persistent knee pain

Greater pain sensitivity found to increase risk of developing permanent knee pain

 There’s very little in life worse than constant, nagging pain in a certain part of your body, and if you’re not aware of that yet, consider yourself very lucky, because it can impact upon your entire lifestyle. And if the part of your body that’s affected happens to be your knee, you already know the obstacle it presents during your day-to-day routine.

We know the role that pain plays in body mechanics, and how it acts as a vital signifier that something has gone amiss. And while many people react to pain by getting themselves checked out and seen to at the earliest opportunity, others will either ‘tough it out’ and try to work through the pain, or shy away completely from the risk of aggravating it. And according to a recent study, compiled by researchers in Montreal and Boston, the latter group are jacking up the risk of their condition becoming permanent.

The study, which was conducted by study teams from Université de Montréal, the Maisonneuve Rosemont Hospital Research Centre (CRHMR), and Boston University, analysed the data of 852 adults aged between 50 and 79 who were diagnosed with or at risk of contracting knee OA, but who weren’t suffering from persistent knee pain at the beginning of the study.


Tolerance to pain essential for avoiding knee arthritis

The research teams scoured each subject’s sociodemographic data and pain sensitization measurements, as well as looking for risk factors traditionally associated with knee pain such as psychological factors, widespread pain and poor sleep. They were then monitored for the development of persistent knee pain over the course of two years.

After crunching the data, the research teams managed to place members of the study group into four distinct subgroups which they called ‘pain susceptibility phenotypes’ – in other words, graded by their varying degrees of pain sensitisation, and discovered that those with the highest degree of sensitisation had the highest risk of developing persistent knee pain.

Out of those in the high-risk group, the biggest sociodemographic predictors were females, non-Caucasians and people aged over 65.

The researchers believe identifying these pain susceptibility phenotypes could be a very important development in understanding the complex pathology of knee OA – and that helping potential kn
Bristol: ee OA sufferers to build up their tolerance to pain or help them avoid pain altogether is crucial in improving their quality of life.

How can a low tolerance to persistent knee pain aggravate and even accelerate the onset of OA?

It’s simple: the instinctive response to knee pain is to not do anything to bring it on, which leads to a sedentary lifestyle – which can lead to an increased risk of developing factors that bring on OA, such as obesity and underuse of the joint mechanism. Medication can help to a certain extent – but both doctor and patient need to be aware of the risk of relying on painkillers to get through the day.

A more prudent approach may be to work out and adhere to an exercise programme geared towards safely and effectively strengthening the muscles around the knee.

walking could delay need for knee replacement surgery

A brisk walk a day could delay need for knee replacement surgery

If you suffer from knee OA and you’re worried that walking across the park or leaving the car at home when you nip to the shops is going to make matters worse, then think again: a new study from America claims that if older adults with the ailment added a mere five minutes of brisk walking to their day, the odds of them needing knee replacement surgery could drop by as much as 16 percent – as long as the walking pace is a notch up from a mere saunter.

The study, which was conducted by scientists at the University of Delaware, provided portable tracking devices to over 1,800 older adults with knee arthritis and monitored their walking intensities for at least four days, in an attempt to examine the effects of replacing non-walking time with time spent walking at different intensities. Their findings?

Substituting just 5 minutes of downtime with moderate-to-high intensity walking was linked to a 16 percent decline in the odds of needing knee replacement surgery. By ‘moderate-to-high intensity’, they mean a brisk walk which takes in over 100 steps per minute.

Why does walking work? There are four key reasons;

Walking rebuilds the joints

Cartilage – the joint tissue which acts like a shock absorber for your knees – can become damaged and worn, which brings on knee OA, resulting in pain, stiffness, and difficulty in moving. But cartilage can also repair itself and can absorb the nutrients from the compression and decompression of your body weight as you walk, meaning that a brisk yomp can speed up that repair job.

Walking strengthens the legs

…and stronger leg muscles can not only take a level of pressure off your joints, but they can also handle more of your body weight, resulting in less knee pain.

