Knee Joint Pain- What Can Be Done
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13th May 2012, 05:14 PM #1
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Knee Joint Pain- What Can Be Done
KNEE PROBLEMS & ARTHROSCOPY
The knee is one of the most versatile joints of the body. Unfortunately, it is one of the most vulnerable joints to injury. Knee problems can be the result of daily wear and tear. Injuries can be caused by overuse, a sudden twist or blow, genetic predisposition to knee problems, or when the knee joint starts to show signs of aging.
WHAT ARE COMMON KNEE PROBLEMS?
Sudden twists can tear the meniscus cartilage causing pain. The knee may lock or give away when stressed by running, kneeling or squatting.
Twisting injuries, even those that seem minor can injure ligaments. Patella
Problems: Tracking problems with the kneecap, which can be traumatic
The cartilage in the patient’s knee joint gradually deteriorates due to wear and tear, genetic predisposition, and primary arthritic diseases. This results in pain and aching in the knee joint when the patient moves the knee or puts weight on it
(also called a Baker’s Cyst) Occurs when the membrane that lines the joint becomes inflamed. Bending the knee may be painful because bulging cysts may form behind the knee due to excess fluid produced by the joint.
Inflammatory problems with various tendons around the knee that create discomfort with activities
HOW KNEE PROBLEMS ARE DIAGNOSED?
Before treatment, to ascertain the extent of the joint damage, the orthopaedic surgeon needs to carefully examine the patient. The examination may include the patient’s medical history, a physical exam, and other diagnostic tests, such as x- rays and MRI , to evaluate problem. X-rays help diagnose any cracks, breaks, abnormal bone structures, or arthritis (severe joint wear). On the other hand, MRI provides the surgeon with images that may show any soft tissue, cartilage, or ligament injuries. The orthopaedic surgeon may advice an arthroscopy to confirm the diagnosis, and in most cases will treat the problem during this procedure.
WHAT IS THE ARTHROSCOPIC PROCEDURE?
The arthroscopy is a procedure in which the orthopaedic surgeon makes 2 to 3 small incisions and inserts an arthroscope into the joint. The arthroscope is a telescopic instrument which is less than ¼ inch in diameter. When inserted inside the joint space, it allows the surgeon to see the internal joint structures directly. A camera attached to the arthroscope gives the physician a clear image of knee joint on a monitor.
HOW IS THE ARTHROSCOPY PERFORMED?
Arthroscopy is considered a surgical procedure. At the beginning of the procedure the patient will receive general anesthesia, or spinal anesthesia or local anesthesia. For Knee arthroscopy tourniquet is usually applied to restrict bleeding during the procedure. Then, the surgeon makes small portals (incisions) in the knee. In one of the portals the surgeon will insert the arthroscope. The joint is distended with sterile fluid. In the other portal the physician will place instruments to accomplish the procedure. During the procedure, the surgeon inspects the type and degree of the joint damage and treats the problem using the arthroscope, shavers, and other specialized instruments. After the procedure a sterile dressing will be placed over the wound and then an elastic bandage will be placed on the operated part. This dressing can be removed five days after the procedure.
WHAT CAN WE EXPECT AFTER ARTHROSCOPY?
After arthroscopy the patient’s joint is bandaged. The patient will be given pain medications and an ice bag is put on operated area to reduce swelling and pain. In the recovery room, and for the next 3-4 days, the patient needs to move the feet (ankle pumps) to improve circulation and avoid blood clots. The patient may be able to go home two or three hours after the procedure; however, the patient needs to rest the joint for 12-24 hours. Someone will need to drive the patient home because of the anesthetic. A patient operated for Knee may need the assistance of crutches for a few days or weeks after the surgery. After going home to help reduce the swelling during the first two, days the patient should apply ice to the knee a few times a day for 20 to 30 minutes. To avoid infection the patient’s dressing needs to be clean and dry. Therefore, before taking a shower the patient should cover the part with a plastic bag tied above the dressing. The patient can shower without a dressing usually after 5 days. It is essential that the patient schedule a post-operation visit 5-10 days after the surgical procedure
Arthroscopy in Arthritic Knee Joint
The treatment of degenerative arthritis of the knee by arthroscopy can be further subdivided into lavage, debridement, abrasion, and cartilage replacement. Lavage alone has been proven to provide temporary relief of symptoms in patients with degenerative arthritis. Many physicians feel that lavage alone is not enough. Debridement of loose articular cartilage or loose bodies has been proven to provide relief in up to 74% of patients at 14 months. Abrasion or subchondral drilling also may be used in the treatment of medial compartment osteoarthritis. In this technique, the subchondral bone is abraded or microfractured to bleeding bone. This allows for the formation of fibrocartilage, which functions similar to articular cartilage but is not nearly as durable. Up to 77% of patients have good results at 2-year follow-up assessments.
As of recently, they are exploring the option of cartilage replacement with autologous osteoarticular transplant surgery (OATS) at the time of osteotomy. Although performed at a limited number of centers, this option enables the replacement of damaged articular cartilage at the time of biomechanical realignment.
Postoperatively, it is important to implement early ROM exercises and isometric quadriceps strengthening as soon as possible after surgery. As swelling subsides and ROM increases, institute a strengthening program. Stationary cycle and walking programs also may be started soon following arthroscopy. In general, the recovery time from an arthroscopy ranges from 1-2 months. Patients who undergo simple debridements and lavages are on the low end of that range, while those undergoing cartilage transplant can expect longer recovery periods.