Do your knees get warm and swollen after activity?
It might be osteoarthritis, the most common cause of knee pain in people over 60, according to Sydney-based Orthopaedic Surgeon Dr George Gayagay - although he is now sees younger patients with osteoarthritic knee pain due to obesity.
For people in their 30s and 40s, inflammatory and post-traumatic osteoarthritis are the most likely causes of knee pain. For the teens to early 30s age bracket, a ligament, sporting or trauma injury is typically to blame.
“Sharp, burning or dull,” the pain can be localised to one aspect of the knee or throughout, potentially referring to the back or the hip, Gayagay said. The knee might click, lock or give way. Some cannot walk, sleep, or rest comfortably.
While knee pain from injury is acute, often settling after sufficient convalescence, “knee pain from arthritis is often insidious and progressive, eventually requiring surgery. Cartilage is affected by any form of arthritis. It does not heal or regenerate, unlike the ligaments and bones affected by injury,”
“As we age, tissues deteriorate and metabolism slows,” resulting in numerous contributors to knee pain: muscle weakness, cartilage degradation, osteoporosis (‘soft bones’) and obesity. “Your knee experiences five to seven times of your body weight,” Gayagay said.
A thorough medical history and physical examination can determine the cause of the pain, complemented by “at least three weight-bearing x-ray views of the knee. If the x-ray is normal, an MRI may identify soft tissue problems,” Gayagay said. Blood tests rule out infection, gout and inflammatory arthritis.
Initially, analgaesics such as paracetamol provide pain relief, and walking aids help offload the knee. Physiotherapy reduces swelling, facilitates mobility and strengthens the knee muscles and the core of the body; “knee pain can cause muscle weakness via a negative feedback mechanism,” Gayagay said.
Injections into the knee such as hyaluronic acid may be administered. Steroids are not a long-term treatment option “because of their potentially destructive side effects.”
Gradual weight loss needs emphasising in obese patients with the assistance of a dietitian and potentially a bariatric surgeon, Gayagay said.
“If all non-surgical options have been exhausted and knee pain remains, then surgical interventions can take place.”
For post-traumatic osteoarthritis, a knee arthroscopy removes damaged tissue, although this is becoming less common. In chronic osteoarthritis, an osteotomy – breaking of the bone and realigning the joint is “ideal – for the young labourer with arthritis at only one area of the knee.”
‘Limited arthroplasty’ is “also ideal for the younger patient,” replacing only the arthritic component of the knee. “Recovery is quicker, but longevity is shorter compared to a total knee replacement.”
Pain after a knee replacement can be managed with analgaesics, walking aids and physiotherapy. Driving can generally commence at week six and a return to manual-type work is 8 to 12 weeks post-surgery, clerical-type work can start at 4 to 6 weeks, Gayagay said.
If an infection, fracture or dislocation is suspected, “go to the emergency department immediately,” Gayagay said. For an aching knee, “see your GP.”
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