1. Treatment Options for Knee Pain

2. Anatomy of the Knee Made up of three bones: Made up of three bones: Femur (thigh bone) Femur (thigh bone) Tibia (lower leg bone) Tibia (lower leg bone) Patella (kneecap) Patella (kneecap) Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

3. Knee Joint Healthy knee joint Arthritic knee joint

4. Causes of Knee Pain Osteoarthritis (wear and tear) Osteoarthritis (wear and tear) Rheumatoid arthritis Rheumatoid arthritis Post-traumatic arthritis caused by: Post-traumatic arthritis caused by: Fractures Fractures Ligament injuries Ligament injuries Meniscus tears Meniscus tears Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

5. Symptoms of Knee Arthritis Pain Pain During activity During activity At rest or sleeping At rest or sleeping Swelling and tightness Swelling and tightness Bone spurs Bone spurs Grinding sound during movement Grinding sound during movement Stiffness and decreased range of motion Stiffness and decreased range of motion Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

6. Diagnosing Knee Arthritis Physical examination Physical examination Medical history review Medical history review X-Rays X-Rays Blood tests Blood tests Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

7. How Can My Life Change with Treatment? A return to mobility A return to mobility Regaining a sense of your former lifestyle Regaining a sense of your former lifestyle Reduce or eliminate pain Reduce or eliminate pain

8. Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) Usually first drug used to treat arthritis Usually first drug used to treat arthritis Can reduce pain, swelling and redness Can reduce pain, swelling and redness Relief can take several months Relief can take several months Examples: Examples: ibuprofen ( Advil ®, Motrin ® ) ibuprofen ( Advil ®, Motrin ® ) naproxen ( Aleve ® ) naproxen ( Aleve ® ) Aspirin Aspirin Reduce joint pain and inflammation Reduce joint pain and inflammation Form of NSAIDs Form of NSAIDs Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

9. Non-Surgical Treatment Options for Knee Pain: Over-the-Counter Medications Acetaminophen Reduces pain Reduces pain Lowers fever Lowers fever Does not reduce inflammation of arthritis Does not reduce inflammation of arthritis Examples: Examples: Tylenol ® Tylenol ® Datril ® Extra Strength Datril ® Extra Strength Tempra ® Tempra ® Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

10. Non-Surgical Treatment Options for Knee Pain: Prescription Medications NSAIDS NSAIDS Most popular type for osteoarthritis treatment Most popular type for osteoarthritis treatment Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Includes ibuprofen ( Motrin ® ), naproxen sodium ( Anaprox ® ), oxaprozin (Daypro ® ), sulindac (Clinoril ® ), etc. Analgesics Analgesics Provide pain relief, but do not reduce inflammation Provide pain relief, but do not reduce inflammation Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Includes Acetaminophen with codeine (Tylenol ® with Codeine), Oxycodone (OxyContin ®, Roxicodone ® ), Hydrocodone with acetaminophen (Vicodin ®, Dolacet ® ), etc. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

11. Non-Surgical Treatment Options for Knee Pain: Prescription Medications Biological Response Modifiers Biological Response Modifiers Treat rheumatoid arthritis; may postpone injury to the joints Treat rheumatoid arthritis; may postpone injury to the joints Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® ) Includes: Infliximab (Remicade ® ), Etanercept (Enbrel ® )Remicade ® Remicade ® Glucocorticoids or Corticosteroids Glucocorticoids or Corticosteroids Treat rheumatoid arthritis; fight inflammation Treat rheumatoid arthritis; fight inflammation Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) Includes: cortisone, hydrocortisone (Cortef ®, Hydrocortone ® ), Prednisolone (Prelone ® ) DMARDS DMARDS Treat rheumatoid arthritis; slow joint destruction Treat rheumatoid arthritis; slow joint destruction Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Includes: methotrexate, injectable gold, penicillamine (Depen ® ), Azathioprine (Imuran ® ), etc. Source: www. AllAboutArthritis.com, 2003www. AllAboutArthritis.com