Walking helps to lose weight

One pound of weight lost equals four less pounds of pressure on your knees – and less pressure equals less pain. And the best low-impact method of losing weight is to commit to a more intensive daily walking distance.

Walking can help boost mental well-being

Like all exercise, walking is one of the best natural ways of getting your endorphins to kick in.

The great thing about the results of the study, according to the research team, is that for the majority of people, it’s not going to be that much of a lifestyle change. Furthermore, it wouldn’t require the expense of a gym membership or any equipment other than a pair of comfortable shoes or trainers. As they point out, the best exercise programmes are the ones you can actually stick to – and when the only sacrifices a person has to make is to get off the bus a stop earlier or actually get leave the house a bit more, there’s an opportunity for the physical activity to snowball.

The moral of the story? Every journey begins with a single step – as long as it’s a brisk one.

knee replacement risks

Aspirin found to be effective for preventing blood clots after knee replacement surgery

It takes the edge off headaches, dulls toothache, makes period pains more manageable, helps you tackle colds and flu, and even be used to help prevent heart attacks and strokes. And according to a recent study from the University of Michigan, there’s a new use for the humble aspirin: as a cheap and effective replacement for expensive anticoagulant drugs to prevent the knee replacement surgery complication of blood clots.

Anticoagulant medication is a crucial component of the post-knee surgery recovery period because although the chances of a blood clot after knee surgery isn’t at all commonplace, it’s still something you really don’t want, as it could be fatal. There are plenty of anticoagulant options available to the medical community, but they all ‘up there’ in cost and make an expensive procedure even more expensive. So, finding a cheaper alternative with the same benefit would be a huge fillip to the global health community.

A cheap and accessible solution?

The study, which was published in JAMA Surgery last month, combed through the medical records of 41,537 patients in the US who had undergone knee surgery between 2013 and 2015, with a firm eye upon the medication they received after the op and the incidences of thrombosis – the medical term for a blood clot.

Among those who received no medicine post-surgery, the rate of thrombosis was 4.79 per cent. For those who were given prescription anticoagulants, the rate was 1.42 per cent. For those who were prescribed both an anticoagulant and aspirin, 1.31 per cent developed clots. But for those who used nothing but aspirin, the rate was 1.16 per cent. The research team deemed the statistical differences as ‘insignificant’.

The other key finding involved bleeding complications – a regular although comparatively rare consequence of using blood-thinning drugs – but the researchers found no difference between aspirin and the prescription drugs in the risk for that side effect either.

Is this the beginning of a switch away from expensive medication and a move towards something we can pick up from the supermarket for pennies? Not necessarily so, according to Dr Brian R. Hallstrom, an associate professor of surgery at the University of Michigan and the senior author of the study, who went to great pains to point out that the patients in the study had their medications selected by their doctors, and that the study itself was not a randomised trial. For example, if he were treating a patient who had experienced a blood clot in the past, he would still use anticoagulants. But he added; “Most people can get aspirin alone without much concern.”

In the meantime, it makes sense to touch upon what you, as a post-op patient, can do to avoid blood clotting. Two of the biggest risk factors for blood clotting is a previous history of blood clots, and if the patient is currently undergoing treatment for cancer. While you can’t do anything about either of those issues, you can take steps to avoid cutting by avoiding the other danger areas: excess weight, sedentary lifestyle, and a smoking habit.

Also, if there’s a family history of blood clotting or you’re taking hormonal medication (such as birth control), your knee replacement surgery specialist will establish this when taking your medical history prior to surgery.

Blood clots are a risk after any orthopaedic surgery, but preventative measures adopted by Mr Jonathan Webb and his team have greatly reduced this risk.

total knee arthroplasty

Walking could be key to avoid total knee arthroplasty

When it comes to knee OA – along with every other medical issue – prevention is always better than cure, and anything which can keep people off the operating table is always worthy of attention. And a new report – from a study team at the University of Delaware – is another firm endorsement to the power of walking to prevent total knee arthroplasty.

The study – which set out to determine if there was a link between walking intensity and the risk of total knee arthroplasty, be it positive or negative – studied the data of 1,854 participants who were marked as ‘at risk’ on the Osteoarthritis Initiative (the American data repository which monitors and tracks all potential and actual knee OA cases). This meant they had not undergone a total knee arthroscopy over the research period, which was 48 months.

