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Total Knee Replacement: Is This Your Best Option?

Total Knee Replacement: Is This Your Best Option?

Knee pain affects both men and women and is often unbearable to live with. Knees are a vital “hinge point” allowing us to walk by bending and straightening at specific points. This joint is also crucial for helping with weight bearing and dissipating forces so that our hips and back can remain stable and pain free. The hinge joint is comprised of two bones: the femur, or thigh bone, and the tibia, or shin bone. Both bones have coverings called articular cartilage, which can wear down over time to cause bone on bone contact.

That’s the technical stuff. Simply going up and down stairs can trigger pain in a specific point in your range of motion. That can be a wearing pattern of your cartilage. Or even while standing still and your knee feels stiff after time, bend and straighten it to provide relief. This removes the compression of weight bearing surfaces affecting worn cartilage.

Just because you have painful osteoarthritis does not mean you need surgery. Other options to reduce pain (rather than over the counter medications) include synvisc injections, weight loss, life style changes and, importantly, physical therapy. Many patients who undertake a combination of the above can reduce their pain and lead more normal, active lives.

Physical therapy, while not a miracle cure, can help to strengthen muscles, provide knee support and flexibility to reduce compression in the knee. Sometimes simple stretches are not enough, and medication may be needed to help. But combining a prescribed exercise program along with medication can be effective in reducing pain and might actually lower medication intakes.

When people walk with a limp, or avoid activity, these compensations actually make the condition worse by continuing to weight bear in the same area of worn cartilage. Physical therapists evaluate and assess overall motion, and strength and range of motion, to determine what precise protocol to follow.

Back to anatomy: the knee has several muscles that cross the knee. When they are tight or weak they may put undue stress on the knee. Reducing these factors can change the wear pattern and enhance one’s ability to walk and return to normal activities. Osteoarthritis is a structural change in the knee; it will not improve with most intervention; however, changing where the joint is contacting can reduce pain, degeneration, and avoid surgery. That’s the province of physical therapy.

However, if surgery is the only alternative, even then physical therapy can help in pre-surgical preparation. Because knee replacement requires a surgeon to cut into the quadriceps muscle, patient recovery time (usually three to four months) can be reduced by at least one month through therapy “rehabilitation” before the knee procedure is undertaken.

Last, the Check List. Before you decide on surgery, consider all options. A pain free life from osteoarthritis does not have to be dictated by surgery. That should be your final option. Physical therapy and its more conservative approach to degeneration of cartilage in the joints should be considered first. The practice today is far more sophisticated then it was decades ago. Prominent physical therapists now work closely with the medical fraternity to reduce, and possibly rid patients of osteoarthritis pain.

Joel Paul, MSPT, is a graduate of Sacred Heart University’s Physical Therapy Program, and is an active member of the APTA. His therapy experience ranges from Parkinsonian treatment to manual techniques and multilevel back therapy programs. He serves as Clinical Supervisor in Amity Physical Therapy’s Hamden office. The practice was founded eleven years ago by Michael Dow MSPT, CEO/Director. They maintain three offices in the Greater New Haven area: Hamden, Woodbridge, and Branford. For more information call 203-389-4593 or visit www.amitypt.com.

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