12. Non-Surgical Treatment Options for Knee Pain: Injection Therapy Cortisone Injections Cortisone Injections Helps reduce swelling and discomfort from arthritis. Helps reduce swelling and discomfort from arthritis. Temporary pain relief. Temporary pain relief. Small risk of infection. Small risk of infection. Hyaluronic Acid (HA) Injections Hyaluronic Acid (HA) Injections Restores lubrication and fluid in the joint. Restores lubrication and fluid in the joint. Creates a shock absorber between the bones. Creates a shock absorber between the bones. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

13. Non-Surgical Treatment Options for Knee Pain Lifestyle Changes Lifestyle Changes Extra weight Extra weight Exercise important to control weight Exercise important to control weight Know what foods to eat Know what foods to eat Orthotics Orthotics Assistive devices (Cane, etc) Assistive devices (Cane, etc) Walking Walking Bathrooms Bathrooms Climbing Climbing Dressing Dressing Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

14. Knee Surgical Treatment Options Arthroscopy Arthroscopy Synovectomy Synovectomy Tibial osteotomy Tibial osteotomy Total knee replacement Total knee replacement Uni-compartmental replacement Uni-compartmental replacement Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

15. Arthroscopy Removes damaged soft tissue. Removes damaged soft tissue. Less invasive surgery, possibly leading to shorter recovery times. Less invasive surgery, possibly leading to shorter recovery times. Sustained pain relief varies in advanced osteoarthritis patients. Sustained pain relief varies in advanced osteoarthritis patients. Source: www.aaos.org, 2003www.aaos.org

16. Arthroscopic Surgery Small camera inserted to see inside the joint. Small camera inserted to see inside the joint. Small instruments remove any debris and smooth cartilage surfaces. Small instruments remove any debris and smooth cartilage surfaces. Source: www.aaos.org, 2003www.aaos.org

17. Arthroscopic Surgery, continued Benefits Outpatient surgery Outpatient surgery Less invasive Less invasive May reduce recovery time May reduce recovery timeDisadvantages Pain relief may be temporary Pain relief may be temporary Source: www.AAOS.org, 2003www.AAOS.org

18. Synovectomy Early stages of rheumatoid arthritis. Early stages of rheumatoid arthritis. Removes inflamed tissue lining. Removes inflamed tissue lining. Potentially saves joint from further damage. Potentially saves joint from further damage. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

19. Synovectomy Surgery Small incision is made. Small incision is made. Arthroscope is used to inspect the joint. Arthroscope is used to inspect the joint. Diseased synovium is removed. Diseased synovium is removed. Physical therapy usually required. Physical therapy usually required. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

20. Synovectomy, continued Benefits Alleviates rheumatoid arthritis pain in the joint Alleviates rheumatoid arthritis pain in the joint Joint may be saved from further damage. Joint may be saved from further damage. Synovium could grow back over time Synovium could grow back over timeDisadvantages Not a permanent solution Not a permanent solution Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

21. Tibial Osteotomy Treats a varus or bowlegged deformity Treats a varus or bowlegged deformity Candidates have: Candidates have: Pain Pain Knee cartilage damage primarily in one section. Knee cartilage damage primarily in one section. Improperly healed broken knee. Improperly healed broken knee. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

22. Tibial Osteotomy Surgery Incision is made on both the front and side of the knee. Incision is made on both the front and side of the knee. Wedge-shaped piece of bone is removed. Wedge-shaped piece of bone is removed. Edge of cut bone is stapled and held by plates and screws. Edge of cut bone is stapled and held by plates and screws. Source: www.AllAboutArthritis.com, 2003www.AllAboutArthritis.com

23. Tibial Osteotomy Benefits Restore knee function Restore knee function Reduce osteoarthritis pain Reduce osteoarthritis pain May even stimulate growth of new cartilage May even stimulate growth of new cartilageDisadvantages Results may be temporary Results may be temporary Cosmetic difference between knees Cosmetic difference between knees Source: www.aaos.org, 2003www.aaos.org

24. When is Knee Replacement Surgery Right for You? Experience significant pain. Experience significant pain. Knee function and mobility decreases. Knee function and mobility decreases.

