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A knack for knees

Treatment options for knee pain


More people are opting for knee replacements. In fact, more than 700,000 knee replacements are performed each year, and the rate of total knee replacement from 2000 through 2010 grew 86 percent for men and 99 percent for women, according to the Centers for Disease Control and Prevention (CDC).

“It’s very common to see some type of joint pain every day, said Dr. Justin Asbury, a family medicine provider at Novant Health Oceanside Family Medicine - Leland. “Knee pain and back pain are always around the top 10 visit types overall for people to primary care offices based on CDC statistics,” he said.

Knee replacement surgery is one of the most common orthopedic procedures in America.  With an aging population wanting to remain active, and with obesity on the rise, it is estimated that knee replacement cases will exceed 3 million a year by 2030.

Causes of knee pain

“In general, the most common causes of musculoskeletal knee pain include osteoarthritis, bursitis/tendonitis, overuse injuries and trauma/acute injuries,” Asbury said.

Asbury said it is important for a provider to gather an accurate history to help narrow a differential diagnosis for a broad symptom such as knee pain. Among the issues a provider will assess:

  • Is the pain acute or chronic?
  • Is there any swelling?
  • Does the patient have a history of previous injury or surgery?
  • Are there other symptoms present?

Provider will also examine patients to determine the specific pain location of the knee as well as the areas above or below the joint.

“This will help lead a more efficient process of diagnosing the cause and, therefore, treatment,” Asbury said. “Any ‘red flags’ or atypical signs noted may lead one to consider less common causes such as fractures, infections, tumors and rheumatologic processes.”

Who is most vulnerable to knee pain?

Patients 50 years old and older are susceptible to pain caused by musculoskeletal issues, particularly osteoarthritis, Asbury said. It is even more frequent in people who are older than age 65.

“Based on CDC and National Health Interview Survey statistics from the last five years, osteoarthritis has been diagnosed in 23 percent of Americans, and arthritis is the leading cause for disability in America,” Asbury said. “Knees are a significant contributor to this.”

That is not to say that younger people are not vulnerable to knee pain as well. Asbury said that there are some reports of increased sports-related injuries including knees over the past decade, but this may also be partially related to improved and earlier diagnosis and more aggressive management.

What does alarm the physician is knee pain in children caused by obesity. “One-third of all American children are overweight or obese, and this is continuing to increase,” Asbury said. “Over the years, this is becoming a major contributor to joint pain and osteoarthritis.”

Treatments for knee pain

Treatments for knee pain may vary greatly, depending on the severity of the problem. In some cases, treatment may simply require resting the leg, elevating it, and applying ice packs and compression, the doctor said. Anti-inflammatory medicines are usually sufficient to help with the pain.

“I will often recommend strengthening and stretching exercises or refer a patient to physical therapy as well,” Asbury said. “Sometimes a brace may be necessary even short-term. If the pain is related to chronic osteoarthritis, there are some joint injections that may be of benefit as well.”

Weight loss is another area that Asbury will recommend when necessary. “There are many studies with clear evidence of osteoarthritis of knees being linked with obesity,” he said. “Moreover, there are studies showing improvement of joint pain and quality of life with weight loss.”

These are normally the first line of treatment unless the pain is caused by an acute injury or trauma.

When surgery becomes necessary

One of the most common causes for knee surgery is the progression of osteoarthritis, Asbury said. Other injuries to the joint may require knee surgery, too.

Asbury said that if the nonoperative management of the pain doesn’t alleviate a patient’s pain or if there are other acute concerns, he would refer a patient to an orthopedic surgeon.

Do you suffer with knee pain? First, talk to your primary care provider about what you’re experiencing. He or she may refer you to a specialist for care. If you don’t have a primary care provider, find one at NovantHealth.org/doctor.





Published: 5/10/2017