. Other exercise therapy techniques can be effective if they enhance quadriceps strength and change patella alignment to reduce friction between the underside of the patella and the femur. This is achieved through bracing/taping techniques and functional electrical muscle stimulation (FEMS), adhering to the same pain-free and patella alignment principles for it to be effective. If the pain sufferers are strongly committed to exercise therapy, it has shown to alleviate symptoms of PFPS in 80% of patients within 6 weeks. Although exercise therapy is effective, PFPS is often a chronic ailment and it is often necessary for continued therapy throughout life with regular exercise sessions to prevent recurrence of symptoms. With this in mind, a well-structured and easy-to-follow, functional-based regime is desirable for the patient to learn and carry on their own in their time out with the clinic. A final consideration for exercise therapy is hands-on physiotherapy management. This may include massage, joint mobilization, patellofemoral mobilization, and use of therapeutic modalities. This may help to reduce symptoms in the short term to allow effective exercise therapy, but research has mixed views on its long-term efficacy and is very much dependent on the skill of the therapist.
Physical Therapy
Physical therapy is an option for non-surgical treatment of knee pain. The primary goal of exercise as a knee pain treatment is to restore function. These exercises increase strength, endurance, and stability of the knee. It is imperative that patients carry out their exercise program under the supervision of a health professional, as incorrect exercise can do more harm than good. Range of motion exercises will help prevent contractures of the surrounding tendons and muscles. Finally, functional exercises attempt to simulate various common activities in an effort to retrain the knee to execute these tasks. This step has the highest rate of treatment success for those with patellar subluxation. This structured program has four main facets: The treatment of tendon and ligament injuries differs vastly. For a sprain or tear, a relatively short period of immobilization will occur, followed by a range of motion and strengthening exercises. Physiotherapy is an important adjunct to the treatment of knee osteoarthritis. Studies have shown that it can provide short-term improvements in function and relief of pain, with long-term relief of symptoms. The main benefits occur with manual therapy and a progressive exercise program. The exercise regime should focus on strengthening the quadriceps, as this will alleviate load on the joint and improve the patient’s function.
Medications
It may be helpful to think about the use of medications as part of a broader treatment plan involving various interventions to relieve pain and improve the structural abnormality underlying knee arthritis. Changes in lifestyle and levels of activity are especially relevant to the pain and disability of knee arthritis and form a logical starting point for the use of medication. Essentially, weight loss and exercise may be curative treatments for an obese individual with knee osteoarthritis. Exercise and targeted muscle training have been shown to have specific beneficial effects on knee arthritis with improvement in pain and function. This is relevant to medication in that exercise is an intervention with a delayed onset of action for which patients must be encouraged to persist with. In such cases, medications may be used to effectively relieve pain, allowing the patient to increase activity levels in attempts to achieve longer-term improvements.
Medications are prescribed to relieve pain and to treat underlying diseases. The pain of arthritis, especially that affecting the knee, can be divided into two types: acute and chronic. Prescription drugs range from simple analgesics (painkillers) to preparations containing anti-inflammatory drugs, to more powerful analgesics such as opiates. Medications are often taken regularly for a trial period to assess their effectiveness. Non-steroidal anti-inflammatory drugs (NSAIDs) are often used for inflammatory types of arthritis. Paracetamol has an analgesic effect with little anti-inflammatory activity and is often recommended for the pain of osteoarthritis. The use of opiate-based analgesics is generally reserved for chronic severe pain. Any medication, especially if taken regularly, should be reviewed periodically to assess the effectiveness against the presence of side effects.
Injections
Corticosteroid (Cortisone) Injection: Corticosteroid injection is given to reduce pain and inflammation. The magnitude of relief is variable, lasting for a few weeks to several months. Cortisone is a powerful medication, and in the short term, it can provide significant relief. However, it does have potential long-term adverse effects, and it is usually limited to a maximum of three injections in one year. Cortisone itself breaks down tissue, and it is for this reason patients are often advised to rest the injected joint for 24-48 hours after injection and also to avoid weight-bearing activities. Cortisone injections are particularly useful as a temporary measure in the lead up to keyhole surgery. This is because they can give swift relief, allowing you to increase the strength and movement of your knee in the pre-operative phase. This can lead to a better post-operative result.
Injections Overview: Your knee pain doctor Singapore may suggest an injection for your knee. There are different types of injections, and each type helps to relieve pain and inflammation. The duration of the relief varies by individual and the type of injection. This page will provide you with general information about some, but not all, of the injections commonly offered for knee pain.
Surgical Treatment Options
Losing weight and engaging in exercises has a demonstrated ability to slow the progression of arthritis. It would be beneficial if a patient was assigned an exercise regime that would improve symptoms of the knee while also not causing any further damage. However, this may be difficult due to the intense pain caused by certain exercises. The use of an assistive device, such as a cane, can decrease the load on the affected leg. These steps are often and should be regularly considered because of the large difference in costs compared to surgical treatments. A change in job fitness will likely help symptoms of knee arthritis, but this option may be unfavorable to many.
Before considering surgical alternatives, it is worth trying to deal with knee problems using non-surgical options. Data needs to be gathered to give a correct diagnosis and identify the cause of the problem. Any inflammation in the joint, such as gout, should be treated first. Options include an intra-articular injection of corticosteroid or a hyaluronic acid derivative (viscosupplementation). The temporary relief of the anaesthetic may enable progression of the patient’s exercises. This may strengthen the quadriceps muscles, which may reduce symptoms of arthritis in the inner section of the knee.