25. Uni-compartmental Knee Replacement Minimally invasive surgery Minimally invasive surgery Removes damaged articular cartilage in single area of the knee Removes damaged articular cartilage in single area of the knee Replaces damaged component with prosthesis Replaces damaged component with prosthesis Goal is quick: Goal is quick: Return to normal activities. Return to normal activities. Pain relief Pain relief Source: www.jointreplacement.com, 2003

26. Benefits of a Uni-compartmental Knee Replacement Resolves arthritis pain Resolves arthritis pain Maintains two-thirds of the natural knee Maintains two-thirds of the natural knee Minimally invasive procedure Minimally invasive procedure Proven procedure Proven procedure Source: www.jointreplacement.com, 2003www.jointreplacement.com

27. After Uni-Compartmental Knee Surgery Before leaving the hospital, you must be able to: Before leaving the hospital, you must be able to: Get in and out of bed. Get in and out of bed. Walk with crutches or a walker. Walk with crutches or a walker. Do exercises that bend and straighten the leg. Do exercises that bend and straighten the leg. May be back to regular activity within four to six weeks. May be back to regular activity within four to six weeks. Source: www.jointreplacement.com, 2003www.jointreplacement.com

28. Total Knee Replacement Total knee is affected by arthritis. Total knee is affected by arthritis. Reduce knee pain Reduce knee pain Improve the motion Improve the motion 323,448 total knee replacements in 2001 1 323,448 total knee replacements in 2001 1 1. Solucient, Inc. 2001. Source: www.preservation-uni.com, 2003www.preservation-uni.com

29. Total Knee Replacement Components Source: www.jointreplacement.com, 2003www.jointreplacement.com Femoral- replaces arthritic portion of thigh bone Femoral- replaces arthritic portion of thigh bone Tibial- replaces arthritic portion of shin bone Tibial- replaces arthritic portion of shin bone Tibial insert- replaces cartilage and acts as shock absorber Tibial insert- replaces cartilage and acts as shock absorber Patella- replaces knee cap Patella- replaces knee cap

30. Total Knee Replacement: Cemented or Cementless Cemented implant is held in place by a type of epoxy cement that attaches the metal to the bone. Cemented implant is held in place by a type of epoxy cement that attaches the metal to the bone. Uncemented implant has a fine mesh of holes on surface allowing tissue to grow into. Uncemented implant has a fine mesh of holes on surface allowing tissue to grow into. Source: www.aaos.org, 2003www.aaos.org

31. Total Knee Replacement Two major types of total knee replacement systems: Two major types of total knee replacement systems: Fixed Bearing- does not allow full range of motion Fixed Bearing- does not allow full range of motion Rotating Platform Bearing- closely simulates the action of the normal knee joint Rotating Platform Bearing- closely simulates the action of the normal knee joint Source: www.jointreplacement.com, 2003www.jointreplacement.com

32. Potential Benefits of Fixed Bearing Total Knee Replacement Provides pain relief. Provides pain relief. Restores the motion of your knee. Restores the motion of your knee. Improves quality of life. Improves quality of life. Good results in appropriate patients. Good results in appropriate patients. Source: www.jointreplacement.com, 2003www.jointreplacement.com

33. Potential Benefits of Rotating Platform Total Knee Replacement Provides pain relief. Provides pain relief. Restores the motion of your knee. Restores the motion of your knee. Rotation similar to a normal knee. Rotation similar to a normal knee. Reduces potential of early wear and loosening. Reduces potential of early wear and loosening. Improves quality of life. Improves quality of life. Source: www.jointreplacement.com, 2003www.jointreplacement.com

