So, you’ve decided to go ahead with a knee replacement surgery; a total knee arthroplasty. A decision not to be taken lightly, but a decision you’ve probably come to terms with. I’m quite sure it has been a long process to get to this point, and unfortunately for most, it may still be a long road before you’re in the operating room.
The following is a list of treatment modalities that may help you live a more active, and pain-reduced lifestyle during this waiting period:
Knee braces are designed to support and reduce the stress on the knee joint. There are many different types of knee braces; ranging from compressions sleeves to custom unloading braces. They all serve a specific purpose, and it is important to know which one(s) will be most beneficial given your pain level, activity level, and pathology. Knee braces can be worn for any length of time during the day. Some individuals may find it helps to wear a brace for longer periods of their work day, others may only wear a brace for weight-bearing activities like hiking, or golf. Focus on when your knee hurts, and start wearing the brace for those times. Ultimately you want to wear a brace to reduce symptoms, which will hopefully allow you to enjoy your activities, and go through life, with less pain in your knee(s).
Physiotherapy and Exercise
A primary goal of a physiotherapist is to educate their patient. This is no different when one is treating symptoms related to knee osteoarthritis. Education is vital to rehab because the treatment modalities and patient goals should be specific to the individual. These goals may include improving range of motion of the knee, improving strength in the hip and knee musculature, decrease swelling, decrease pain, and improving function. Your surgeon would tell you that being in your best physical condition possible before surgery can improve your post-operative outcomes. Physiotherapy modalities that decrease your knee symptoms, along with the strength-increasing exercises they give you, will put you in the ideal preoperative state.
Neuromuscular electrical stimulation (NMES) is the application of electrical stimuli to muscle tissue. The purpose is to combat disuse atrophy, and assist in muscle retraining. In terms of knee osteoarthritis, when you start to reduce your activity level because of pain, you start to lose muscle mass that provides strength and stability to the knee joint. In this sense, you’re dealing with a cycle of detrimental factors; the more pain you’re in, the less you might do, the less you do, the more pain you could have. Secondary to muscle weakness, or disuse atrophy, is muscle reeducation. We can look at compensatory factors as a cause for having to reeducate muscles. Most people will avoid pain in their knee(s) by adjusting the way they walk; shifting their weight from the bad side to the good side. This can lead to the improper use of certain muscles, even if you are trying to keep up with activity levels or daily tasks – “fighting through the pain”. NMES is best used in conjunction with specific exercises, and a physiotherapist is a great resource to set you up with these exercises.
Transcutaneous Nerve Stimulation (TENS) technology consists of sending electrical pulses through electrodes or conductive gel pads placed on the skin to provide pain relief. The following are general theories accepted by the medical community for how surface neurostimulation provides pain relief.
- Pain gate control blocks the pain signals going to the brain
- Endorphin release, whereby it increases the production and release of endorphins reducing the pain sensation.
Orthotics, although not as effective as other treatment modalities listed here for treating knee osteoarthritis, can be a great adjunct for continuing an active, healthy lifestyle while waiting for your surgery. Orthotics can help with lower extremity alignment issues, but they are even better at dampening the forces that the lower extremity joints and soft tissues experience during weight-bearing activities.
Kodiak Cold Therapy Therapy
Increasing your activity to improve strength and function of the affected knee(s) may seem counterproductive if every time you exercise, your knee becomes swollen and irritated. The Kodiak ice therapy is a great device that can help combat these post-exercise/activity symptoms. Keep in mind it is best to have a physiotherapist direct the exercises and activities you’re doing. There may be certain movements you should stay away from despite the strength and cardiovascular benefits, but try not to allow the symptoms of knee osteoarthritis limit you from everything. The Kodiak device allows you to apply continuous cold therapy for a longer duration than ice, along with an easy to use, joint-specific pad, it is a safer and more efficient way to reduce swelling and inflammation. In addition to post-exercise, or even daily preoperative use, these devices are strongly recommended for post-operative care.
Monovisc is a type of hyaluronic acid injection; a gel-like substance that is a component of the synovial fluid of a healthy knee joint. The naturally occurring synovial fluid of a healthy joint acts as a lubricant and shock absorber. The thought behind the Monovisc injection treatment is to inject the compartment(s) of the knee joint affected by knee osteoarthritis to lubricate and decrease pain. The effects of Monovisc has been shown to last up to six months.
Cingal is a viscous, sterile mixture of hyaluronan with a steroid. The thought behind this treatment is to combine the fast-acting effects of a corticosteroid with the longer-lasting effects of a viscosupplement.
Atlantic Arthritis School Association
Attend a free public information session on Living with Osteoarthritis held by the Atlantic Arthritis School Association. This is a non-profit organization working to inform the public of innovative treatment options and simple lifestyle changes that can help with the pain. During these sessions certified healthcare professionals offer education on exercises, nutrition, conservative treatment options, pain management and more. You can find out more about who they are at http://arthritisschool.ca/.
The problem in Atlantic Canada with respect to the growing wait list in regards to knee (and hip) replacements is a serious issue that we, at Arthritis & Injury Care Centre, follow and try to do all that we can for our community. So while you wait please give us a call and schedule a no obligation, one-on-one consultation to see what options are out there for you!
Russell Cattoor, BSc Kin., C.Ped (C)
Arthritis and Injury Care Centre