By Judd Matsunaga, Esq.
For the past few weeks, I’ve been limping around with knee pain. But, before I see a doctor, I thought it would be a good idea to research my options. So, I purchased a guide called “Total Knee Replacement” from Harvard Medical School.
Apparently (self-diagnosed), I’ve got osteoarthritis, a degenerative joint disease. Up to 97% of total knee replacements are performed, directly or indirectly, because of osteoarthritis.
Osteoarthritis, often called chronic “wear and tear” arthritis, is the most common joint disorder in the U.S. By age 65, most of us will be dealing with some degree of arthritis, and it becomes more common with aging. One in three people over age 62 has osteoarthritis in one or both knees. An estimated 10% of all men and 13% of all women in the U.S. have knee arthritis.
However, before I see the doctor, I wanted to know more about how the knee is put together so that I can have a more informed and productive conversation. According to the Harvard guide, the knee joint consists of three bones: the thighbone (femur), shin bone (tibia), and kneecap (patella). These bones are protected by shock-absorbing pads of cartilage.
Deeper inside the joint, a pair of ligaments connects the femur and tibia in the front and back. They are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). The PCL and ACL are prone to injury from high-impact sports like skiing, football, and basketball. This joint bears extra stress when you walk on inclined terrain, go up and down stairs, kneel, squat, or rise from a sitting position.
In healthy joints, the ends of the bones are covered by cushioning cartilage that allows the joints to flex smoothly and painlessly. This padding helps to protect the knees, which are vulnerable because they bear the daily burden of walking, carrying, climbing, kneeling, and other movements, at home or at work.
Osteoarthritis breaks down the soft, slippery covering of cartilage where bones meet to form joints. As the cartilage wears away, bones may start to rub against each other, causing pain, stiffness, loss of motion, and swelling. As the disease advances, damage to bone and cartilage can lead to visible deformities, like bowed legs or knock-knees, that interfere with normal walking.
The symptoms of osteoarthritis depend on how far the disease has advanced, what parts of the knee joint are affected, and individual factors like body weight and physical activity level. Over time, osteoarthritis starts to rob you of your ability to exercise, work, travel, and live independently. Classic signs of knee arthritis:
- Pain that gets worse with activity but eases when you rest
- Stiffness when you wake up or after prolonged sitting
- Swelling and a feeling of warmth in the joint
- Sudden locking or buckling of the joint
- Decreased range of motion
- Grinding or crunching sounds when you flex your knee.
If your ability to function day to day declines, you may start wondering if you need to have a new knee joint (or two) installed. Knee repair can be life-changing. It often reduces pain dramatically and boosts overall quality of life. A recent study found that most people were 80% to 100% satisfied with the results of their knee replacement. In total knee replacement, metal, ceramic, and plastic parts replace deteriorated bone and cartilage.
Knee replacement is an elective procedure — you decide whether and when to have it. For most people, knee replacement surgery results in less pain, increased mobility, improved day-to-day function, and greater independence and self-reliance. A new knee won’t allow you to do more than what you could before, but it should provide a better quality of life.
However, knee replacement is a major surgery. You and your doctor will work together to decide whether knee replacement offers you enough benefit to offset the risks. Risks??? Not all total knee replacement procedures are successful. Some implants fail early, typically because they loosen or become infected. The failed implant usually needs to be removed and replaced, a procedure known as revision surgery.
So here’s where I am. Based on my research from the Harvard guide and other sources, I should consider knee replacement surgery ONLY IF non-surgical options fall short or stop working. “Knee replacement should only be considered after you’ve tried everything else,” says Harpal S. Khanuja, M.D., chief of hip and knee replacement surgery with the Department of Orthopedic Surgery at Johns Hopkins. (Source:www.hopkinsmedicine.org)
So what’s “everything else”? According to Dr. Khanuia, “That includes following your doctor’s recommendations for losing weight, physical therapy, pain management, and modifying your activities”:
• Weight Management. This is one of the top ways to fight osteoarthritis. Excess weight puts more pressure on your knees. This increases inflammation and likely contributes to disease progression. Every 10-pound loss relieves 30 pounds of force on your knee per step. One study found that overweight people who lost just 10 percent of their body weight experienced significantly less knee pain, could walk faster, and moved better. They also had lower levels of inflammation.
