How common is surgery for knee pain?
Knee operations are extremely common and usually very effective. Surgery may be appropriate for repairing damage to the knee ligaments, cartilage or bone, or a combination.
What is your advice for patients with knee pain?
For Pain relief and swelling – Take the medication your GP has prescribed. Over-the-counter painkillers such as Paracetamol and Ibuprofen may also help.
Try an ice pack on the knee for 10 – 15 minutes only, up to 4 times a day. Gel packs are also available now which can be used in exactly the same way as frozen peas. Remember not to put the ice directly on the skin.
If you cannot walk without a limp, try taking some stress off the knee by using a stick in the opposite hand to the bad knee.
Wear sensible well fitting shoes or trainers.
If you are overweight you are putting more stress on your knee than if your weight is average for your height and sex.
Pace your activities throughout the day activity/rest/activity/rest and avoid deliberately making your pain worse.
When resting, sit with the leg supported with the ankle higher than the hip (especially if it is swollen).
DO NOT USE ICE ON YOUR KNEE IF YOU HAVE POOR SENSATION OVER THE AREA, RAYNAUD’S SYNDROME, AN INFECTED WOUND OR BROKEN SKIN. IF YOU ARE UNSURE OF THE CAUSE OF THE PAIN IN YOUR KNEE ALWAYS SEEK EXPERT ADVICE AND TREATMENT.
What is arthritis and why does it make my knee hurt?
Virtually any form of arthritis can affect the knee, and cause pain and swelling. These include:
Osteoarthritis. The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. The knee is one of the joints most commonly affected by osteoarthritis.
Rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disease of the joints which occurs when body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. In addition to the knees, rheumatoid arthritis, commonly affects the hands, wrists, feet, elbows and ankles.
Juvenile arthritis. Juvenile arthritis is the term used to describe arthritis when it begins at age 16 or before. There are several different types of juvenile arthritis, including juvenile rheumatoid arthritis (JRA) and juvenile idiopathic arthritis (JIA). Many can cause pain and swelling of the knee.
Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee, before becoming chronic.
Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints (primarily the knee, sacroiliac joints and joints of the feet), eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder.
Lyme disease. Lyme disease is an infectious disease characterized by a skin, rash, joint swelling and flu-like symptoms. The disease is caused by the bite of a tick infected with a bacterium called B. burgdorferi. The knee is often the first joint affected by Lyme disease.
Lupus. Lupus, or systemic lupus erythematosus, is a chronic autoimmune disease, meaning the body’s immune system creates antibodies that attack healthy tissues. In addition to causing inflammation in the knee and other joints, lupus can affect many organs, including the skin, heart, lungs, and kidney.
Ankylosing spondylitis. Ankylosing spondylitis is a form of arthritis that primarily affects the spine, causing inflammation in the spine that can lead to chronic pain and stiffening of the spine. In some people, particularly younger people, it begins with pain and swelling in the knee rather than the spine.
Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease.
Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often cause by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi.
What is a total knee replacement?
Knee replacement surgery (arthroplasty) involves replacing a damaged, worn or diseased knee with an artificial joint.
It’s a routine operation for knee pain most commonly caused by arthritis.
More than 70,000 knee replacements are carried out in England and Wales each year, and the number is rising. Most people who have a total knee replacement are over 65 years old.
For most people, a replacement knee lasts over 20 years, especially if the new knee is cared for properly and not put under too much strain.
The most common reason for knee replacement surgery is osteoarthritis. Other conditions that cause knee damage include:
- rheumatoid arthritis
- knee injury
A knee replacement is major surgery, so is normally only recommended if other treatments, such as physiotherapy or steroid injections, haven’t helped reduce pain or improve mobility.
You may be offered knee replacement surgery if:
- you have severe pain, swelling and stiffness in your knee joint and your mobility is reduced
- your knee pain is so severe that it interferes with your quality of life and sleep
- everyday tasks, such as shopping or getting out of the bath, are difficult or impossible
- you cannot work or have a normal social life
When should I have surgery?
You won’t necessarily need a knee replacement if you have arthritis of the knee. But it may be worth considering if your knee is damaged by arthritis and the pain, disability or stiffness are having serious effects on your daily activities.
Even then, your healthcare team will always try other measures before suggesting a knee replacement, including drug treatments, physiotherapy and weight loss. If your symptoms are still manageable and your medication is effective then you may prefer to wait.
Your orthopaedic surgeon will be able to advise you on the surgical options and the potential pros and cons of having or delaying surgery, taking into account your age, health and level of activity.
Most people who have a knee replacement are over 60. The earlier you have a knee replacement, the greater the chances that you’ll eventually need further surgery. However, there’s evidence that the surgical outcome may be better if you don’t wait until your knee becomes very stiff or deformed.
