DEAR DR. ROACH: I am a female in my 60s, and for the past couple of months I have been having some discomfort and swelling in my right knee. I am slightly overweight and have osteoarthritis. I have no pain when walking, but when leaning over, I get a tight pain in the front of the leg, below the knee. I saw my orthopedic doctor, who told me that the cartilage is worn away, and said that I would need a knee replacement. I was given a cortisone shot, which helped the pain.
Would losing weight help me avoid surgery? I take an anti-inflammatory and rubbed Bengay on the knee, which helped. I went for another opinion from a second orthopedic surgeon, had more X-rays taken and was given the same diagnosis. Is there anything more I can do to avoid having a knee replacement soon? — C.W.
ANSWER: Osteoarthritis of the knee can cause permanent loss of the cartilage. Once the cartilage is gone, the knee replacement is by far the best option to reduce pain and improve function. However, there are some things you can do to delay the need for surgery, as well as to feel better. Losing weight is important, if you are carrying more than you should. Your body weight is multiplied when you are going up and down stairs, so losing even a few pounds means much less pressure inside the knee.
Anti-inflammatories and Tylenol reduce pain but don’t affect the progression of disease. Bengay, topical anti-inflammatories and capsaicin creams help some people. Steroid injections are a good option for some: Hyaluronic acid shots, such as Synvisc, help many as well. Exercise, however, defi- nitely improves both pain and function. Walking a little bit farther each day means being able to walk still more without pain.
A joint-replacement surgery shouldn’t be undertaken lightly. Not everybody has a good outcome, and an infection in an artificial joint can be devastating. However, it has been my experience that most people who have gotten a joint replacement wish they had done so sooner, so don’t suffer for too long if these treatments aren’t helping.
The arthritis booklet discusses osteoarthritis, along with rheumatoid arthritis and lupus. Readers can order a copy by writing: Dr. Roach — No. 301W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.