Yet issues underlying knee pain are timeless. Most often, the joint’s cartilage, which provides a cushion between bones, gradually wears away. This can cause painful arthritis that may severely limit movement and degrade quality of life. “Cartilage does not have a great ability to repair itself, and each joint gets only one natural set of cushions,” Anbari says.
Pain often can be relieved at first with nonsurgical treatments. But when pain becomes intense or lack of mobility interferes with daily life, total knee replacement is often the best solution.
Transformed surgery
Replacing a knee entails accessing the joint through an incision, shaping bones where they meet and installing an artificial prosthesis. “That part hasn’t changed,” Anbari says. “But everything around it has become better.” Some of the most striking improvements include:
- Better materials: “Plastics in particular have improved and are less likely to wear out during a person’s lifetime than they used to be,” Anbari says. As a result, people receiving artificial knees today are less likely to need additional surgeries later in life.
- Fewer transfusions: Specialized drugs reduce bleeding during surgery so people are less likely to need blood transfusions. “When I trained, it wasn’t unusual to transfuse 20 percent of patients,” Anbari says. “Now it’s close to zero.”
- Early activity: People receiving new knees often are on their feet and walking the day of surgery – often within two or three hours – to promote faster recovery.
- Advanced pain control: “Today we use as few narcotics as possible and instead rely on multimodal pain management that includes anti-inflammatory medications, ice packs, anesthetic inside the joint and nerve blocks that control pain in the joint but don’t affect your ability to move the leg,” Anbari says.
- Shorter stays: Added together, advances have reduced the amount of time people spend in the hospital following total knee replacement. “It used to be three or four days,” Anbari says. “Now you’re most likely to stay one night, and some patients have started to go home the same day.”
Nonsurgical options
Another trend in recent years is to get as healthy as possible before surgery. “Things like quitting smoking, controlling diabetes and exercising more to strengthen the joint and surrounding muscles give you the best chances of having a successful surgery,” Anbari says.
Most important of all may be losing weight. “That’s a big deal because extra weight stresses the knee and correlates with development of arthritis,” he says. Dropping 20 pounds reduces the chance of complications from surgery and may even reduce or delay the need for a new knee. It is also helpful for improving the pain from knee arthritis since “extra weight stresses the knee and correlates with development of arthritis,” he says.
Once you need treatment, potential options that don’t involve an operation include:
- Taking pain relievers: “We start with the simplest things, like fighting inflammation with over-the-counter ibuprofen or naproxen or prescription pain relievers, and go from there,” Anbari says.
- Wearing a brace: Supporting the knee with a noninvasive external brace can be especially helpful if arthritis is confined to one side of the joint. “An unloader brace gently redistributes weight so your body is held by the good part of the knee,” Anbari says.
- Getting injections: “The knee is very accessible, and delivering a steroid injection to the knee can alleviate inflammation and pain,” Anbari says. If steroid effectiveness wanes or use becomes restricted due to other medical considerations, injecting a lubricant gel into the joint can provide pain relief for weeks at a time.
“There are many non-operative treatments we can try prior to surgery,” Anbari says.
