A person may want to consider knee replacement surgery if they have a stiff, painful knee that prevents them from performing even the simplest of activities and other treatments are no longer working.

What happens during knee joint replacement surgery?  [ Top ]

Once you are under general anesthesia (meaning you are temporarily put to sleep), an eight to ten-inch cut is made in the front of the knee. The damaged part of the joint is removed from the surface of the bones, and the surfaces are then shaped to hold a metal or plastic artificial joint. The artificial joint is attached to the thigh bone, shin and knee cap either with cement or a special material. When fit together, the attached artificial parts form the joint, relying on the surrounding muscles and ligaments for support and function.

What happens after the surgery?  [ Top ]

The average hospital stay after knee joint replacement is usually three to five days. The vast majority of people who undergo knee joint replacement surgery have dramatic improvement within weeks of the surgery. The pain caused by the damaged joint is relieved when the new gliding surface is constructed during surgery.

After knee joint replacement, people are standing and moving the joint the day after surgery. At first, you may walk with the help of parallel bars and then a walking device -- such as crutches, walker or cane -- will be used until your knee is able to support your full body weight. After about 6 weeks, most people are walking comfortably with minimal assistance. Once muscle strength is restored with physical therapy, people who have had knee joint replacement surgery can enjoy most activities (except running and jumping).

How long will I need physical therapy after knee joint replacement?  [ Top ]

After you are discharged from the hospital, you are usually sent home or to a rehabilitation facility, depending on your condition at that time. If you are sent to a facility, the average rehabilitation stay is approximately seven to ten days. If you are sent directly home from the hospital, your doctor will usually have a physical therapist come to treat you at home. Your doctor also may have you go to an outpatient physical therapy facility as the final stage of the rehabilitation process. Outpatient therapy may last from one to two months, depending on your progress.

Remember, every person is different and the course of rehabilitation will be determined on an individual basis with the assistance of your doctor and physical therapist.

Will I have to avoid certain movements and/or activities following surgery?  [ Top ]

After knee joint replacement surgery, you should not pivot or twist on the involved leg for at least six weeks. Also during this time, when lying in bed, you should keep the involved knee as straight as possible. Kneeling and squatting also should be avoided soon after knee joint replacement surgery.

Your physical therapist will provide you with techniques and adaptive equipment that will help you follow guidelines and precautions while performing daily activities. Remember, not following the given precautions could result in the dislocation of your newly replaced joint. How can I manage at home during recovery?  [ Top ]

The following tips should make your recovery at home easier.

• Stair climbing should be kept to a minimum. Make the necessary arrangements so that you will only have to go up and down the steps once or twice a day.
• A firm, straight-back chair is extremely helpful in adhering to these joint precautions. Recliners should not be used.
• To help avoid falls, all throw rugs should be removed from the floor and rooms should be kept free of unnecessary debris.
• Enthusiastic pets should be kept far away until you have healed.

You should ask your doctor before returning to such activities as driving, sexual activity and exercise.

Is knee joint replacement surgery safe?  [ Top ]

Knee joint replacements have been performed for years and surgical techniques are being improved all the time. As with all surgeries, however, there are risks. Since you will not be able to move around much at first, blood clots are a particular concern. Your doctor will give you blood thinners to help prevent this.

• Pieces of fat in the bone marrow may become loose, enter the bloodstream and get into the lungs, which can cause very serious breathing problems.
• Nerves in the knee area may be injured from swelling or pressure and can cause some numbness.
• Other bones may be broken during the surgery, which may require a longer hospital stay.
• The replacement parts may become loose or break. (This occurs rarely and takes years to develop.)

When joint replacement procedures were first performed in the early 1970s, it was thought that the average artificial joint would last approximately 10 years. We now know that about 85 percent of the joint implants will last 20 years. Improvements in surgical technique and artificial joint materials should make these artificial joints last even longer.

Osteoarthritis affects about one in every seven Americans. The chance of developing the disease increases with age. Most people over age 60 have osteoarthritis to some degree, but its severity varies. Even people in their 20's and 30's can get osteoarthritis.

