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