Knees Archive

If knee pain and swelling are severe an are not getting better, see your primary care doctor for a thorough evalucation. Image: Thinkstock

Arthritis is not the only possible cause of knee pain, swelling, and disability.

Joint replacement is a complex procedure, and finding the right surgeon and hospital can make a big difference in your outcome. In general, you're likely to have a better result and fewer complications if your surgeon performs the operation frequently (at least 100 times per year) and operates in a hospital where these procedures are commonplace. Don't be surprised if this rules out the most convenient hospital for your location.

Your orthopedist, rheumatologist, or primary care physician, or a friend who has undergone successful joint replacement, may be able to recommend a specific surgeon. But keep in mind that your insurer may restrict you to certain specialists or require a larger copayment if you go outside your plan.

Physical therapy is helpful for wear-and-tear knee osteoarthritis, especially if you start doing it early. But injecting a painful knee with an anti-inflammatory steroid medication before starting physical therapy offers no additional benefit, according to a clinical trial in JAMA Internal Medicine.

Studies have shown that physical therapy modestly reduces pain and improves daily functioning in people with knee osteoarthritis. That could mean being able to walk farther with less pain or to continue leisure activities such as gardening. Before you start physical therapy, your doctor may offer to inject the knee with a cocktail of anti-inflammatory steroid medication and an anesthetic. Hypothetically, this could make it easier for you to stick with exercise and therefore lead to better results.

Knee replacements can restore your mobility, but you don't want to get one too soon—or wait too long.

A desire to stay active and a natural aversion to pain send nearly 800,000 Americans to orthopedic surgeons each year for a hip or knee replacement. And we're seeking these operations much earlier in life. According to Dr. Scott Martin, associate professor of orthopedic surgery at Harvard Medical School, this isn't a healthy trend. "A lot of joint replacements are being done because they can be," says Dr. Martin.

Every surgical procedure carries the risk of complications — or even death. Because the average joint that's replaced only lasts 10 to 15 years, having the procedure done at age 50 instead of 70 means there's a good chance you'll need a second procedure when you're older and at higher risk for complications.

The pain from an arthritic knee can be intense, limiting daily activities and independence. Men can try a range of medications, but overall acetaminophen (Tylenol, other brands) appears to relieve pain only slightly better than a placebo pill, according to a research review in Annals of Internal Medicine.

The researchers pooled results from 137 randomized clinical trials involving about 33,000 people with knee arthritis and compared the relative effectiveness of the following treatments:

Physical therapy and weight loss can relieve knee pain and protect your mobility.

Mobility relies on the body's two largest joints, the hips and knees. We ask a lot of both these joints: they must bear our full weight and coordinate movement over a lifetime of standing, walking, running, dancing, and sports. Not surprisingly, hip and knee pain are common complaints, and nearly everyone who lives into old age can expect some trouble with these joints. But taking care of your hips and knees and managing any pain that arises will help you avoid losing mobility as you age.

Try these self-help measures when knee or hip pain strikes:

Don't rush into it, but don't wait longer than you need to.

More than 700,000 Americans will have one or both knee joints replaced this year, usually because of damage from wear-and-tear arthritis. Age itself is no barrier, and about half of total knee replacements go to people 65 and older. Replacing a joint damaged by osteoarthritis helps men stay active and independent.

Q. I have had arthritis of the knee for many years, and I prefer not to take medications for the pain. Can acupuncture help?

A. Acupuncture has been promoted for many conditions, but the results for knee arthritis have been mixed. A recent study in The Journal of the American Medical Association showed that acupuncture had a small benefit compared with no treatment in people with knee arthritis. However, when compared with a simulated or "sham" acupuncture treatment; real acupuncture was not more effective. A larger study published in 2006 with more than 1,000 people showed a similar finding.