Symptoms of osteoarthritis include:

• Joint aching and soreness, especially with movement
• Pain after overuse or after long periods of inactivity
• Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)

There are several factors that increase a person's chances of developing osteoarthritis. These include:

• Heredity. Some people have an inherited defect in one of the genes responsible for making cartilage. This causes defective cartilage, which leads to more rapid deterioration of joints. People born with joint abnormalities are more likely to develop osteoarthritis, and those born with an abnormality of the spine (such as scoliosis or curvature of the spine) are more likely to develop osteoarthritis of the spine.
• Obesity. Obesity increases the risk for osteoarthritis of the knee and hip. Maintaining ideal weight or losing excess weight may help prevent osteoarthritis of the knee and hip or decrease the rate of progression once osteoarthritis is established.
• Injury. Injuries contribute to the development of osteoarthritis. For example, athletes who have knee-related injuries may be at higher risk of developing osteoarthritis of the knee. In addition, people who have had a severe back injury may be predisposed to develop osteoarthritis of the spine. People who have had a broken bone near a joint are prone to develop osteoarthritis in that joint.
• Joint Overuse. Overuse of certain joints increases the risk of developing osteoarthritis. For example, people in jobs requiring repeated bending of the knee are at increased risk for developing osteoarthritis of the knee.

The diagnosis of osteoarthritis is based on a combination of the following factors:

• Your description of symptoms
• The location and pattern of pain
• Certain findings on physical examination

Your doctor may use X-rays to help confirm the diagnosis and make sure you don't have another type of arthritis. X-rays show how much joint damage has occurred.

Sometimes blood tests will be given; but blood tests do not show anything in particular that helps your doctor confirm that you have osteoarthritis. However, they can help your doctor figure out if you have a different type of arthritis.

If fluid has accumulated in the joints, your doctor may remove some of the fluid (called joint aspiration) and examine it under a microscope to rule out other diseases.

How is osteoarthritis treated?  [ Top ]

Osteoarthritis usually is treated by medications, exercise, application of hot and cold compresses to the painful joint, use of supportive devices such as crutches or canes, and weight control. Surgery may be helpful to relieve pain when other treatment options have not been effective.

The type of treatment prescribed will depend on several factors including your age, activities and occupation, overall health, medical history, location of your osteoarthritis, and severity of the condition.

What medications are used to treat osteoarthritis?  [ Top ]

Medications may be prescribed to reduce pain caused by osteoarthritis. Pain-relieving medications include acetaminophen (for example, Tylenol) and painkillers (often called NSAIDs), such as aspirin, ibuprofen, or naproxen. Some medications in the form of creams, rubs or sprays may be applied over the skin of affected areas to relieve pain.

Synvisc, Supartz and Hyalgan are medications given as a series of 3 to 5 weekly injections that can relieve pain in some people with osteoarthritis.

When osteoarthritis pain is severe and other treatments are not working, some doctors will give stronger pain pills, such as narcotics.

Unfortunately, medications do not reverse or slow the progression of joint damage caused by osteoarthritis.

How does weight and exercise impact osteoarthritis?  [ Top ]

Staying at your recommended weight helps prevent osteoarthritis of the knees, reduces the stress on weight-bearing joints and reduces pain in affected joints. Once you have osteoarthritis, losing weight also can relieve the stress and pain in your knees.

Exercise is important to improve joint movement and to strengthen the muscles that surround the joints. Gentle exercises, such as swimming or walking on flat surfaces, are recommended because they are less stressful on your joints. Avoid activities that increase joint pain, such as jogging or high impact aerobics.

Are there alternative treatments for osteoarthritis?  [ Top ]

Some medical research has shown that the supplements glucosamine and chondroitin can relieve pain in some people with osteoarthritis -- especially in the knee. There is also evidence that they can help rebuild some cartilage.

Some people also use methylsulfonylmethane (MSM) for arthritis but there is less medical evidence showing its benefits. MSM is a naturally occurring sulfur that is taken as a dietary supplement. Hot or cold compresses may be recommended to provide temporary relief of pain and stiffness. These treatments may be given in the form of a hot shower or bath, or by applying heating pads or cold compresses.

Acupuncture and bioelectric therapy also may be useful at relieving pain.

What supportive devices are available to help with osteoarthritis?  [ Top ]

Supportive or assistive devices may be helpful to decrease pressure on the joints. Knee supports may be helpful for some people to stabilize the ligaments and tendons and decrease pain. Canes or crutches may be helpful to take pressure off certain joints.

