Ask the Expert: Dr. Seth Jerabek, Joint Replacement Specialist, Answers Your Questions About Knee Arthritis & When to Get a Knee Replacement

by Dr. Seth Jerabek
Knee Injury

Q1. I am 35 years old and was diagnosed with arthritis of the knee. I run about 40 miles a week and want to continue running. Is there treatment to prevent the arthritis from progressing?

I am not aware of any medications that prevent arthritis from progressing. There is a study underway at HSS on whether bracing for knee arthritis may delay the progression for certain people. In general, I’d recommend running on softer surfaces and avoid running on hard surfaces such as concrete.  Running on hard surfaces causes more impact loading of the knee, which potentially accelerates cartilage damage/arthritis. However, the location of the arthritis within your knee should also be considered. Early arthritis is often localized to an isolated compartment of the knee. My recommendations for patients with patellofemoral compartment (between the knee cap and thigh bone) arthritis are different than those with arthritis between thigh bone and shin bone. Consult with your physician about your exercise regimen.

Q2. I’m 60 years old and have pain and swelling in my knees and difficulty walking. How do I know when I should get knee replacement?

Determining the best time to have a knee replacement is based on a combination of factors. Your doctor will first determine why your knee hurts and swells. It could be many things, such as osteoarthritis, rheumatoid arthritis or gout. It also depends upon what other treatment you’ve tried. There are many non-operative treatments for arthritis and those should be tried prior to having your knee replaced. Your doctor will also take into account the degree of your disability from your condition as well as the severity on x-ray. Only after all of these factors have been considered, can a doctor provide a thoughtful answer to when your knee should be replaced.

Q3. Every time I squat down to pick up something, my knees hurt from arthritis. Is there anything I can do for the pain?

If your knees only hurt with squatting or deep knee bends and not with standing or walking, you should be evaluated by your doctor.  It could be from arthritis, but depending on the location of your pain, it could also be from a meniscus. The best treatment depends on the cause of the pain.  For arthritis, I often start with anti-inflammatory agents, physical therapy and possible bracing.  If that doesn’t help, injections are an option.  Surgery can be an option, but it depends on many factors (as listed above in Q2). Consult with your physician about treatment.

Q4. Are there any over-the-counter drugs or supplements to treat mild pain from knee arthritis?

Many patients ask about Glucosamine and Chondroitin.  Anecdotally, I have family members who swear by it.  However, quality clinical studies have failed to show a proven benefit.  I typically start by recommending anti-inflammatory agents, but co-existing medical conditions, such as kidney disease, heart disease or GI disorders, must be considered prior to starting these medications. Consult with your physician about taking supplements and other medication.

Q5. How do I know if I am a good candidate for a partial knee replacement as opposed to a total knee replacement?

The ideal candidate for a partial knee replacement is thin with a knee that has arthritis isolated to a single compartment (medial, lateral or patellofemoral), very little deformity, near full motion and ligaments that are intact.  If the arthritis is in multiple compartments, there is a large joint deformity (knock-kneed or bowlegged), a large flexion contracture (unable to fully straighten the leg) or if the knee is unstable from a ligament injury, total knee replacement is the best option.  However, many patients fall into a ‘gray area’ and the potential risks and benefits of each option should be discussed with your orthopedic surgeon.

Dr. Seth Jerabek, Orthopedic Surgeon


Dr. Seth Jerabek is an orthopedic surgeon at Hospital for Special Surgery. He is a specialist in hip and knee musculoskeletal care, including joint preserving procedures, joint replacement and complex revision joint replacement. 

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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

HSS on the Move says:

Hi Myra, our physicians will work with you to determine the best option for you. To help you find a physician, please contact Physician Referral Service at 877-606-1555 or at https://www.hss.edu/secure/prs-appointment-request.asp.

Myra Lieberman says:

Interesting. My doctor says there is nothing between my two bones in my knee. But the ACL is intact. I was a professoonal Balletdancer for years and have abused my knees. But, I””m 64 and already had my other knee replaced locally 8 years ago and regretted it. I exercise daily to keep my quads strong. Locally, it””s all or nothing. My doc has referred me to your facility as, I believe, you have a dance dept. I would love to avoid a total knee. I am able to walk without much discomfort and I think my daily exercise helps. Will they evaluate which way to go .? Doing this too young means having to do it again . Once was horrible enough and left me only 90 degree rotation , which, to me, was devestating .Any advice is welcome

julianswilson says:

Is knee replacement one of the good ideas for knee problem? What are the benefits of it? Will that have any side-effects in future or will make the joints flexible for mobility?

HSS on the Move says:

Thanks for reaching out! Knee replacement can be a good solution for knee pain. To find out if this is the right option for you, it is best to consult with an orthopedic specialist. If you are interested in visiting Hospital for Special Surgery, please contact our Physician Referral Service at 877-606-1555 or visit them online at https://www.hss.edu/secure/prs-appointment-request.asp.

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April 15, 2014 at 4:57 pm

Anjie was born with a number of challenging conditions, including bilateral PFFD- a birth defect affecting the pelvis- and a left club foot. She came to HSS when she was a baby and received treatment from a team of professionals including Dr. Daniel Green and Dr. Roger Widmann, HSS Pediatric Orthopedic Surgeons, and Glenn Garrison, Director of Prosthetics & Orthotics. Anjie began intensive physical therapy when she was only 1, and started working with Magdalena Oledzka as her primary therapist 6 years ago. Now at 13, she has a better prosthetic fit, decreased pain and was even able to walk down the aisle as a bridesmaid in her sister's wedding! We're very proud of her! #transformationtuesday #pediatrics #orthopedics #HSS

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