The study team also quantified and tracked the walking habits of each participant, first by giving each participant an accelerometer and tracking their steps over four days, and then by breaking the amounts of steps per minute down into four groups: non-walking (no steps per minute), very light walking (1 to 49 steps per minute), light walking (50 to 100 steps per minute) and moderate-to-vigorous walking (over 100 steps per minute).

The results determined that an extra five minutes of moderate-to-vigorous walking instead of non-walking can reduce the risk of total knee OA by 16%, while the same five minutes of very light or light intensity walking has no overall effect.

So why is this? Well, there three established points of view about the benefits of walking:

Walking rebuilds the joints

Cartilage is the tissue in your joints which acts as a shock absorber for your knees. Unfortunately, they can become damaged and worn, which can bring on OA, resulting in pain, stiffness, and difficulty in moving. Because cartilage acts like a sponge, it can absorb the nutrients from the compression and decompression of your body weight as you walk, meaning it can attempt to repair itself faster.

Walking strengthens the legs

This is very important: walking, like all exercise, helps to build leg muscles and stronger leg muscles can take a level of pressure off your joints and can handle more of the weight themselves, resulting in less knee pain.

Walking helps lose weight

Studies prove that one pound of weight lost removes four pounds of pressure on your knees – and less pressure equals less pain. That’s a huge difference, and the best low-impact method of losing weight is the extension of your daily walking distance.

“Walking may exacerbate knee pain and further make things worse, but on the other hand, walking is helpful to build and maintain strength and may prevent the development of difficulty functioning,” said study co-author Hiral Master, PT, MPH, during the presentation of the study in Chicago last month. “Small changes in walking behaviour could delay the need for total knee arthroplasty in people with or at high risk of knee osteoarthritis.”

knee replacement surgery specialist

Could a glass of wine a day keep knee pain away?

If you’re unfortunate enough to be suffering from knee osteoarthritis, you know all too well that you’ll try anything to take the edge off the pain – and a new study from the Al-Rafidain University College in Baghdad attracted a lot of attention last month, as it claimed that a compound called resveratrol has the potential to bring a substantial amount of relief to osteoarthritis sufferers.

As resveratrol is chiefly found in red grapes, and red grapes are used to make red wine, it’s not surprising the story got a hefty amount of headlines.

The study – which involved 110 patients – investigated the potential of red wine as an OA symptom alleviant by splitting up the study group into two, and giving one group a resveratrol treatment and the other half a placebo. In the end, the research team discovered that the group on resveratrol not only reported much less pain than the placebo-taking group, but also measurably showed less physical markers of inflammation.

Red red wine goes to my knee

We’ve known for a while that red wine – taken in moderation – boasts a welter of health benefits. For starters, it’s a natural antimicrobial agent – which can help our immune system fend off the likes of Staphylococcus aureus, Clostridium perfringes, Bacillus sp. and Klebsiella sp. More importantly, it’s very good at attacking S.aureus, which is the leading cause of septic arthritis.

Moreover, it’s been demonstrated that red wine is very effective in preventing cartilage damage and protecting our bones, preventing disease progression in osteoarthritis, fending off the onset of gout and improving metabolic health – and can even aid weight loss. The more you look into it, the more you believe that this stuff should be on the NHS. However, there’s a catch…

…you’d have to get legless

The bad news is that a glass of wine contains a tiny amount of resveratrol, and to receive the full benefits of it, you’d have to get through a glass big enough to contain eleven litres of plonk a day to get the recommended amount used in most studies – which would definitely go some way towards alleviating knee pain, but would cause far more health problems.

No doubt there’ll be more studies about the potential benefits of resveratrol and, maybe, one day scientists will work out how to deliver enough of it to fend off the effects of knee OA – but until then, we’re going to have to rely on the very real benefits of knee replacement surgery – be it total or partial replacement.