When is surgery necessary?  [ Top ]

When osteoarthritis pain is not controlled with medications and the other mentioned treatments, or when the pain prevents you from participating in your normal activities, you may want to consider surgery.

There are two surgical procedures that could be used. They include:

• Arthroscopy to clean out the damaged cartilage
• Joint replacement surgery to replace the damaged joint with an artificial one or fusing bones and essentially getting rid of the joint. Even under the best of circumstances, surgery cannot return the joint to its normal state (artificial joints do not have all of the motion of a normal joint). However, an artificial joint will very likely diminish pain. The two joints usually replaced are the hip joint and the knee joint.

What is the goal of physical therapy?  [ Top ]

The goal of physical therapy is to get a person back to the point where he or she can perform normal, everyday activities without difficulty.

Preserving good range of motion is key to maintain the ability to perform daily activities. Therefore, increasing the range of motion of a joint is the primary focus of physical therapy. Building strength in the involved muscles surrounding the joint also is extremely important, since stronger muscles can better stabilize a weakened joint.

Physical therapists provide exercises designed to preserve the strength and use of your joints. They can show you the best way to move from one position to another and can also teach you how to use walking aids such as crutches, a walker or a cane, if necessary.

What are some benefits of occupational and physical therapy programs?  [ Top ]

There are many benefits to participating in a physical and occupational therapy program, including:

• You gain education about your type of arthritis, so that you can be well informed.
• If you are overweight, a dietary plan will be created to reduce the stress of excess weight on supporting joints of the back, legs and feet. (As yet, no specific diet -- other than a diet designed for weight loss -- has proved helpful for arthritis.)
• You gain foot-care advice, including choice of well-fitting shoes with shock-absorbing outer soles and sculptured (orthotic) insoles molded exactly to the contour of each foot.
• You will learn therapeutic methods to relieve discomfort and improve performance through various physical techniques and activity modifications.

What techniques will I learn?  [ Top ]

• Rest. Bed rest helps reduce both joint inflammation and pain, and is especially useful when multiple joints are affected and fatigue is a major problem. Individual joint rest is most helpful when arthritis involves one or only a few joints. Custom splints can be made to rest and support inflamed joints and a soft collar can support the neck while you are sitting or standing.
• Thermal modalities. Applying ice packs or heating pads, as well as deep heat provided by ultrasound and hot packs, can help relieve local pain. Heat also relaxes muscle spasm around inflamed joints. Heating joints and muscles with a warm bath or shower before exercising may help you exercise more easily.
• Exercise. Exercise is an important part of arthritis treatment that is most effective when done properly every day. Your doctor and therapist will prescribe a program for you that may vary as your needs change.

Preoperative programs of education and exercise, started before surgery, are continued at home. They may be changed in the hospital after surgery to fit new needs during the rehabilitation period. These exercises may be added to your usual exercise regimen, and you may find your ability to exercise has improved after surgery.

What joint protection techniques are offered?  [ Top ]

There are ways to reduce the stress on joints affected by arthritis while participating in daily activities. Some of these include:

• Controlling your weight to avoid putting extra stress on weight-bearing joints such as the back, hips, knees and feet.
• Being aware of body position, using good posture to protect your back and the joints of your legs and feet. When possible, sit down to do a job instead of standing. Change position often since staying in one position for a long time tends to increase stiffness and pain.
• Conserving energy by allowing for rest periods, both during the workday and during an activity.
• Respecting pain. It is your body's way of telling you something is wrong. Don't try an activity that puts strain on joints that are already painful or stiff.

An occupational therapist can show you ways to do everyday tasks without worsening pain or causing joint damage. Some joint protection techniques include:

• Using proper body mechanics for getting in and out of a car, chair or tub, as well as for lifting objects.
• Using your strongest joints and muscles to reduce the stress on smaller joints. For example, carrying a purse or briefcase with a shoulder strap rather than with your hand.
• Distributing pressure to minimize stress on any one joint. Lifting dishes with both palms rather than with your fingers and carrying heavy loads in your arms instead of with your hands.
• If your hands are affected by arthritis, avoid tight gripping, pinching, squeezing and twisting. Ways to accomplish the same tasks with alternate methods or tools can usually be found.