• Physical Therapy. Your physical therapist will also instruct you on exercises you should do on your own to improve joint range of motion and to strengthen your leg muscles. Many orthopedic surgeons recommend stretch and strengthen the knee exercises for 20 to 30 minutes, two to three times a day. The stronger the muscles holding your knees, the better. Your joints will be more stable and will work better with less pain. After leaving the hospital, find a physical therapist who is used to working with people who have had joint replacement. Follow your physical therapist’s instructions so you don’t overwork the repaired knee or surrounding muscles and tendons.
• Pain Management. Your healthcare provider might suggest medications to relieve the knee pain and any other symptoms you’re experiencing. Most people can take over-the-counter NSAIDs (ibuprofen, aspirin and naproxen) or acetaminophen (Tylenol). Don’t take these medications for more than 10 days in a row without talking to your provider or if you have kidney or liver disease.
• Modifying Your Activities. Be smart. Don’t start training for a marathon or join a basketball team. Instead, try lower-impact exercise such as swimming, walking, or using an elliptical machine. Moderate physical activity won’t increase your risk of osteoarthritis. Most people can discontinue physical therapy after three months, by which time all activities should resume.
Because I don’t like being in a hospital as a patient, I plan on trying all the above — and more! I also found online a video on the “Five Worst Foods for Arthritis and Joint Pain” by licensed chiropractor Dr Brian Paris. He’s been featured in The Washington Post, NBC, TEDx, Men’s Fitness, Women’s World, The Chicago Tribune, The Washington Examiner, plus much more. (Source: www./healthandwellnesstools.com/products)
According to Dr. Paris, the five worst foods for arthritis and joint pain are:
1. Gluten. Gluten is a protein found in many grains, including wheat, barley, and rye. It’s common in foods such as bread, pasta, pizza, and cereal. In addition, gluten can be in everything from soy sauce and ice cream to certain medications, beauty products and dietary supplements. Gluten provides no essential nutrients. A gluten-free diet is necessary to eliminate the inflammation and the symptoms.
2. Trans-fat. Most trans-fats are formed through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature. This partially hydrogenated oil is inexpensive and less likely to spoil, so foods made with it have a longer shelf life. Industrially produced trans-fat can be found in margarine, vegetable shortening, fried foods, and baked goods such as crackers, biscuits and pies. Trans-fat is a type of dietary fat. Of all the fats, trans-fat is the worst for your health. Too much trans-fat in your diet increases your risk for heart disease and other health problems.
3. Alcohol. In high amounts over many years, drinking can damage your liver, blood vessels and heart. It also increases inflammation and blood pressure and may alter gene expression, leading to various types of cancer and other problems. Alcohol can increase your risk of having a heart attack or stroke. Alcohol also weakens heart muscles, which can affect the lungs, liver, brain and other body systems, and cause heart failure. Drinking also adds calories that can contribute to weight gain.
4. Sugar. The body requires no added sugars to function properly. Many people consume too much sugar from drinks and foods that contain added sugar. Too much sugar can cause a range of serious health problems, including diabetes, dementia, and obesity. A study by Harvard researchers found an association between a diet high in refined sugars and a greater risk of dying from cardiovascular disease.
5. Blackened, Charbroiled and Grilled Foods. To get that blackened crust, you’ll ideally need to make sure your food is dipped in melted butter and then coated in the seasoning mix. Charring meat, poultry and fish can lead to the formation of heterocyclic amines (HCAs), carcinogens that may cause cancer, according to the American Institute for Cancer Research (AICR). Grilled foods can be bad for you because cooking meat at high temperatures can create carcinogens that may increase the risk of cancer. However, grilling vegetables is generally safer because they don’t contain muscle proteins or fat. The AICR also cautions that diets high in red and processed meats increase the risk of colon cancer regardless of how you cook them.
In conclusion, the experts say that you want your first knee replacement to be your last. Artificial joints have a limited life span. Assuming an average level of physical activity, you can expect today’s joint implants to last 15 to 20 years, sometimes longer. So, if I want to still be walking at 95, I want to try to delay total knee replacement until I’m 75. Then, if I’m still around, I’ll still be walking at age 95.
With any luck, I’ll be able to get around for a few more years (I’m currently 66). But, according to the Mayo Clinic (www.mayoclinic.org/diseases-conditions/knee-pain), I’ll go see the doctor sooner if I:
- Can’t bear weight on my knee or feel as if my knee is unstable or gives out
- Have marked knee swelling
- Am unable to fully extend or flex my knee
- See an obvious deformity in my leg or knee
- Have a fever, in addition to redness, pain and swelling in my knee
- Have severe knee pain that is associated with an injury
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.