It’s a procedure which can become necessary at any age, due to ageing, injury or disease, and is required when the current knee has deteriorated to the point where your mobility has been sufficiently reduced and you are experiencing pain.

Runner's knee injury

New study reveals perfect running technique to avoid runner’s knee

It might sound strange – particularly to the layperson – but the professional athlete knows how to run correctly. For most people, running – like walking – seems as it should be one of the most natural things in the world: if you’re not falling over, you must be running correctly, right?

However, a new study from Salford University has demonstrated that there is a correct style of running – and if you’re a regular jogger who isn’t adhering to the proper technique, you’re running the risk of developing myriad ailments and injuries down the line.  The study also revealed that, if you’re one of the people who doesn’t know what that technique is, you’re not alone.

Researchers at Salford University’s Running Performance Clinic, used 3D infrared cameras to analyse the running style of 72 joggers. Not any old joggers, though – all volunteers were sufferers of common running complaints, from patellofemoral pain (runner’s knee) to medial tibial stress syndrome (shin splints).

After the various techniques were analysed, the research team then switched their attention to a pool of 36 runners who had never suffered a common injury, filming their styles – and after running the rule over both groups, the research team discovered that pelvic drop (a positioning which lowers the pelvis, obviously) was the key factor: they found that for every 1° increase in pelvic drop, there was an 80 per cent increased chance of a runner’s knee injury.

“These running injuries are some of the most common experienced by runners and can lead to considerable time off the roads,” claimed Chris Bramah, who led the study team. “What we wanted to do with the study is identify whether there were aspects of running technique that may be contributing to these injuries. If so, we can hopefully use this information to help runners recover from injury, and prevent future injuries happening.”

How to prevent runner’s knee

Why would pelvic drop be the prime culprit for so many ailments? According to the study team, a posture with excessive pelvic drop creates extra stress throughout the entire body, meaning that the weakest part of the lower body – the knee, maybe, or the Achilles, or anywhere else – is the first to go. And while other poorly-performed techniques were also pinpointed, such as an outstretched leg, high foot angle at initial contact and a greater forward lean, the detection of pelvic drop as a major knock-on factor should be a wake-up call for all runners, be they professional or otherwise.

While the research team are now looking into the effects of step rate and cadence on a runner’s risk of injury, their latest study is a timely reminder that it always pays to keep tabs on the fundamentals. If you feel that your current technique could do with a tune-up – or you’re wondering if the way you’re currently running could be the cause of recent setbacks – it makes sense to turn to a knee injury expert for an MOT at your earliest convenience – and if you can get someone to video your next treadmill session, even better.

hip and knee replacement combined

Joint replacement of the hip and knee does not mean an increase in short-term complications

Although they’re two very separate parts of the body, our hip and knee joints have an uncanny ability to wear out at the same time. It’s not that much of a mystery when you think about it – the deterioration of one means we tend to put excess pressure on the other when we go about our day-to-day business.

Consequently, total hip and knee replacement procedures overlap more often than we think. Makes perfect sense from a medical point of view – if you’ve come in for one treatment, it saves time and money to get both parts replaced. However, concerns have been raised across the board by both practitioners and patients about the safety and quality of this scenario, and for good reason: they are two very distinctive and incredibly specialised procedures. And naturally, the risk of post-surgical complications automatically double – if one goes wrong, the patient will find it difficult to perform the necessary exercise regime required to bed the other replacement in.

Hip and knee replacement combined

However, a recent study compiled by the Department of Orthopaedic Surgery at Ohio’s  Cleveland Clinic and its counterpart at the SUNY Downstate Medical Center in Brooklyn, found there is very little risk involved in ‘joint’ joint replacements. And in many cases, there is a strong link between dual replacement procedures and a general improvement in patient quality of life.

The study, which aimed to compare the operative time and the incidence of 90-day complications between overlapping and non-overlapping total joint arthroplasties, as well as evaluating the effect of the duration of overlap on operative time, scoured the data of 9,192 patients who underwent primary total hip arthroplasty or total knee arthroplasty at a large academic hospital from 2005 to 2014.

