Evan Hawkins, MD, is an orthopedic surgeon at Crystal Run Healthcare, practicing out of the organization’s’ Newburgh, NY facility. Dr. Hawkins specializes in the treatment of hip and knee arthritis, including hip and knee replacement, with a special interest in the anterior total hip replacement.
Common Questions I’m Asked about Knee Arthritis and Knee Replacement Surgery
I love to operate (I’m an orthopedic surgeon, after all). Knee replacement surgery is a procedure that I truly enjoy performing, not only because it reduces pain but also because it restores function and has the potential to allow patients to return to activities they once loved. But most of what keeps me busy day-to-day is talking with patients about how to avoid surgery. Because for me, surgery is and will always be a last resort.
My patients with knee pain and arthritis often want to know what they can do to preserve their knees and avoid surgery as they get older. I thought for this first post I might highlight a few of the topics that most frequently come up:
So, what exactly is arthritis? And is this how I am going to feel from now on?
There are a number of different forms of arthritis, but the end result is the loss of the normal cartilage of the joint, which protects the bone and allows for smooth, painless motion. When the cartilage is lost, it’s like having potholes in a street. The ride gets a little bumpier. Unlike potholes, cartilage in the knee can’t be so easily filled in. Unfortunately, we don’t yet know how to regrow cartilage in our bodies to the degree that would be necessary to cure severe arthritis; so when it is gone, it is gone for good. The degree of lost cartilage does not always correlate to a patient’s pain level or function. I usually tell my patients that arthritis is a slowly progressive disease with highs and lows and a somewhat unpredictable course. Luckily for us, there are many strategies to slow that progression down.
Can losing weight reduce my knee pain?
Absolutely! Weight loss may be the single most important thing you can do to prevent the progression of arthritis and reduce your knee pain. Studies have shown that overweight women have a 4x higher rate of developing arthritis, and overweight men are 5x more likely to get arthritis. When we walk, our knees carry the burden of anywhere from 2-4x our own body weight. This means that even a modest weight loss of 10 pounds is up to 40 pounds that our knees are no longer supporting. Consult with your primary physician about healthy strategies to lose weight, but remember that gradual loss is far more sustainable and healthy than crash diets.
Here’s a motivational tip: For every pound you lose, pour two cups of water into an empty milk jug. When you’ve filled up the jug, that’s more than 8 pounds your body is no longer carrying around. It’s a good way to visualize your progress and remember why you are doing it in the first place.
OK. What about physical therapy?
A patient with symptomatic arthritis of the knee will rarely leave my office without a referral for physical therapy. Knee strengthening exercises, low impact aerobic exercise, and even yoga have all been shown to reduce pain in patients with arthritis. If you can’t fit a structured PT program into your life, there are a number of good at-home exercise programs that accomplish many of the same goals. The key is to stay active and stay moving for healthier, longer lasting joints.
What are all these supplements about?
The most common supplements to take for arthritis are glucosamine and chondroitin. They are essential building blocks that make up the cartilage in our knees, and are available over the counter at any drug store.
Some studies have suggested that when combined, they may reduce pain and prevent the progression of arthritis. A lot of these studies have big flaws and some are sponsored or paid for by the companies that produce the products that are being tested.
Orthopedic surgeons as a group do not endorse the use of glucosamine and chondroitin, not because they are harmful, but because there is no strong scientific argument proving that they work.
So what medication can I take to reduce my pain?
There is no medication that can reverse the damage done by arthritis, but a class of drugs called NSAIDS (non-steroidal anti-inflammatory drugs) has been shown to reduce pain in patients with arthritis. The major side effect of NSAIDs, like ibuprofen or naproxen, is that they can irritate the stomach, especially in people with acid reflux or a history of peptic ulcer disease. It is a good idea to speak with your primary care physician when considering any new medication, even if it’s over the counter.
How do I know if I need a knee replacement?
I often say that the decision to have a knee replacement is one made out of frustration at not being able to enjoy life the way it once was. Oftentimes, patients become accustomed to the pain associated with knee arthritis, all the while slowly changing their life to avoid activities they once enjoyed. If your bad days outnumber your good ones, and all else has failed, it may be time to have a conversation about a knee replacement with your provider.
Stay tuned for my next blog post on Anterior Total Hip Replacement – coming on Tuesday, April 25th!