What are assistive devices?  [ Top ]

Many assistive devices have been developed to make activities easier and less stressful for the joints and muscles. Your therapist can suggest devices that will be helpful for tasks you may find difficult at home or at work.

A few examples of helpful devices include a bath stool for use in the shower or tub, grab bars around the toilet or tub and long-handled shoehorns or sock grippers. Your therapist can show you catalogs that have a wide variety of assistive devices.

What are the benefits of exercise as an arthritis treatment?  [ Top ]

A tailored program that includes a balance of three types of exercises -- range-of-motion, strengthening and endurance -- can relieve the symptoms of arthritis and protect joints from further damage. Exercise also may:

• Help maintain normal joint movement
• Increase muscle flexibility and strength
• Help maintain weight to reduce pressure on joints
• Help keep bone and cartilage tissue strong and healthy
• Improve endurance and cardiovascular fitness

What are range-of-motion exercises?  [ Top ]

To help relieve pain, people with arthritis often keep their affected joints bent -- especially those in the knees, hands and fingers -- because it's more comfortable during the early stages of arthritis. Although this may temporarily relieve discomfort, holding a joint in the same position for too long can cause permanent loss of mobility and hinder the ability to perform daily activities.

Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. In this group of exercises, gently straightening and bending the joints in a controlled manner as far as they comfortably will go can help condition the affected joints. During the course of a range-of-motion exercise program, the joints are stretched progressively farther (maintaining comfort levels) until normal or near-normal range is achieved and maintained.

In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises, or engaging in any other physical activity. A doctor or physical therapist can provide you with instructions on how to perform range-of-motion exercises.

What are strengthening exercises?  [ Top ]

Strong muscles help keep weak joints stable and comfortable and protect them against further damage. A program of strengthening exercises that targets specific muscle groups can be helpful as part of your arthritis treatment.

There are several types of strengthening exercises that, when performed properly, can maintain or increase muscle tissue to support your muscles without aggravating your joints.

Some people with arthritis avoid exercise because of joint pain. However, a group of exercises called "isometrics" will help strengthen muscles without bending painful joints. Isometrics involve no joint movement, but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation.

Isotonics is another group of exercises that involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or by introducing light resistance with small dumbbells or stretch bands.

A physical therapist or fitness instructor (preferably one who has experience working with people with arthritis) can tell you how to safely and effectively perform isometric and isotonic exercises.

What is hydrotherapy?  [ Top ]

Hydrotherapy, also called "aqua therapy" (water therapy), is a program of exercises performed in a large pool. Aqua therapy may be easier on painful joints because the water takes some of the weight off the painful areas while providing resistance training.

What are endurance exercises?  [ Top ]

The foundation of endurance training is aerobic exercise, which includes any activity that increases the heart rate for a prolonged period of time. Aerobic activity conditions the heart and lungs to:

• Use oxygen to more efficiently supply the entire body with larger amounts of oxygen-rich blood
• Build stronger muscles

At first, people with arthritis should perform about 15 minutes of aerobic activity at least three times a week, and then gradually build up to 30 minutes daily. The activity also should include at least 5 to 10 minutes of warm-up plus 5 to 10 minutes of cool-down.

Although peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments of time throughout the day to suit your comfort level, without overexerting yourself. Aerobic exercise should be performed at a comfortable, steady pace that allows you to talk normally and easily during the activity. Ask your therapist what intensity of exercise is appropriate for your fitness level.

During exercise, your heart's "training range," or target heart rate, should be closely monitored. To improve your body's aerobic condition, you should calculate your maximum heart rate-220 minus your age-and exercise at a level of intensity between 60 percent and 80 percent of your maximum heart rate.

Examples of aerobic activities include walking, swimming, low-impact aerobic dance, skiing and biking, and may even include such daily activities as mowing the lawn, raking leaves or playing golf. Walking is one of the easiest aerobic exercise programs to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes and it's less stressful on joints than running or jogging.

Biking also may be more beneficial to people with arthritis than other aerobic activities because it places less stress on knee, foot and ankle joints. Swimming is also often recommended because there is minimal pressure on joints.

Appropriate recreational exercise, including sports, can be helpful to most people with arthritis. But only if the activity is preceded by a program of range-of-motion and strength exercise to reduce the chance of injury.

