Case study ( 6440 views as of December 19, 2018 )
Eileen, a 58-year-old female, complains of increased pain in the right knee over the last eight months. She has a history of pain in the right knee, which started last summer when she started walking in the evening with her husband to lose weight. She has given up walking regularly and now finds she is limping and having trouble going up and down stairs. Last week she saw her doctor to determine the cause of her knee pain. Her doctor ordered X-rays of the knee and told her she has advanced arthritis and will eventually need a knee replacement. The only advice she was given by the doctor was to lose weight. Eileen wants to avoid knee surgery, and she is thinking of paying privately for an MRI as her doctor says there is 'no indication' to have an MRI.
The rheumatologist advises her to confirm the correct diagnosis with standing X-rays. If standing X-rays show she has complete loss of the cartilage, also known as 'bone on bone', her doctor may be right about having advanced arthritis. It is important however, to rule out other causes of knee pain. More likely, she has either early to moderate osteoarthritis of one of the standing compartments of the knee, usually the medial or inner distal thigh. However, it is very common to have pain in the front of the knee, known as patellofemoral pain. It tends to come on when doing stairs (particularly down) or getting in and out of a chair. It also usually improves with quad strengthening exercises. A doctor might suggest a local physiotherapist that can help.
Eileen's concerns include what medications should she take, and whether it is really that important to lose weight. The rheumatologist advises her that acetaminophen is usually the first line of medication. Her doctor might suggest this if there are no contraindications. Losing weight has many health advantages, but the doctor is right about the importance of weight reduction if she has arthritis of the knee. Even an extra 10-20 pounds can cause a force several times that weight across the joint because of the "lever effect". The lever effect explains why a small child can lift an adult on a teeter-totter. A combination of weight reduction and quad exercises may put off knee surgery for years.
Eileen may also wish to consult with a registered dietitian and/or exercise professional who can assist her with developing an appropriate exercise program and healthy eating plan to support her weight loss efforts, and avoid injuring her knee.Author: Dr. John Wade