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Learn About Treatment Options for Knee Problems

April 05, 2011

Not all knee pain is created equal.

Sometimes knee pain can be caused by an acute injury, such as a tear to one of the ligaments that connect the shinbone to the thighbone, or damage to the cartilage that acts as a "shock absorber" for the knee. In other cases, knee pain stems from an overuse injury or an infection that causes inflammation and swelling. And then there is knee pain that results from an underlying chronic medical condition, such as arthritis.

Not all knee pain treatment options are equally effective, either.

"Getting an accurate diagnosis of the cause of knee pain is key to determining the most effective course of treatment," says Dr. John Dearborn, orthopedic surgeon and medical director of Washington Hospital’s Center for Joint Replacement.

To help people in the community learn about the causes and treatment options for knee problems, Washington Hospital is sponsoring a free Health & Wellness seminar featuring presentations by Dr. Dearborn and his colleague at the Center for Joint Replacement, orthopedic surgeon Dr. Alexander Sah. The seminar is scheduled for Friday, April 15 from 2 to 4 p.m. in the Conrad E. Anderson, M.D. Auditorium at the Washington West Building, 2500 Mowry Avenue in Fremont.

Many cases of knee pain caused by overexertion or strain can be treated at home by taking ibuprofen to reduce pain and swelling and by following the "RICE" method of resting the knee to avoid aggravating the pain, icing the knee to reduce pain and swelling, compressing the knee with an elastic bandage or sleeve and elevating the knee as much as possible.

"A person who has moderate knee pain that persists for several days or worsens should seek an evaluation of the problem by a physician," Dr. Dearborn advises. Other indications that you should call a doctor include:

  • An inability to bear weight on the knee.
  • Severe pain, even when not bearing weight.
  • The knee buckles, clicks or locks.
  • The knee is deformed or misshapen.
  • A fever accompanied by redness, warmth or significant swelling around the knee.
  • Pain, swelling, numbness, tingling or a bluish discoloration in the calf below the knee.

"Taking an X-ray to look for bone fractures and cartilage loss due to arthritis is usually the first step in evaluating knee problems," Dr. Dearborn explains. "An MRI might also be necessary if an X-ray doesn’t show significant damage that explains the extent of the knee pain. For example, an X-ray wouldn’t show a tear to the ligaments or cartilage in the knee. The cause and severity of the knee problem will dictate the proper course of treatment."

"Most knee problems will heal with non-surgical treatments," says Dr. Sah. "Sometimes it may simply entail modifying the patient’s physical activities to avoid high-impact exercises such as jogging and substitute swimming or biking instead. Losing weight may also help, since extra weight can put additional strain on the knee."

Dr. Sah notes that physical therapy to strengthen the muscles around the knee and to improve balance is beneficial for many patients, as are knee braces that can help support and protect the joint.

Another non-surgical treatment option for knees damaged by arthritis is injections of steroids or hyaluronic acid.

"Steroid injections in the knee can help reduce inflammation caused by arthritis and provide pain relief that lasts a month or longer," Dr. Dearborn says. "Hyaluronic acid is a component of the normal lubricating fluid found in healthy joints, and injecting it into damaged knees may ease pain and provide cushioning for the joint. The relief can last for about three months, and the injections can be done two or three times a year."

Sometimes the only treatment option is surgery. But once again, the type of surgery employed depends on the cause of the problem.

"In cases where a patient has an acute cartilage or ligament tear but an otherwise healthy knee, arthroscopic surgery to repair the damaged joint can readily remedy the problem," Dr. Dearborn explains. "On the other hand, if the patient has a dramatic loss of cartilage due to arthritis, and bone is wearing on bone, arthroscopic surgery wouldn’t help because it simply can’t bring cartilage back. In cases like that, the patient may be a candidate for either partial or total knee replacement."

Dr. Dearborn, who performs over 600 minimally invasive total knee replacement surgeries each year, notes that the choice between partial and total knee replacement again depends on the patient’s specific diagnosis.

"There are three areas of the knee that need to be evaluated – both sides of the knee and under the kneecap," he says. "Total replacement would be indicated if the patient’s cartilage is badly damaged on both sides of the knee and under the kneecap or on one side of the knee and under the kneecap. Partial replacement would be an option for patients who have damage on only one part of the knee."

The advantages of partial knee replacement can be substantial for patients whose arthritis has affected only one part of the knee.

"Partial knee replacement is less invasive, and the ligaments in the center of the knee are not removed, unlike in a total knee replacement," says Dr. Sah. "Because the ligaments are left intact, the joint feels more like a ‘natural knee.’ It’s a good option especially for younger patients in their 40s, 50s and 60s whose arthritis has not spread throughout the knee."

With the addition of Dr. Sah to the staff in 2008, the Center for Joint Replacement has been performing more and more partial knee replacement surgeries. "Dr. Sah’s presence has really enhanced our ability to perform partial knee replacements because he completed his fellowship in joint replacement at Rush Hospital in Chicago where they did a high volume of those surgeries," Dr. Dearborn says.

For his part, Dr. Sah considers working at the Center for Joint Replacement to be a "great privilege." He explains: "I was born at Washington Hospital. Also, my father was an ear, nose and throat (ENT) physician at the hospital for 30 years, and he now volunteers there along with my mother. I have a special connection to Fremont, and it feels good to give something back to the hospital and the community."

Center for Joint Replacement Ranked #1 in California by HealthGrades

HealthGrades, a leading, nationwide health care ratings, information, and advisory services company has named Washington Hospital’s Center for Joint Replacement (CJR) as the number one joint replacement program in California. CJR has now been ranked among the top 10 in California for six years in a row and has been ranked among the top five percent in the nation for five years in a row.

"We are delivering this high level of care in a personal way," says Dr. John Dearborn. "When we get rated number one in California, I think our entire patient care team – from myself to the nurses and therapy staff is doing a great job."

HealthGrades uses proprietary, objective provider ratings and expert advisory services, to compile its ratings. HealthGrades produces its ranking and ratings in a report released annually. To learn more about the Center for Joint Replacement, visit www.whhs.com/joint.