Arthroscopy
Arthroscopy is a keyhole surgical procedure. The knee is distended with fluid and a small incision is made through which the arthroscope is inserted. It is attached to a camera and the surgeon is able to see inside the knee joint without the need for a large incision. This allows assessment of the articular cartilage and meniscal tissue as well as identifying any loose bodies. At the same time, there are usually one or two other small incisions made and long instruments are inserted to repair any damage found in the articular cartilage. This is usually only a day procedure and is performed under a general anesthetic. Once the procedure is complete, the fluid is drained and the small incisions are closed with adhesive strips. Arthroscopy is particularly useful in the earlier stages of arthritis where damage to the articular cartilage can often be successfully repaired.
Partial Knee Replacement
If the damage of arthritis is limited to just one compartment of the knee, your doctor may recommend a unicompartmental knee replacement. This is often a suitable option for younger patients, as the wear and tear in the other compartments which have good articular surface can still be treated with a total knee replacement if this becomes necessary in later years. Patient selection for this procedure is very strict, as the result is very dependent on achieving the correct diagnosis and also identifying the correct patient. In cases where there is damage in two compartments of the knee, but the rest of the knee is in good condition, a bicompartmental knee replacement may be considered. This is a newer procedure and hence there is not such a long-term data compared to the previously mentioned procedures. However, results appear promising, and it is an alternative to a TKR where less bone is removed. The types of knee replacements mentioned are not mutually exclusive, and you may even be given a choice of procedures, depending on your case, symptoms, and expectations. All knee replacements provide pain relief, and the decision-making process should involve discussion on the risk:benefit ratio in terms of pain relief versus functional improvement, balancing the invasiveness of the procedure to the patient’s expectations, and also taking into account the long-term results of the proposed procedure.
Total Knee Replacement
The decision to undergo total knee replacement is a big one. One of the most important factors is the degree of pain and disability caused by knee arthritis. When the pain is disabling and affects your quality of life despite treatment with medication and changes in daily activities, total knee replacement should be considered. This is a viable option for you if you no longer derive pain relief from anti-inflammatory drugs, can’t tolerate the side effects of the medication, the pain prevents you from sleeping through the night, or affects the performance of normal recreational or work activities. It is important that you understand what life will be like after the total knee replacement. Most patients with painful arthritis are able to do many things that were challenging before surgery. Some patients can walk without pain, participate in low-impact sports like swimming, or play golf. The surgery has limitations; not everyone has a successful outcome in terms of pain relief and function improvement. This is especially true for people with other serious health problems. The expectations have to be realistic. Total knee replacement won’t allow you to do more than you could before you developed arthritis. It is important to discuss these markers with the doctor to assess whether total knee replacement is right for you or not.
Choosing the Right Treatment Option
The decision to proceed with joint replacement surgery is one that should not be taken lightly and is usually the final option when deciding on the best form of treatment. Advances in surgical techniques and implant design mean that joint replacements are not only reserved for the elderly. With increased life expectancy, there are higher demands for older people to remain active and healthy, so joint replacement surgery can become an increasingly more attractive option. The decision to proceed should be made when the pain and disability of the arthritis have resulted in reduced quality of life, and the risks of surgery are outweighed by potential benefits. There are risks of joint replacement surgery that need to be taken into account, which include infection, blood clot, pulmonary embolism, nerve palsy, prosthesis failure, and medical complications. These risks are higher for older people with medical conditions, so consideration can be made to have surgery earlier to avoid severe disability from arthritis affecting medical risks. High tibial osteotomy and joint fusion are joint-preserving surgery options that are available for certain types of arthritis. Osteotomy is a method of realigning the maligned axis of a leg to transfer load from damaged cartilage to a healthier area of the joint. Joint fusion is usually reserved for end-stage arthritis in one joint, where the joint surfaces are removed, and the ends of the bone are fused, thereby stopping the bone ends rubbing together and causing pain.
As the science of arthritis advances, there are increasingly more pharmacological therapy options available. Simple painkillers are often used by knee pain doctors to control pain and are often effective for osteoarthritis. Topical non-steroidal anti-inflammatory drugs have less systemic absorption and may be equally effective to oral agents, with fewer side effects. Largely, those are intended to modify the disease, making the inflammation process less aggressive, slowing the destruction of the cartilage, and attempting to repair damaged cartilage. This can be achieved with anti-inflammatory drugs or, for those with inflammatory osteoarthritis, disease-modifying anti-rheumatic drugs. The use of corticosteroids to control a flare of the arthritis in a particular joint can be very effective, and joint replacement surgery can be avoided if arthritis is controlled well.
In the initial stages of arthritis, treatment usually involves a combination of non-pharmacological therapies to help control pain and improve joint function. Weight loss and exercise can be an effective way to reduce pain in the knees, as it can lessen the pressure on them, leading to less pain and increased function. Exercise can also strengthen the muscles around the joint, resulting in less pain and a more stable joint. Exercise programs may need to be tailored to the individual to ensure the right amount and intensity is being done, as doing the wrong type of exercise can exacerbate the condition. Other non-pharmacological options include physiotherapy, walking aids, knee braces, and shoe insoles.
If you do find out that you are suffering from advanced knee arthritis, it is advisable to see a knee pain doctor to discuss the best form of treatment. The net worsening effect of arthritis can be slowed considerably with appropriate treatment. Though there is no cure for arthritis, there are many treatment options available to manage pain and maintain a good quality of life.
