FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

READER'S KNEE PAIN MAY SIGNAL NEED FOR REPLACEMENT SURGERY

Question: I've talked with two different doctors about my knees. Both have told me that I now have bone against bone and will continue to have pain until I get an artificial knee. How does one determine when a knee replacement is truly needed?

Answer: None of us pay attention to our knees or other body parts, for that matter until they hurt. The knees both support the individual's weight and allow the lower leg to have the freedom of movement necessary for normal walking. Because of this, it is obvious that an injury or illness that interferes with the normal strength and mobility of a knee creates a serious disability.

Arthritis is the inflammation and swelling of a joint, and it may result from several underlying conditions such as rheumatoid arthritis or, more commonly, osteoarthritis. In a normal knee, the smooth surfaces of the upper leg bone and lower leg bone are covered by a tough layer of cartilage over the surfaces where they contact one another. This makes the gliding and rolling motion of the joint smooth and easy. In arthritis, these areas of contact become roughened and irregular, and motion then produces a grinding, uncomfortable sensation. As the condition progresses, as yours has done, the smooth cartilage covering within the knee becomes totally worn out. That is what your doctors are telling you when they say you have "bone against bone."

Physical therapy, anti-inflammatory medications taken by mouth, and cortisone injected into the damaged joint can give good relief from the discomfort of mild arthritis. Brief periods of these treatments are all that is necessary for most individuals who suffer from arthritis of the knee. In those with the most severe cases, however, the arthritis can increase to a point where these therapies fail to give relief. Then, the condition becomes a serious disability.

So to answer your question, it is time to have knee replacement surgery when all of the less aggressive therapies fail to provide satisfactory improvement in the pain and limited mobility caused by your arthritis. The key word in this recommendation is "satisfactory" because it says that you are the person who must make the final decision. When your knee hurts so much that you are willing to let the surgeon cut it out and put in a metal replacement then you are ready.

Knee replacement is an extensive surgery that requires months for total recuperation. Despite the magnitude of the procedure, most individuals who were surveyed two to six years after their surgery were pleased with their results. Over 90 percent scored their improvement in mobility and decrease pain as excellent. About 5 percent of individuals had some problem that required a second operation to correct, and the success rate of the second operation is about that same 90 plus percent.

So, to determine if it is time for your knee surgery, consider the amount of pain and disability you have now. If it is bad enough to make you willing to put up with even more pain and disability in the immediate post-operative weeks, then you are ready.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.