34. Surgical Procedure Patient is anesthetized. Patient is anesthetized. Incision is made. Incision is made. Arthritic surface at the end of the thigh bone or femur is removed. Arthritic surface at the end of the thigh bone or femur is removed. Bone is prepared for a new covering. Bone is prepared for a new covering. Femoral component is attached. Femoral component is attached. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

35. Surgical Procedure Arthritic surface on top of the shin bone is removed. Arthritic surface on top of the shin bone is removed. A metal tray (tibial tray) is placed on top of remaining bone. A metal tray (tibial tray) is placed on top of remaining bone. Tibial insert locked into tray. Tibial insert locked into tray. Incision is closed. Incision is closed. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

36. Preparing for Joint Replacement Surgery Ease anxiety by mentally preparing with: Ease anxiety by mentally preparing with: Breathing exercises Breathing exercises Meditation Meditation Talking with friends and family Talking with friends and family Learn more about knee replacement surgery: Learn more about knee replacement surgery: Brochures Brochures Handouts Handouts Websites Websites Videos Videos Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

37. The Night Before Surgery Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.). Do not consume any food or liquid after midnight. Do not consume any food or liquid after midnight. Make sure you have everything you’ll need at the hospital. Make sure you have everything you’ll need at the hospital. Ask any questions you may have before surgery. Ask any questions you may have before surgery. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

38. After Surgery Movement of knee determined by doctor. Movement of knee determined by doctor. Physical therapy is very important to regain mobility and strength. Physical therapy is very important to regain mobility and strength. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

39. A Caregiver’s Role Provide support and show patience Provide support and show patience Help with needs that the patient can not do, like: Help with needs that the patient can not do, like: Bathing Bathing Cooking Cooking Dressing Dressing Daily chores (running errands, driving to appointments, etc.) Daily chores (running errands, driving to appointments, etc.) Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

40. Hospital Discharge You will be released from the hospital as soon as you can: You will be released from the hospital as soon as you can: Get in and out of bed safely. Get in and out of bed safely. Walk up to 75 feet with your crutches or walker. Walk up to 75 feet with your crutches or walker. Get up and down flight of stairs. Get up and down flight of stairs. Access the bathroom. Access the bathroom. Demonstrate good muscle contraction of the upper thigh muscle. Demonstrate good muscle contraction of the upper thigh muscle. Hospital stay usually lasts 3 to 4 days. Hospital stay usually lasts 3 to 4 days. May continue physical therapy at a rehabilitation center or at home. May continue physical therapy at a rehabilitation center or at home. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

41. Recovery in the First Week Continued use of your walker or crutches is required. Continued use of your walker or crutches is required. With a cemented procedure, increase weight on sore leg as comfortable. With a cemented procedure, increase weight on sore leg as comfortable. With a cementless procedure, place only the toes down until a follow-up x-ray. With a cementless procedure, place only the toes down until a follow-up x-ray. Source: www.Jointreplacement.com, 2003www.Jointreplacement.com

42. Recovery in the First Month Sutures or staples usually taken out 10-14 days after surgery. Sutures or staples usually taken out 10-14 days after surgery. Do not shower or bathe until the sutures or staples are removed. Do not shower or bathe until the sutures or staples are removed. Motion exercises should be progressing. Motion exercises should be progressing. Source: www.aaos.org, 2003www.aaos.org

43. Recovery After Six Weeks Swelling normal for first three to six months Swelling normal for first three to six months Elevate leg slightly and apply ice. Elevate leg slightly and apply ice. Driving Driving 1 to 2 weeks- Left knee replaced and automatic transmission. 1 to 2 weeks- Left knee replaced and automatic transmission. 6 to 8 weeks- Right knee replaced. 6 to 8 weeks- Right knee replaced. Return to work in 6 to 8 weeks depending on type of work. Return to work in 6 to 8 weeks depending on type of work. Source: www.aaos.org, 2003www.aaos.org

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