Their ground rules for what constituted an ‘overlap’ procedure and what didn’t was simple: a procedure was defined as ‘overlapping’ if it had an incision to closure overlap time of at least 1 minute with any other surgery performed by the same surgeon. According to their findings, a total of 2,669 procedures fell into the ‘overlap’ bracket – which was 29% of all replacement procedures.

After examining the length of operative times and the incidences of complications within a 90-day period between both overlapping and non-overlapping surgeries – and adjusting for baseline characteristics – the research teams came up with the unsurprising finding that operative times were longer for the overlapping surgery group. However, when they examined the instances of wound dehiscence, superficial infection and wound hematoma, they discovered very little difference in the overlapping and non-overlapping groups. And when it came to instances of thromboembolic events and periprosthetic joint infections, there were fewer occurrences amongst the group who had had both procedures done at the same time.

So what conclusions can we draw from this? From the practitioners’ viewpoint, a dual joint replacement procedure isn’t the risk that many thought it was. Although overlapping surgeries are inevitably a more drawn-out procedure, they can save time and money in the long run, for many reasons. For the patient, the findings can be a reassuring factor. It’s clear that the medical community is more than capable of delivering a quality procedure while addressing two major problems at the same time, and one period of recovery is always better than two.

ACL Tears in Female Athletes

Gender difference in ACL tears identified in aim to improve outcome

With female sports continuing their rise to prominence, it’s no surprise that more and more women are beginning to participate. It’s also no surprise that more participants mean more sports injuries, and the race is on to understand the particular gender-related needs of injured athletes.

A new report, published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), has shed some light on the role that gender plays in the most common sports injuries and treatment outcomes. And the key points are interesting, to say the least.

We all know the key differences between the body structure of males and females: women have a narrower intercondylar notch and a smaller ACL, which makes them more prone to injury. They also have a wider pelvis, which applies more pressure to the inside of the knee, which can cause the ACL to tear. Their ligaments also tend to have more laxity than men’s, a microscopically slower response in knee-stabilizing muscles, and weaker hamstring strength.

More male sports injuries

However, the report discovered that male athletes still compromise the vast bulk of sports-related injuries (71% in all), due to greater exposure to high-risk activities. Fair enough – but this also increases the danger that the sports injury community are over-catering to the needs of male athletes, while saddling female athletes with treatment strategies that aren’t bespoke.
The study authors examined five common sports-related injuries – stress fractures, ACL tears, shoulder instability, concussion and femoroacetabular impingement – a condition in which extra bone grows along one or both bones that form the hip joint.

One particular study – which focussed on participants aged between 5 and 17 – threw up the following stats:

  • Females are more likely than males to sustain overuse injuries such as anterior knee pain, while males are at an increased risk of sustaining acute traumatic injuries such as fractures.
  • Females tended to demonstrate patterns of landing after a jump which are different from male landing patterns, and which are closely associated with ACL tears.
  • For both sexes, training programs can be used to teach at-risk athletes to modify landing patterns, in order to help prevent ACL injury.

Bespoke treatment is key

Lead study author Cordelia Carter, MD encapsulated the findings by stating; “Males and females have different risk factors for experiencing SRIs. Anatomic and physiologic characteristics such as skeletal structure, muscle mass, ligament laxity, and hormone levels differ between the sexes and may contribute to disparate injury risk.

“The best ways to avoid or treat a sports-related injury in a male may be different for a female. Understanding the sex-based differences can help orthopaedic surgeons be better equipped to care for patients with these injuries and improve their treatment outcomes.”

The moral of the story? One-size-fits-all treatments run the risk of destabilising injured female athletes, and we are still in our infancy when it comes to the role of gender in sports injury.

ACL injuries in young athletes

Fatigue is key risk factor in ACL injuries in young athletes

We’re all aware of the dangers of burnout in young athletes, but new research presented by the American Orthopaedic Society for Sports Medicine shows has added a new and even more dangerous factor: the increased risk of ACL injuries in young athletes.

