From a presentation by
Dr. Eric Heimberger
McLeod Orthopaedics Seacoast
Bad knees rank as one of the most common problems an orthopedic surgeon sees. McLeod Orthopedic Specialist Eric Heimberger, MD, says that knee joint replacement may be the ultimate treatment, but it’s not where he starts:
Here’s a summary of Dr. Heimberger’s treatment options for knee arthritis:
Knee arthritis is definitely the most common patient complaint that I see in my office. Typically, it’s osteoarthritis (normal wear and tear), although we do get patients with rheumatoid, psoriatic, or post-traumatic arthritis from a past injury.
Treatment always starts with conservative options. The worst thing is to recommend surgery when the patient has not tried other treatments. For knee arthritis, we will try anti-inflammatory medications, cortisone injections or gel shots. Success with injections largely depends on how far the arthritis has progressed. We might also try physical therapy, bracing and eliminating certain vigorous activities. In the majority of people, arthritis can be managed that way for a while. Yet, eventually they end up with painful bone-on-bone and difficulty walking. It’s more than pain. It’s stability. A person’s knee buckles or gives out on them. At that point, we’ll turn to surgery for a total knee joint replacement.
You may have heard about partial knee replacements. Also, at one time people talked about female knee replacement joints. But there really is no difference between a female and a male anatomy of a knee. So, the women’s knee was really more of a marketing gimmick and never really panned out to be anything more than that. Partial knee replacement’s kind of the same way. But those patients would end up coming back and having to have a regular knee replacement done. Total knee replacement is pretty much the gold standard. The “joint” is basically two metal pieces with a plastic piece. By using these inserts, we can get rid of the arthritis and straighten the deformity of the knee, allowing the patient to walk without the pain and instability that they had before surgery.
These days, recovery has improved. Probably 90 percent of my patients go home the day after surgery. They don’t have to go to rehab anymore. They go home. Therapy starts at home day one, walking in the hallway that day. In 6 to 8 weeks, the patient is up walking around without using a cane. They may still have some pain and swelling, but doing pretty well. Recovery time for knee replacements is longer than hip replacements. Hip replacement patients usually recover in about 6 weeks. The patients are doing great and we’re having to tell them to slow down. But with knee replacement, it’s the other way around. They take a while, but the end result is a much, much better knee.
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