No guarantees with knee surgery
You can avoid getting knee surgery, but it’s a long and laborious process
The burning in his kneecaps was what Richard Bedard noticed first. Then came the tenderness and pain. Sitting for 10 hours a day as a financial editor in Hong Kong was agonizing. So was walking short distances or just standing in the elevator.
Neither doctors nor physical therapists could offer any lasting relief. Surgery loomed. But Bedard tried a different approach: a personal experiment to try to repair the cartilage in his knees with special exercises. It wasn’t easy and it took more than a year to accomplish, but he sidestepped a knee operation.
Now, 10 years later, Bedard, 57, runs around with his young kids, climbs stairs and bikes up to 60 miles on weekends, all without pain.
“It was, all and all, a lengthy process,” said Bedard, who has written an e-book about his successful effort to fix his knees without surgery. These days, he added, “I still notice some burning in my knees when sitting,” but for the most part, “my knees feel really good.”
Studies suggest about one in four adults suffer from chronic knee pain.
The number of sore, swollen and stiff knees has risen 65 per cent in the past four decades and the increase can’t be explained by aging or obesity alone, according to the National Health and Nutrition Examination Surveys and the Framingham Osteoarthritis study.
Knee pain is mostly caused by osteoarthritis, a chronic condition that afflicts an estimated 30 million Americans of all ages. It is the most common form of arthritis and is caused when the cartilage, which cushions joints, becomes injured and worn, resulting in pain, swelling and stiffness.
Cartilage is the cushion that enables joints to move. But it has no pain receptors, so injuries go unnoticed until much of the cartilage has worn away and the joint is damaged.
When the knee cartilage is gone and the joint pain severe — known as stage four or end-stage knee disease — the treatment options are painkillers and total knee replacement, the most commonly performed in-patient surgical procedure for people 45 and older in the United States.
While artificial knees can rid recipients of chronic pain and improve quality of life, research suggests that pain persists in as many as 20 per cent of knee replacement patients.
The procedure requires general anesthesia and an average of three to four days of hospitalization, followed by months of physical therapy. Potential risks of knee replacement surgery range from infection to blood clots.
Which is why experts say there is strong interest in non-surgical alternatives to cut joint pain and provide more mobility and a better quality of life.
The first line of treatment for osteoarthritis includes the basics: strengthen leg, hip and core muscles, engage in low-impact aerobic exercise and neuromuscular education, according to evidence-based guidelines issued by the American Academy of Orthopedic Surgeons in 2013.
The bottom line is that those who have early osteoarthritis, which is described as knee pain during physical activity and joint achiness, are most likely to benefit from the standard lifestyle treatment of more physical activity and weight loss.
“But it takes time and effort,” Matzkin says, “and a lot of patients are looking for a quick fix.”
This is why many other treatments are now available and are often advertised for knee relief.
They include acupuncture, external braces, dietary supplements glucosamine and chondroitin sulphate, needle lavage, injections of growth factor, stem cells or hyaluronic acid, arthroscopy to repair meniscus tears, use of acetaminophen, steroid injections, opioid drugs and pain patches.
Most of these widely used treatments fail to address the underlying problems of cartilage loss and joint repair, says Matzkin, noting that “once the cartilage is damaged and worn down you can treat the symptoms, but you can’t really make (osteoarthritis) go away.”
Since cartilage cells don’t have their own blood supply, it has long been thought that these cells could not regrow. But some research suggests that may be wrong.
Among the evidence showing that cartilage can heal is a 2006 study of 325 people, with an average age 45.
In the two-year study, which simply followed the natural history of these patients, 37 per cent of participants showed improvements in cartilage as measured by MRI, compared with 33 per cent whose cartilage worsened.
The challenge is that cartilage repair takes a lot of time, since the only way cartilage cells are nourished is by being bathed in joint fluid.
“Cartilage has no direct blood supply, so its ability to use energy to repair itself is very, very slow,” says Austin physical therapist Doug Kelsey, who has written The 90 Day Knee Arthritis Remedy.
“So, consequently, it takes a lot of time, a lot of (knee exercise) repetitions and persistence.”
Finding the “sweet spot” for injured knees can also be tricky and varies widely from person to person.
It takes just the right amount of movement and weight-bearing pressure to bathe the cartilage cells in joint fluid, allowing them to be nourished and recover without causing more joint damage. It means gently moving joints that may be stiff, swollen and painful.
What makes recovery even more complex is that knee pain doesn’t usually surface until hours after an activity.
“It can be difficult for someone to know what activities to stop doing because knee pain doesn’t usually happen during the activity,” says Laurie Kertz Kelly, a physical therapist and board-certified orthopedic clinical specialist in Austin. “The pain happens later that day or the next day.”
Is this approach right for everyone?
“All patients that go on to knee-replacement therapy have failed nonoperative treatments,” says Matzkin.
“I’m not sure that these people are really restoring their cartilage, but they made the symptoms better, and that can absolutely be done with diet and exercise.”
“Once the cartilage is damaged and worn down you can treat the symptoms, but you can’t really make (osteoarthritis) go away.”