Osteoarthritis of the knee has a major impact on the patient’s ability to perform routine daily tasks. According to the American Academy of Orthopedic Surgeons, over 13 million adults in the US presented with OA symptoms in 2001. The majority of these patients were older adults.
Pain, swelling and stiffness are the most common symptoms associated with knee OA. And those patients lose the ability to bend or straighten the knee, and also feel a creaking, popping, locking or giving way.
Dr. Harry Derderian, an orthopedic surgeon at East Lexington Clinic in Lexington, Kentucky, specializes in both hip and knee replacement surgeries< /a> . As one of Dr. Derderian’s clinical assistants, I saw many patients suffering from the effects of OA.
When patients are initially seen for knee pain consultation, Dr. Derderian uses this protocol for the diagnosis and treatment of knee OA;
1. X-rays of the knees are taken to look for signs of OA, such as bone spurs or joint space. narrow Normal cartilage appears as a “cleft” between the thigh (femur) and leg (shin) bones. Advanced knee OA shows a “bone on bone” appearance on x-ray.
2. Physical examination of both knees includes assessment and comparison of the patient’s motion in both knees. Dr. Derderian also determines if the patient has swelling (effusion) of the knee joints. Then check the points of maximum tenderness along the medial lines (inside the knee joint) and the lateral lines (outside the knee joint).
There is pain when the knee is bent or extended. This is most often due to chondromalacia patella (below the knee cap wearing and tearing).
3. In addition to conventional x-rays and physical examination, an MRI of the knee may be ordered for meniscal tears, a C-shaped cushion, and a shock absorber.
After the diagnosis of knee OA is made, an appropriate treatment plan is determined. It is a general protocol that varies according to the health and needs of the patient.
4. Physical-therapy Therapy can be instituted for one month in the hope of alleviating symptoms by strengthening the quadriceps muscles of the thighs which would help pressure the knees . The therapist may also use other modalities at his discretion, such as heat or ultrasound.
5. If physical therapy does not improve the patient’s symptoms, the doctor may choose to drain any excess fluid from the knee joint and begin cortisone injections if the patient meets the appropriate symptoms.
6. The patient needs to change activity levels or work with restrictions until symptoms improve. Losing weight is also recommended if the patient is overweight. For every pound body fat is lost, four pounds of pressure is taken off the knees!
Sometimes a lead supplement called Synvisc may be infused instead of cortisone therapy. This leadership week has been infused for three consecutive weeks.
A total knee replacement is performed if the patient has advanced knee OA.
Many factors are taken into account before this surgery, such as the general health of the patient, whether the following surgery will help, and other details.
If the doctor and the patient both agree to follow total knee replacement, the patient should proceed to the following. :
Join the class in the hospital to inform the hospital about the procedure and what to expect from the following surgery.
*Pre-op physical with a primary care physician.
* Pre-op appointment with Orthopedic a week before surgery.
Currently, Dr. Derderian uses tools that include:
*Femoral, chrome cobalt made of metal,
*Tibial component, made of durable plastic material placed in a metal tray, and a
*Patlar component, also plastic.
The average hospital stay is three days, but it can vary depending on the patient. “Cell saver” units usually reduce the need for blood transfusions. If anyone helps, they should be paid at home. Otherwise, the patient may be admitted to a rehabilitation facility for several days following discharge from the hospital.
The patient is usually placed on anti-coagulant therapy to help prevent blood clots in the leg, which is a risk with this hand. Lovenox injections may be prescribed post-operatively for 7-10 days to prevent clotting.
Staples at the incision site are usually removed after a period of 10-14 days.
Physical therapy will be instituted soon after discharge, initially at home through visiting therapists, then progressing to treatment at the patient’s physical therapy facility of choice. The main goal is to achieve optimal flexion and extension following knee replacement.
The “new generation” will not be the “normal generation”. It is hoped that the knee will be replaced, so that most of the pain and disability will be felt before the surgery; but there is no guarantee.
In the end, knee OA is a potentially disabling diagnosis, but treatment is available to help many patients.
Lucy A. Cain
Orthopedic Assistant
Harry Derderian, MD
Director of Orthopaedics
St. Joseph’s Hospital East
Lexington, Kentucky
