MANAGING KNEE OSTEOARTHRITIS
1) DIAGNOSIS IS NOT BASED ON YOUR X-RAY
A diagnosis of knee Osteoarthritis (OA) needs to be done clinically. Just because you are older and have knee pain does not mean OA is the cause. We may use an X-ray of your knees to assist with diagnosis, but this is more to exclude other pathologies such as fractures. Degenerative changes found on an X-ray has poor correlation with symptoms and disability and AVOyou can guarantee mostpeople your agehave it.
2) THE AIM IS TO ID A JOINT REPLACEMENT
As joint replacements become more common we forget that they are major surgeries with significant risks. We should not be rushing to replace your knee before trying other less invasive, less risky and less costly interventions first. Furthermore, most people think a knee replacement will have a 100% chance of success. In fact, research has shown 20% of people continue to have significant pain after a knee replacement.
3) INITIAL TREATMENT SHOULD INCLUDE EXERCISE, PHYSIOTHERAPY AND WEIGHT LOSS
The initial management of knee OA should focus on non-invasive proven methods to help relieve your pain. Research shows that strengthening exercises that target the knee and hip as well as walking will help your pain. The stronger you are in the hip and leg the less force we put through the knee. Treatment by a physiotherapist can also help your pain and range of movement, and they will be able to guide you in starting exercises. Weight loss is of huge benefit in knee pain. A loss of 5% body weight can improve your pain and function significantly. Exercise and consulting a dietician can help with this.
Pain relief medication is an important aspect of managing knee OA. Talk to your GP or pharmacist about appropriate medication. The aim of pain relief medication is to enable to you be more active so that you can lose weight if needed and strengthen the muscles around your knee and hip. It may also be used as a long term strategy if mild medications are enough to cover your pain.
If knee OA is the true cause of your knee pain then it isn’t something that has happened overnight. Years of bony changes couples with poor muscle strength and increased load on the joint have been gradually making the nerves in your knee more sensitive. It is only reasonable that treatment will take some time and not fix you overnight or in 2-3 sessions. The changes in weight and strength we need to see to relieve your knee pain take months to happen. So be realistic with your expectations and you will see gradual improvements.
6) DON’T BE TEMPTED BY KNEE ARTHROSCOPIES
In some cases where the knee is locking or giving way they are indicated, but if this is the case then it probably isn’t knee OA causing your pain.
7) THERE’S A REASON QUEENSLAND HEALTH TAKES A LONG TIME TO GIVE YOU A KNEE REPLACEMENT
And I mean other than long waiting lists. Queensland Health takes a long time because they use an evidence based approach to managing knee OA. They know that most of the time people’s pain can be significantly reduced with simple measures like physiotherapy, weight loss, exercise and pain relief medication. They want people to attempt these interventions first because it is better for you and for the health system. That is why every elective knee replacement through Queensland Health sees a physiotherapist, dietician and pain psychologist before they even see a surgeon.