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Keeping Your Knees Strong Safe and Stable

Online Chat: Keeping Your Knees Strong Safe and Stable

Wednesday April 24, 2013

Spectrum Health:
Welcome to today’s live chat with Dr. Patrick Zietz, a board-certified orthopaedic surgeon with West Michigan Orthopedics. Dr. Zietz specializes in sports medicine, total joint replacement, and arthroscopic surgery.

Spectrum Health:
The knee is a vulnerable joint that bears a great deal of stress from everyday activities, such as lifting and kneeling, and from high-impact activities such as jogging and aerobics. For the next hour, Dr. Zietz will answer your questions about knee injury, prevention and treatment options. He will share expert advice on ways to pace yourself as you return to warm weather and outdoor activities, choosing safe, low impact activities, and more.

Dr. Zietz will try to answer all of your questions in the next hour. If several of you ask similar questions, he may reply to one question with an answer that applies to all.

Dr. Patrick Zietz:
Good afternoon. Thank you for joining me today. Approximately 18 million patients visit a doctor or hospital because of knee pain each year. Fortunately, there are many ways to successfully treat knee pain. As more people are getting active during the spring warm-up, now is a good time to address your questions about injury prevention, knee pain and treatment. Let’s get started with your questions.

Comment From Emily:
Is there any injection treatments that have demonstrated having a beneficial effect on knee/joint pain?

Dr. Patrick Zietz:
There are two main types of injection that can help with knee pain. One is cortisone which acts as an anti-inflammatory. The other type of injections are termed viscosupplementation which can also benefit people with knee osteoarthritis. There is no evidence that injections can prevent arthritis.

Comment From Emily:
How can I prevent knee problems?

Dr. Patrick Zietz:
The best way to prevent knee problems is to stay active with low-impact exercises and to stay at a healthy weight. For every excess pound of weight you carry, your knee sees 3-5 times that when walking on flat ground.

Comment From John:
Do weight-bearing exercises on the knee alleviate arthritis?

Dr. Patrick Zietz:
Low-impact weight bearing exercises are an important treatment for knee arthritis as they can help keep the muscles around the knee strong. There is good evidence that this helps to alleviate symptoms from arthritis.

Comment From Guest:
Do you recommend any dietary supplements?

Dr. Patrick Zietz:
Many people with arthritis take glucosamine and chondroitin supplements. Many of my patients feel that this definitely helps their symptoms from arthritis. However, there is no strong evidence from the scientific literature that these supplements improve symptoms from arthritis.

Spectrum Health:
FAST FACT: What Do the Knees Do? How do they work?

The knees provide stable support for the body. They also allow the legs to bend and straighten. Both flexibility and stability are needed to stand, walk, run, crouch, jump, and turn. Other parts of the body help the knees do their job. These are: bones, cartilage, muscles, ligaments, and tendons.

Comment From Lisa:
My 16 year old daughter has had 2 knee dislocations; the last resulting in surgery to reconstruct the ligaments. She is currently in PT 2-3 times per week. She is on a varsity team at her high school and very much wants to get back to a competitive level. Is there anything else in addition to her rehab that she could be doing which will minimize the chance of another reoccurrence?

Dr. Patrick Zietz:
The most important thing is to do her rehab exercises diligently. Having strong muscles supports the knee joint and can decrease the risk of recurrent ligament injuries.

Comment From Millie:
For knees that you know there is arthritis should you stop your regular exercise when you experience just a small amount of discomfort. Age 77

Dr. Patrick Zietz:
For patients with knee arthritis, regular low-impact exercise is an important component of preventing worsening symptoms. I think it is probably safe to continue exercising despite a small amount of discomfort. If the pain worsens, you should rest or contact your physician.

Spectrum Health:
FAST FACT: What kinds of doctors treat knee problems?

Injuries and diseases of the knees are usually treated by an orthopaedist—a doctor who treats problems with bones, joints, ligaments, tendons, and muscles.

Comment From Sammy:
I have pain in my knees, mainly at night. It tends to keep my awake and lessens when I take Ibuprofen, to some extent. I don't usually have pain during the day even though I bend my knees a lot as a delivery person.

Dr. Patrick Zietz:
My patients frequently describe having pain at night but not during the day when they are active. I am not certain why this is, but I think it is related to the fact that there are no other external stimuli at that time so you notice your knee pain more.

Comment From Vicki:
Thank you for doing this Dr. Zietz. I'm 63 year old woman, overweight. Lately I've had problems with alternate pains in both knees in the same place. I don't know if it's joint or ligament. The pain is located on the lower right of the right knee and the lower left of the left knee--not on the outside, but near the outside of the knees. Comes and goes. Worse if I twist my knees. Doesn't hurt walking up steps or bending. Just wondering how to strengthen my knees and prevent this from happening. I do like to walk--maybe 6-8 miles a week.