How do I know if I am a candidate for minimally invasive partial knee replacement?
Patients who are of appropriate age–certainly older than age 40 and older is better–and who have osteoarthritis limited to one compartment of the knee may be candidates for this exciting new surgical technique (see figures 16 17 and 18). Partial knee replacements have been done for over 20 years and the “track record” on the devices used for this operation is excellent. The new surgical approach which uses a much smaller incision than traditional total knee replacement significantly decreases the amount of post-operative pain and shortens the rehabilitation period. The decision of whether this procedure is appropriate for you can only be made in consultation with a skillful orthopedic surgeon who is experienced in all techniques of knee replacement.
Minimally-invasive knee replacement is not for everyone. Only certain patterns of knee arthritis are appropriately treated with this device through the smaller approach.
Generally speaking patients with inflammatory arthritis (like rheumatoid arthritis or lupus) and patients with diffuse arthritis all throughout the knee should not receive partial knee replacements.
Patients who are considering knee replacements should ask their surgeon whether the “mini” partial knee replacement is right for them.
What is AposTherapy®?
AposTherapy® is a clinically proven drug-free and non-surgical treatment for knee osteoarthritis and other musculoskeletal disorders. The therapy was developed by orthopaedic doctors, founded on established medical principles and incorporates cutting-edge biomechanical technology. A fully personalised care programme re-designs the way you walk by aligning the body and re-educating the muscles around your joint. AposTherapy® fits seamlessly into your daily routine, delivering lasting pain relief so you can move with confidence and Be yourself again.
Who provides the treatment?
Treatment is administered and monitored by AposTherapists, certified physiotherapists specially trained to provide AposTherapy®.
What makes the AposTherapy® personalised medicine approach so successful?
Many of our patients tell us that having tried endless solutions, with AposTherapy® they’ve finally found an approach that works. That’s because we treat you the patient as an individual, starting with a full clinical analysis of your problem joints, level of pain and day-to-day restrictions – whether climbing stairs, walking, gardening or dancing. This in-depth evaluation forms the basis of your personalised therapy programme which is easy to carry out and blends in with your existing routine for around an hour a day.
What is the technology behind AposTherapy®?
As part of AposTherapy® you receive a personally adjusted biomechanical system featuring Pertupods – convex pods located beneath the front foot and heel. Your AposTherapist will select and position the most suitable Pertupods in order to release pressure from your painful joint and introduce controlled micro-instability for muscle re-education.By combining correct body alignment with micro-instability, the unique AposTherapy® technology represents a breakthrough in the treatment of knee pain. Optimal body alignment is determined by Pertupod positioning and height, shifting the centre of pressure to control the forces acting on the joints. Controlled micro-instability – perturbation – is achieved by selecting the appropriate Pertupod convexity, resilience and weight combination.
What do AposTherapy® consultations entail?
During your initial consultation at an AposTherapy® Centre your AposTherapist will conduct a number of examinations in order to develop a personalised therapy programme that responds to your unique treatment needs. You’ll experience our state-of-the art computerised gait analysis lab, complete pain, joint function and quality of life surveys as well as be interviewed and physically examined by your dedicated AposTherapist to assess your movement patterns. Based on this evaluation you’ll receive your individually adjusted biomechanical device, the technology around which your therapy programme is built. The AposTherapy® team regularly initiates phone check-ups to monitor your progress more closely, as well as continually reassessing your therapy programme at follow-up consultations which take place at the AposTherapy® Centre. Here you’ll repeat many of the examinations you did at the initial consultation to provide an objective and subjective assessment. Throughout the process, wherever necessary, your AposTherapy® biomechanical system is adjusted and your personalised therapy programme updated to ensure your optimal treatment outcomes.
What does the computerised walking analysis check?
When an individual suffers from knee or low back pain, typically they change the way they walk to compensate for the pain. Stride gets shorter, walking speed decreases, and they avoid putting weight on the injured leg, which may lead to limping. A computerised gait analysis provides an objective scientific assessment of the way the patient walks including load distribution on each leg, stride length, gait symmetry, and more. This enables the personalised therapy programme to be developed in such a way that it responds to your unique therapy needs, as well as a source for objective comparison throughout your pathway of care.
Do I have to exercise with AposTherapy®?
The beauty of AposTherapy® is that it transforms your ordinary daily routine into a positive, pain-free rehabilitation process. Treatment aligns your body and re-educates your muscles with minimal interruption to daily life and maximum rehabilitation. In fact, you won’t feel as if you’re working your muscles at all, you’ll just stop noticing the pain.