We all know the damage an ACL injury can do to a sporting career: the anterior cruciate ligament is an incredibly vital component of the knee, playing a crucial role in the restraining force of the knee. If you’re playing a sport which requires a lot of lateral movement, such as tennis, football and volleyball, an ACL injury can be brutal. What’s more the long recovery period and achingly gradual recovery period from an ACL injury can be hugely demoralising on a young athlete.

Tiredness can kill a career

The research, conducted by researchers at the Henry Ford Health System in Detroit, studied 85 athletes over the course of 15 years in a range of sports – from track and field and basketball to volleyball and soccer. Utilising film of young athletes undergoing vertical and drop jumps, the researchers analysed the ergonomics of the jumping techniques, measured again fatigue levels.

Their conclusion: over half of the athletes who demonstrated over 20% fatigue showed an increased ACL injury risk, with female athletes and those over the age of 15 were more likely to demonstrate fatigued jumping that increased their risk of ACL injury.

Fatigue in young and potentially undisciplined athletes can bring on a lapse in concentration which affects the performance of the fundamentals a particular sport requires and is more than simple tiredness: symptoms of fatigue are similar to those of flu, and can be brought on by illness, depression, joint and muscle pain, stress, overextending, poor sleep, anaemia or a lack of physical activity.

There’s more to a movement than you think

Obviously we can rule out the last symptom, but the pressures endured by young athletes can easily mount up, and can easily play havoc (however momentarily) with the sensorimotor system – which helps us to sense our body position and formulate our next move, be it putting one foot in front of the other, coming to a stop, or – in the case of athletes – performing a series of movements a little bit faster and smoother than the average person. Think carefully about the mechanics of performing a jump: now think about them again. There are more elements involved in the performing a safe jump than you first thought.

While the sample size of the study was a relatively small one, it gives further guidance for coaches and how they should structure training sessions, taking into account the physical and mental state of their young athletes to prevent ACL injuries in young athletes.

London knee replacement surgery

As Queen reluctant to undergo knee surgery, what does recovery in older knee replacement patients entail?

The recent news story about the Queen turning down the opportunity for knee replacement surgery in order to carry on with her forthcoming engagements gives us the ideal opportunity to discuss knee surgery in older patients.

While most people the Queen’s age don’t tend to put themselves through the 200-plus engagements she goes through every year, we’re long past the stage where the older generation are expected to spend the rest of their lives sat in bath chairs – and today’s generation of seniors are certainly more active (and want to be) than their grandparents were. And when knee problems set in, many people in later life want to take advantage of new surgical advances.

A potential placebo effect

But is it worth it? A study conducted earlier this year by the John Hopkins School of Medicine in Baltimore looked into post-operation reports from people over 65 who had undergone arthroscopic partial meniscectomy – a procedure which involves shaving or cutting out damaged or torn tissue, which accounts for an estimated two-thirds of knee operations on the over-65s in the US.  And while the procedure is seen as a massively successful operation for younger patients who have suffered severe knee damage, the reports suggest it may not be the thing for seniors.

According to the study, which was published in February of this year, APM surgery only works on older patients as a placebo effect: the patient has had something done to their knee, therefore the knee must be better. In actual fact, studies prove that the procedure has little to no beneficial physical effect on patients over 65.

So, when is too old?

Then again, what the experts think about knee replacement surgery isn’t as important as what the patients feel after they’ve had it, and a few studies bear out the idea that it’s still worth it. A 2010 study found that patients aged 75 to 90 generally felt that knee surgery had improved the quality of their lives – out of the 48 people surveyed, all but one believed that having surgery was a wise decision.

A more recent study – conducted in 2014 – focused upon hip replacement surgery on people in their 90s and concluded that the results were comparable to a study group of younger patients – assuming that the older patient was generally in good health in the first place. However, and for obvious reasons, patients in their 90s stay in hospital for longer, and were more likely to be readmitted after three months – but infection rates were no different when compared to the younger study group.

So, in summary: it’s complicated, but not necessarily in a bad way. Some people of senior age will be happy to undergo London knee replacement surgery and feel better for doing so, while others will feel it’s not worth the bother and are willing to make accommodations to their lifestyle to work around their knee problems. Or, in the case of people like Her Maj, they’re just too busy to go through the downtime of surgery.