Dr. Patrick Zietz:
Without having a chance to examine your knees or look at x-rays, it is difficult to know what your exact problem is. I think it is great that you are doing regular walking for exercise and you should continue with this. The best way to strengthen your knees is to remain active. The best activities are those that do not significantly exacerbate the pain.

Comment From Joanne:
I'm a runner and had a fall and tore my PCL about 9 weeks ago. My doctor said it should be fine, but to lay off the running, so I did. Only thing is 9 weeks later it's still a little sore. Should I give it more time or should I schedule another appointment?

Dr. Patrick Zietz:
I am not surprised that you still have some soreness nine weeks after tearing your PCL. In my opinion, you should be doing some rehab exercises to stretch and strengthen your knee. The most important muscle to strengthen is the quadriceps muscle which can help compensate for your torn PCL. If your improvement has plateaued or your symptoms are getting worse, you should see your doctor again.

Spectrum Health:
FAST FACT: Common Causes of Knee Problems

Mechanical knee problems can be caused by:

A direct blow or sudden movements that strain the knee

Osteoarthritis in the knee, resulting from wear and tear on its parts

Inflammatory knee problems can be caused by certain rheumatic diseases, such as rheumatoid arthritis and systemic lupus erythematosus (lupus). These diseases cause swelling that can damage the knees permanently.

Comment From Andy:
I shredded my ACL and cartilage two years ago. I had cartilage scope and complete ACL reconstruction in 2012, but still haven't completely recovered. My joints are week and I experience a lot of pain going up and down steps. I am currently involved with PT but the pain seems to radiate at time after excessive bending. Any exercise advice for a 35 year old man trying to get his active lifestyle back?

Dr. Patrick Zietz:
Based on your symptoms, it sounds like some of your cartilage injury involved the kneecap region of your knee. This can cause problems when going up and down stairs and with excessive bending. It is important to make sure that you are not overweight and that you keep your leg and core muscles strong. If there are specific exercises that aggravate your pain, you might want to consider skipping those.

Comment From Kendra:
My knees never “hurt” per say, but sometimes they do pop and click…should I be worried and get them checked out or is that fairly normal? I’m 33.

Dr. Patrick Zietz:
Popping and clicking of the knee is very normal. As long as it is not associated with pain, I would not worry about it.

Comment From Sammy:
Thank you for responding to comment about night knee pain. Should I continue to take Ibuprofen at night or pursue alternative pain relief?

Dr. Patrick Zietz:
If you need to take ibuprofen indefinitely, then you should discuss this with your primary care physician to make sure that it is safe. Stretching may help alleviate your pain.

Comment From Don Freehafer, PT :
Dr. Zeitz, I am a physical therapist who recently opened Freedom Physical Therapy in Byron Center and have had the opportunity to assist some of your patients. My question is in regard to the increasing number of overuse injuries that we are seeing in young athletes. A recent study out of Loyola University recommends that athletes compete/train fewer hours per week than their age. Any other specific recommendations that you routinely provide to parents/coaches to prevent injuries? Thanks!

Dr. Patrick Zietz:
There is no doubt that we are seeing more overuse injuries in younger patients. I believe this is because young athletes are participating in the same sport year round which places continued stress on the same body parts. When I discuss these problems with parents and young athletes, I stress the importance of cross-training or playing different sports to try to prevent overuse injuries. This is a difficult problem because in order for the athletes to compete at the highest level, they feel that they need to train year round.

Comment From Guest:
What is your opinion regarding knee replacement since I have very bad osteoporosis. I have gotten different opinions. Thank you

Dr. Patrick Zietz:
Knee replacement in patients with severe osteoporosis can be challenging. The problems we face at the time of surgery include getting good fixation of the implants to bone and the possibility of a fracture occurring during surgery. The decision of whether or not to proceed with a knee replacement needs to be based on the severity of your symptoms and the severity of your osteoporosis. A knee replacement should only be considered if you have failed all non-operative treatments.

Comment From Katie:
My 15 year old son’s knees click loudly when he walks up stairs and when he squats they pop. He says they don’t hurt, just often very stiff. I’m concerned there might be something else going on. Should I schedule an appointment for him to see an orthopedic specialist?

Dr. Patrick Zietz:
Most of the time, popping and clicking in a knee is normal. His complaint of the knee feeling stiff is less common. If these symptoms persist, you might want to consider having him see an orthopaedic doctor.

Spectrum Health:
FAST FACT: Ligament Injuries to the Knee

Two commonly injured ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). An injury to these ligaments is sometimes called a "sprain." The ACL is most often stretched or torn (or both) by a sudden twisting motion. The PCL is usually injured by a direct impact, such as in an automobile accident or football tackle.

Comment From Abby:
I had reconstructive knee surgery about 4 years ago to repair my ACL and MCL. Am I more prone to develop knee arthritis?

