How to choose the right treatment…

Why live with a bum knee when you can have less pain and more mobility with a new one? With such great promises and the relative ease of knee–replacement surgery, it’s no surprise that this is now one of the most popular procedures in the US.

It’s true that the procedure can be a blessing for those with severe arthritis (the main reason for surgery) that impairs their ability to live an active, pain-free life. But the decision to have surgery should not be made casually—and if you do end up getting a knee replacement, there are facts you should know before choosing between the tried-and-true approach and the newer, less invasive surgical procedure.

To Avoid Surgery

If you have mild-to-moderate knee pain, but you’re still able to work and do normal activities, chances are you can greatly improve without surgery by following these steps…

• Stretch and strengthen the muscles. Studies have shown that simply strengthening the muscles that support the knees (the quadriceps in the front of the thighs and the hamstrings in the backs) can reduce damage, pain and disability.

My advice: Work those muscles three or four times a week for at least six to eight weeks before making a decision about surgery. Examples: Leg extensions, hamstring curls and clamshells. Even if your knee is hurting, it’s worth taking an over-the-counter painkiller, such as ibuprofen (Advil) or acetaminophen (Tylenol), about 30 minutes before your workout so that you can do the exercises. Curcumin supplements have also been shown to decrease inflammation and arthritis pain. A physical therapist or personal trainer can help design a workout that includes targeted stretches and strengthening exercises that are right for you.

• Drop some excess weight. Every pound of body weight equals several pounds of “loading force.” This means if you are 10 pounds overweight, for example, your knees get an extra 40 pounds of pressure. That’s enough to increase pain and limit mobility—and accelerate arthritis-related damage.

My advice: If you’re overweight—even by a few pounds—it’s affecting your knees. Get serious about losing those extra pounds!

• Try hyaluronic acid. This naturally occurring substance acts as a lubricant to the joints and may work as well as painkillers and steroids (without the side effects) for some people. It’s usually injected into the affected joints once a week for three to five weeks.

My advice: There’s no way to predict who will benefit from these injections. Consider them if exercise and weight loss haven’t given you adequate relief. Insurance typically covers the cost.

WHAT NEXT?

If you’ve given the strategies described earlier your best shot and still have serious knee pain, surgery is usually the next step. What to consider…

• Partial knee replacement. This approach, also known as unicompartmental knee replacement, is newer than total knee replacement and gets a lot of attention because it is less invasive. The advantages include an incision that is roughly half the size (about three to 3.5 inches) of that used for total knee replacement. Patients also are hospitalized for just a day or two rather than three to five days for a total knee replacement. With the partial approach, the knee may feel more “natural”—for example, it may have less “creakiness” and better range of motion—than it would after a more extensive procedure.

But a partial knee replacement isn’t for everyone. To be a candidate for this procedure, the damage is generally isolated to only one part of the knee. Also, the research is not yet clear, but patients who have partial procedures may be more likely to require subsequent “revision” surgery—because of continuing arthritis, for example, or because the first procedure didn’t improve pain and/or mobility. For many patients, the risks from repeat surgery could outweigh the benefits of a less traumatic initial procedure.

• Total knee replacement. This procedure is called a “total” replacement because the damaged surfaces of the knee bones are replaced—the tibia (shinbone)…femur (thighbone)…and sometimes the patella (kneecap). The surgery requires a large incision (usually seven to eight inches) and typically takes about two hours.

The majority of patients who opt for knee surgery require a total replacement. Surgeons have a lot of experience with the procedure—and there’s strong evidence that it works. More than 90% of total knee-replacement patients report that they have a lot less pain…and about 85% of these artificial knees are still going strong after 20 years. While patients who receive total replacements have somewhat less flexibility than those who go the partial route, most are able to do light hiking, ballroom dancing and biking.

THE BOTTOM LINE

No matter which approach your surgeon suggests, make sure you’re comfortable with the plan. Some patients will feel best about the decision if they get a second opinion.

Until more is known about the long-term benefits and risks of partial knee replacement, most surgeons advise their patients with severe arthritis to get it over with and have a total replacement.

Patients with osteoarthritis in all areas of the knee and those with inflammatory arthritis (such as rheumatoid arthritis), which tends to affect the entire knee, are not candidates for a partial approach and require a total knee replacement.

Consider a partial procedure only if you mainly have damage in just one part of the knee, you haven’t improved after physical therapy, weight loss and the other suggestions described above, and your pain prevents you from sleeping through the night and/or performing your normal daily activities.