Do I have to set time aside for AposTherapy®?
AposTherapy® takes place in your own environment and blends into your everyday life, for around an hour a day, making treatment easy to comply with for the best results. AposTherapy® allows you to decide the time and place, ensuring that therapy fits in with your lifestyle, as opposed to having to fit your life around therapy.
How long does the AposTherapy® process last?
AposTherapy® fits seamlessly into your existing daily routine needing only around an hour a day, at home or at work with no special exercises required. Your personalised treatment programme continues for an average of 6-12 month depending on your specific clinical needs.The process begins with visiting the AposTherapy® Centre for an initial consultation, typically lasting up 1.5 hours, and then 3-5 follow up consultations, typically around an hour each. The purpose of the follow-ups is to ensure on-going optimal progress and maximum pain relief.It really is that simple and easy!
How long before an improvement is felt?
Many AposTherapy® patients say they feel some pain relief during their initial consultation, while experiencing the unique biomechanical system for the first time. According to a survey of patients who had been suffering for an average of 6 years, patients reported reduced pain within 4 weeks of starting AposTherapy®1.A clinical study that monitored patients for two years attests to the lasting effect of AposTherapy®2. As with any medical interventions, individual results may vary.1. Independent survey conducted by Network Research in Nov., 2009 amongst 150 AposTherapy® patients.
2. Bar-Ziv Y. et al. Osteoarthritis and Cartilage 2010:15(Suppl. C):C83
How long does symptom relief last?
New data about the long term benefits of AposTherapy® is emerging on an ongoing basis. One recent clinical trial re-examined osteoarthritis patients two years after an original study had shown reduced pain and improved knee joint function with AposTherapy®. The follow-up found significant pain relief of 63% and 65% improved knee joint function even after 24 months1. 1. Bar-Ziv Y. et al. BMC Musculoskeletal Disorders 2010;11:179.
Who can benefit from AposTherapy®?
AposTherapy® was developed by orthopaedic doctors with the aim of helping people with disabling musculoskeletal disorders, particularly focusing on knee osteoarthritis. AposTherapy® has been found to be effective for the following conditions:
- Knee pain (Osteoarthritis, patellofemoral pain syndrome, meniscal tear, ligament tear)
- Low back pain
- Rehabilitation before and after total knee and hip replacement surgery
- Hip pain (particularly osteoarthritis)
- Ankle problems (rehabilitation post fractures, recurrent ankle sprain)
- Sports injury rehabilitation
Who is not suitable for AposTherapy®?
Generally AposTherapy® is not suitable for individuals who:
- Have sustained recurring falls
- Experience balance problems
- Suffer from severe osteoporosis
If in doubt please call us for a phone consultation with an AposTherapist to discuss suitability.
Do I need a prescription for AposTherapy®?
Anyone can come for a free initial consultation to establish whether they are suitable for AposTherapy®. You may however need a referral from your doctor to be eligible for coverage from your insurance provider.
Is AposTherapy® appropriate before joint replacement surgery?
If the surgery is in one month or more, AposTherapy® can prepare the joint for the surgery and enable muscle exercise until the surgery is performed. As a result of the treatment, the joint can learn how to manage proper and coordinated muscle movement, which will assist in returning you to normal function with less postoperative pain.
Is AposTherapy® appropriate after joint replacement surgery?
Yes. AposTherapy® enables efficient and relatively rapid rehabilitation, with less pain. AposTherapy® assists in the implementation of proper and symmetrical gait patterns following joint replacement, and will improve stability and confidence while walking.
Is AposTherapy® safe?
Yes. AposTherapy® is non-surgical and non-pharmaceutical. It is registered with the FDA and has a CE marking. AposTherapy® is appropriate for most patients of all ages including elderly patients. All AposTherapy® patients are continuously monitored. Clinical experience indicates that any side effects are minimal and rare and may manifest in mild fatigue and muscle spasms. In rare cases where they appear they pass very quickly as treatment progresses.
Does AposTherapy® work?
Clinical studies investigating AposTherapy® published in leading medical journals indicate significant reductions in pain and substantial improvements in joint function and quality of life. That’s because AposTherapy® was based on the latest evidence regarding the central role biomechanics plays in osteoarthritis and developed by orthopaedic doctors to offer a safe and effective new approach for the treatment and management of the disease. AposTherapy® has already benefited tens of thousands of people around the world and has proved highly effective in providing lasting pain relief and long-term improved function.
Where is AposTherapy® available?
Presently, AposTherapy® is available in the UK, Singapore, and Israel, and will be expanding to other countries in the near future.
Is AposTherapy® subsidised?
You may be eligible for cover under your private medical insurance plan, please call us for more details.