Dr. Patrick Zietz:
 We used to think that reconstructing an ACL after it was torn would decrease the risk of developing arthritis. Longer term follow-up studies of patients who have undergone ACL surgery indicate that there is, in fact, a higher risk of developing knee arthritis. We believe that at the time of the injury when you tear your ACL, there is likely some significant injury to the articular cartilage as well as the ligament. This likely contributes to the higher risk of developing arthritis in the future. The fact that you also tore your MCL does not likely contribute significantly to your risk of developing arthritis.

Comment From Barb:
I have arthritis in my knees. I live in a home with three levels, and also, I would love to start jogging again, what kinds of things would help?

Dr. Patrick Zietz:
The best treatment for arthritis includes low-impact exercises to strengthen the knee. This can also help keep your weight down. Occasional over-the-counter medication such as Tylenol or ibuprofen may also be helpful. Based on the fact that you have arthritis, I am not sure that jogging would be the best exercise for you. Swimming, biking, or walking are lower impact exercises that you may tolerate better.

Comment From Millie:
Is a stationary recumbent bike considered low-impact for the knees?

Dr. Patrick Zietz:
I would say that a stationary recumbent bike is definitely low-impact exercise. Most patients with knee arthritis would tolerate this well.

Comment From Frank:
I am 42 years old and have had hip pain for about 10 years. Am I too young to consider joint replacement surgery?

Dr. Patrick Zietz:
The decision of whether or not to proceed with joint replacement surgery is based on the severity of your symptoms, the severity of your arthritis, and whether you have had adequate nonoperative treatment. This decision needs to be individualized for every patient. In general, I counsel patients that they should put off joint replacement surgery for as long as possible. If your symptoms are severe and you have failed non-operative management, then you may be a candidate for joint replacement despite your young age.

Spectrum Health:
FAST FACT: Cartilage Injuries and Disorders

Chondromalacia (KON-dro-muh-lay-she-uh) occurs when the cartilage of the knee cap softens. This can be caused by injury, overuse, or muscle weakness, or if parts of the knee are out of alignment. Chondromalacia can develop if a blow to the knee cap tears off a piece of cartilage or a piece of cartilage containing a bone fragment.

Spectrum Health:
Is knee arthroscopy a good treatment for knee arthritis?

Dr. Patrick Zietz:
Knee arthroscopy is not a recommended treatment for knee arthritis as it is unlikely to provide any significant long-term benefit. The problem is that we are unable to replace the cartilage that is missing when somebody has arthritis. It is fairly common for a patient with knee arthritis to have an arthroscopy to treat a meniscus tear. Although if a patient has severe arthritis and a meniscus tear, they are unlikely to gain significant benefit from an arthroscopy.

Comment From guest:
What age is considered too old for joint replacement?

Dr. Patrick Zietz:
When deciding whether to proceed with a joint replacement, age is a less important factor than the patient's symptoms from arthritis and overall medical condition. I frequently ask a patient's primary care physician to assist in determining the risk involved with joint replacement surgery.

Comment From Sue:
Can you tell me about the cartilage replacement treatment and if it is available and if so, who would be a good candidate for it?

Dr. Patrick Zietz:
Only patients with localized cartilage loss are candidates for cartilage replacement procedures. The great majority of patients with arthritis have diffuse cartilage wear, so they are not good candidates for cartilage procedures. There are many different treatment options for those patients with localized cartilage loss. It ranges from stimulating scar tissue cartilage growth with micro fracture to growing cartilage cells in a lab and implanting them in the cartilage defect.

Spectrum Health:
FAST FACT: Types of Arthritis in the Knees

A common type of arthritis of the knee is osteoarthritis where the cartilage in the knee gradually wears away. Rheumatoid arthritis is another type of arthritis that affects the knee. This is when the knee becomes inflamed and the cartilage may be destroyed.

Comment From Don Freehafer, PT:
I occasionally receive inquires from patients regarding returning to running following knee replacement. I generally try to recommend alternative methods of exercise that create less impact on the joints. Even with the continued improvement in implants, do you feel that running is an absolute contraindication following knee replacement?

Dr. Patrick Zietz:
Don, I agree with your recommendations about finding alternative methods of exercise in patients after knee replacement. In my opinion, running places too much stress on the implant, and I feel it will likely lead to earlier failure. We have had continued improvement with knee implants and how we perform knee replacement surgery, but I do feel that running is an absolute contraindication.

Spectrum Health:
FAST FACT: Treatment for Knee Problems

Specific treatment for knee problems will be determined by your doctor based on: Your age, overall health, and medical history

Extent of the disease, injury, or condition

Your tolerance for specific medications, procedures, or therapies

Expectations for the course of the disease, injury, or condition

Your opinion or preference

If initial treatment methods do not provide relief, and X-rays show destruction of the joint, the orthopaedist may recommend total joint replacement for the knee.

Dr. Patrick Zietz:
Thank you again for taking time to join me today. I hope I was able to shed some light on ways to help you keep your knees strong, safe and stable and provide you with a few useful solutions for knee pain relief and treatment.

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