How do I begin?  [ Top ]

Regardless of your condition, discuss exercise options with a doctor before beginning any new exercise program. Also, begin any new exercise program under the supervision of a physical or occupational therapist, preferably one who has experience working with people with arthritis.

People with arthritis who are beginning a new exercise program should spend some time conditioning with a program that consists of only range-of-motion and strengthening exercises, depending on their physical condition and level of fitness. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level.

As with any change in lifestyle, your body will need time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, your sleep patterns or energy levels. These changes are to be expected with increased activity levels. However, improper exercise levels or programs may be harmful, making symptoms of arthritis worse. Check with your doctor or physical therapist and adjust your program if you experience any of the following:

• Unusual or persistent fatigue
• Sharp or increased pain
• Increased weakness
• Decreased range of motion
• Increased joint swelling
• Continuing pain (lasting two or more hours after exercising)

Regardless of the exercise program you select, it's important to begin slowly and choose a program you enjoy so that you maintain it. Make exercise part of your daily routine so that it becomes a lifetime habit.

What are glucosamine and chondroitin?  [ Top ]

Glucosamine sulfate and chondroitin sulfate are components of normal cartilage. In the body, they are the building blocks for cartilage and appear to stimulate the body to make more cartilage.

Common treatments don't change the progression of osteoarthritis. Because these supplements stimulate the production of new cartilage, it is thought that they may be able to help the body repair damaged cartilage. In fact, a study conducted in 2001 showed that glucosamine appears to slow the progression of osteoarthritis of the knee and relieves symptoms such as pain and loss of function in a majority of patients.

The supplements, which are available in pharmacies and health food stores without a prescription, are well tolerated and appear to be safe. However, there are no long-term studies to confirm their long-term safety and effectiveness.

It is important to check with your doctor before starting any new treatments. Your doctor can review the other medications you are taking and help you decide whether or not these supplements are right for you. In addition, always follow the instructions on the medication label. Do not take more of the supplements than is recommended.

Which brand of supplement should I use?  [ Top ]

There are many different brands of glucosamine and chondroitin, which are usually sold together in one supplement. Unfortunately at this time, there is no government monitoring to ensure the purity of these products.

In order to assure that you get a consistent dose of the supplements, stick with a reputable manufacturer; choose products sold by large and well-established companies. If you don't recognize a brand name, ask about the company's reputation, how long it has been in business and how long the store has stocked the brand.

Who should not take these supplements?  [ Top ]

People with diabetes should use caution when taking glucosamine because it can raise blood sugar. People taking blood-thinning medication (anticoagulants) should consult their doctors before taking glucosamine and chondroitin.

These supplements may also have a blood-thinning effect so people taking these supplements in addition to an anticoagulant may have to have their blood tested more often. People who are allergic to shellfish also should consult their doctors before using glucosamine and chondroitin. Glucosamine is extracted from a substance in shellfish.

The effects of these supplements on a growing child or developing baby are not yet known. For that reason, glucosamine and chondroitin are not recommended for children, women who are pregnant and women who could become pregnant.

What are the side effects of glucosamine and chondroitin?  [ Top ]

These supplements are generally well tolerated. However, side effects can occur. The most commonly reported side effects of glucosamine and chondroitin include:

• Nausea
• Diarrhea or constipation
• Heartburn
• Increased intestinal gas

What is MSM and can it help my arthritis?  [ Top ]

MSM, or methyl sulfonylmethane, is a dietary supplement said to help a wide range of conditions, including arthritis, allergies and even snoring.

MSM is an odorless and tasteless natural sulfur compound found in all living things. Sulfur is needed by the body for healthy connective tissue and joint function and has purported pain-quashing and anti-inflammatory properties.

While MSM is found in many foods -- including meat, fish, certain fruit, vegetables and grains -- it is destroyed when foods are processed. Dietary supplements of MSM have become increasingly popular in recent years and many people feel they have had some pain relief since taking MSM. Although some studies have reported improvement in pain with MSM, very little or no rigorous scientific research has been done to support its use for arthritis.

Moreover, as with many supplements that have not been studied, the long-term benefits and safety of the chemical are unknown.

Talk to your doctor before taking MSM.

What are the side effects of MSM?  [ Top ]

MSM is considered very safe, and side effects are very rare. Side effects that have been reported include:

• Diarrhea
• Skin rash
• Headache
• Fatigue