TREATMENT OPTIONS FOR SEVERE KNEE PAIN Michael O. Williams, MD FAAOS Edmond Orthopedic Group 1 How the knee works Anatomy of the knee Largest joint in body Referred to as a hinge joint because it allows the knee to flex & extend; while hinges can only bend and straighten, the knee has the ability to rotate (turn) & translate (glide)
3 bones Tibia Femur Patella Common Causes of Knee Pain? Its estimated 70 million people in the U.S. have some form of arthritis.1 Osteoarthritis is one of the most common types. Osteoarthritis Wear and tear that deteriorates the cushion in the joints Traumatic injury to joint surface i.e. fracture or internal derangement such as meniscus tear that leads to loss of joint space
Rheumatoid Arthritis An autoimmune disease that attacks the lining 1. Landers, S. Another reason to exercise for those with arthritis. American Medical Association website. of joints, causing swelling, possibly throbbing pain , 2005. and deformity What causes arthritis pain?
Healthy knee The end of each bone in the joint is covered with cartilage, acting as a cushion so the joint functions without pain Diseased knee (osteoarthritis) Wear and tear deteriorates natural cushion, leading to bone-on-bone contact, soreness and swelling Assessing Knee Joint Pain Does the knee hurt one or more days per week? Does the pain interfere with sleep?
Is it painful for to walk more than a block? Are pain medications no longer working? Is knee pain limiting participation in activities (e.g. family vacations or other functions)? Has inactivity from knee pain caused weight gain? Assessing Knee Pain
Rate the pain on a scale of 1 to 5 For most people, the tipping point is about 4 or 5 thats when the pain becomes too difficult and they turn to a surgeon for relief1 Little or no pain 1. 2007 DePuy Orthopaedics, Inc. Knee Attitudes & Usage Study. Excruciating, debilitating pain Assessing Knee Pain Check patients mobility
If performing any of the movements below, it may be time to consider some type of medical intervention Walk Bend at the hips and knees Pretend to drive: push the gas/brake Pretend to golf: swing a club How can the pain be treated? Water therapy
Soaking, ice packs, hot packs Exercise & physical therapy Also good for weight loss Medications Analgesics (non-steroidal antiinflammatories) Corticosteroids (short term) Injections Corticosteroids or hyaluronic acid preparations (e.g., ORTHOVISC, HYALGAN, EUFLEXXA, SYNVISC, SUPARTZ)
Total Knee Replacement Implants replace damaged surfaces Helps relieve pain and restore mobility Approximately 580,000 knee replacements are performed each year in the U.S.1
One study has shown that ten years after surgery, 99.6% of patients still depend on their SIGMA Knees with fixed bearing option in their daily lives2 1. American Association of Orthopaedic Surgeons. Total Knee Replacement Your Orthopaedic Connection. http://orthoinfo.aaos.org/topic.cfm?topic=a00389 Accessed April, 2011. 2. Dalury et al. Midterm results with the P.F.C. SIGMA Total Knee Arthroplasty System. The Journal of Arthroplasty Vol.23, No.2, 2008: 175-181. What is knee replacement? A surgical procedure that removes and replaces diseased joint surfaces with implants Femoral component
Tibial component How does TKA work? Diseased areas at top of shin bone (tibia) and bottom of thigh bone (femur) are removed and reshaped Femoral component covers the thigh bone (femur) Tibial component covers the
shin bone (tibia) Polyethylene insert placed between femoral and tibial components Patellar component replaces the kneecap (patella) Femoral component Polyethylene insert Patellar
component Tibial component How does TKA work? Healthy knee Knee replacement Total Knee Arthroplasty TKA come in a wide range of shapes, sizes and materials and can be individualized to the patient
Most TKA systems come in enough sizes to essentially custom fit the implants to the individual knee TKAs are available in both fixed bearing designs and mobile bearing designs Fixed Bearing Knees Most widely used type of knee replacement in the U.S. today1 Designed to enhance stability of the joint
New designs and advanced materials - Helps reduce wear 1. IMS Health Fixed Bearing Knees Rotating Platform Knees Designed to rotate as it bends, imitating your natural knee movement The surfaces of the knee joint roll and glide against each other as you bend. In other words, your knee naturally rotates as it bends Designed for patients who want to
remain active since it minimizes implant wear, compared to traditional knee replacements1 One study has shown after 20 years, 97% of patients still depend on their rotating platform knees in their daily lives2 1. McNulty, D. et al. In Vitro Wear Rates of Fixed-bearing and Rotating Platform Knees (Rev. 2). 2003. 2. Buechel F., et al. Twenty Year Evaluation of Meniscal Bearing and Rotating Platform Knee Replacements. Clinical Orthopaedics and Related Research July 2001: 41-50. When should TKA be done? Assess pain and ability to function Is the knee pain severe? (4-5 of 5) Has the pain and loss of function affected quality of life? Is it difficult to sleep or perform basic functions (walking, driving, climbing stairs)? Does medication no longer provide relief?
Consult your physician Early diagnosis and treatment are important 1 Delaying may lower your quality of life2 Osteoarthritis is degenerativeit wont get better and may get worse 1. Fortin PR, et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism. 1999;42:1722-1728. 2. Fortin PR, et al. Timing of Total Joint Replacement Affects Clinical Outcomes Among Patients With Osteoarthritis of the Hip or Knee. Arthritis & Rheumatism. 2002;46:3327-3330. Summary The leading cause of knee pain is osteoarthritis Osteoarthritis is degenerative it wont get better and may get worse
Early diagnosis and treatment for total knee replacement are important1 An Arthritis Foundation study shows total knee replacement has a 90-95% rate of patient satisfaction2 The newer total knees come in a wide range of shapes, sizes and materials, and have improved longevity over past designs Arthritis Foundation is a trademark of The Arthritis Foundation, Inc. 1. Fortin, Paul R., et al. Outcomes of Total Hip and Knee Replacement. Arthritis & Rheumatism 42 (1999): 1722-1728 2. The Arthritis Foundation. , 2006.
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