by patrick lyons
This week I met a new patient with a long (four year) history of knee pain. He described his pain as mostly manageable… except for the past six months or so, over which time the pain had become worse for no obvious reason. He had had some x-rays of his knees done three years ago, and consulted with an orthopaedic surgeon at the time. The patient said that the surgeon thought his knee pain was a product of osteoarthritis in the medial compartment of his knee and the patellofemoral joint. The surgeon didn’t recommend surgery at the time, but he did predict that he would eventually need to have total knee replacement surgery.
Fast forward to today and this patient is reasonably certain that joint replacement surgery is the only way forward. But before making the final decision to have surgery, he was convinced by his wife to trial a period of physio first.
The patient seemed keen to better understand the need for surgery, relative to non-surgical options, as he was keen to avoid surgery if it was possible. We had what I thought was a really useful conversations about the pros and cons of proceeding with the knee replacement surgery.
I’ll provide a summary of that conversation as well as some details of the treatment I provided in the entries below.
***UPDATE***
For this patient, who for simplicity’s sake I’ll refer to as John, a major concern was that there were no viable non-surgical options to manage his knee problem. John’s view was that his knee was arthritic, and that the arthritis was causing his knee symptoms. So the only way to resolve his symptoms would be to remove the influence of arthritis by way of a joint replacement. He had assumed that the recent worsening of his pain was a result of accelerating progression of his arthritis.
John was relieved to hear that a plausible explanation for his recent increase in symptoms was his daily activity levels. John has been more sedentary over the few months. His usual golf routine had been disrupted by covid19 restrictions, and he had fallen out of the habit of walking around centennial park in an attempt to avoid crowds of people.
I explained that arthritic knees tend to be happier when we use them. And that they get cranky when we trend toward being sedentary. I felt really confident that at the very least, we could get John back to his “pre-flare up” level of symptoms… which was a level he was managing well. And I’d also be hopeful that there is room for further improvement.
The plan to get John there revolves around an initial focus on symptom reduction and setting up activity parameters so that we don’t keep stirring up the knee. And then progressing to a graded walking program to get him going on the golf course and coastal path again!