​​Your knees are your body's workhorses. They carry you everywhere you go. When they hurt or don't work correctly, you need relief.

​In a recent webinar, orthopedic surgeons Todd Kelley, MD and Dinesh Thawrani, MD, along with senior physical therapist Yasuhiko Inoue, PT, MPT, discussed knee pain causes and surgical and nonsurgical approaches to treatment.

“We will explore all non-surgical options first before surgery," says Dr. Kelley, “but sometimes there's a sweet spot when it's time for surgery. Sometimes the longer you wait, the stiffer the joint becomes, and the more weakness that you get, the more crooked the knee becomes in terms of bow legged or knock knee. And it becomes a harder surgery for us to do.

“It's also better to do surgery when you​'re relatively healthy. If you wait and you wait, there is a chance that you become unhealthy and now all of a sudden, you're not a candidate for that surgery anymore.

So it may actually be better to do surgery earlier when you're healthy, when you're active and when we feel that you're going to have your best recovery and quality of life."

Here's what you should know to keep your knees feeling great.

Causes of knee pain

There are many knee pain causes. Some lead to immediate pain and affect your everyday movement. Others, like long-term wear and tear, cause more gradual pain and swelling.

Common knee injuries include:

• Acute injuries—These sudden injuries involve damage to cartilage, ligaments, tendons or bones. Sports or accidents cause most acute injuries.
• Inflammation—Inflammation is your body's natural response to an injury. Common types of inflammation associated with the knees are tendonitis (inflammation of tendons) and bursitis (inflammation of the bursa, a fluid-filled sac that cushions your tendons).
• Arthritis—Arthritis is joint swelling caused by wear and tear on cartilage. Osteoarthritis is a common form of arthritis, especially in people over 40. Other forms of arthritis include rheumatoid arthritis (when the immune system attacks the joint), post-traumatic arthritis (arthritis following an injury) and post-septic arthritis (arthritis following an infection).

Arthritis can be genetic (passed down from family members), caused by old injuries or caused by obesity.

“Extra weight puts a lot of pressure on the joints and, over time, can take its toll," Dr. Kelley says.

It's also important to remember that knee pain doesn't always start in the knee.

“You know that old song," Dr. Kelley says. “'The thigh bone's connected to the hip bone. The hip bone's connected to the backbone.' That song is true. Sometimes, when people come in with knee pain, we examine the knee and get X-rays, but we find out it's not the knee causing pain after all."

The first steps for treating knee pain

If you have knee pain, you may think you need surgery. But other treatments may work to help you manage knee pain.

Inoue says the same strategies that are good for your overall health can also be good for knee pain prevention and reduction. These approaches include:

• Addressing depression or other mental health problems that impact your coping strategies
• Controlling weight
• Managing diabetes or heart issues
• Staying active
• Quitting smoking

Why quit smoking? “Smokers have a 50% higher risk of infection than non-smokers," says Dr. Thawrani. “Nicotine constricts your blood vessels. This restricts the blood flow, keeping the blood from getting where it needs to be to heal your knee, leading to that higher infection risk."

​Movement may be the most important way to keep knee pain at bay. Not only does physical activity help reduce excess weight, but it also keeps joints lubricated and flexible.

“My favorite saying is: 'motion is lotion,'" Inoue says.

When it comes to exercise, Inoue says you can improve pain, function and range of motion in a variety of ways. These include:  

• Adapt activities to avoid pain. Switch from high-impact exercises to low-impact ones, like walking, cycling, swimming, yoga, Tai Chi and Pilates.
  
• Strengthen your thigh muscles (quadriceps) to help you climb stairs and get out of chairs.
• Wear supportive shoes instead of flip-flops or sandals.

You may also benefit from diet changes and certain anti-inflammatory supplements when exercise isn't enough. Talk to your doctor about options that may work for you.

Taking knee pain treatment to the next level

If your knee pain doesn't improve with lifestyle changes and exercise, other nonsurgical treatment options may help.

Dr. Thawrani says braces, medications, injections, nerve blocks and emerging new treatments may relieve knee pain without surgery.

Braces

Some evidence shows braces can reduce knee pain, but Dr. Thawrani warns to be careful.

“Don't fall into the trap of television advertisements about specific braces. You don't have to spend a lot of money on these things. Talk to your physician. They will suggest a reasonable brace for you."

Medications and ointments

Over-the-counter anti-inflammatory medicines like acetaminophen or ibuprofen can help relieve knee pain. There's also evidence that ice and topical pain-relief ointments can help.

Injections

For longer-lasting pain relief, Dr. Thawrani recommends steroid or gel injections.

Steroid injections are the first option, he says.

“These injections give some relief that can last several months," Dr. Thawrani says. “Patients may need a repeat injection when the relief wears off. After some time, when this injection no longer works, we then talk about gel injections."

Like steroid injections, gel injections aren't permanent, and you may need to get them again.

Nerve blocks

Dr. Thawrani says nerve-blocking medication injected around the joints may offer temporary relief when other treatment options don't work. Nerve blocks work by blocking pain signals sent from nerves to the brain.

Emerging treatments

There is ongoing research on stem cell and platelet-rich plasma (PRP) injections, but so far not enough evidence to support their efficacy and safety. So, The Christ Hospital Health Network does not offer these injections nor do insurance companies cover the cost of these injections.

Surgery for knee pain

Surgery may be the best option for treating knee pain when nonsurgical treatment options don't provide relief.

Knee arthroscopy is one surgical option. During this minimally invasive procedure, doctors make small cuts in your knee and clean out damaged tissue in the joint. Knee arthroscopy allows doctors to treat small amounts of cartilage damage, but more severe cases may require partial or complete knee replacement surgery.

​Advances in pain management and new implants have led to over 95% success rates for knee replacement surgeries.  And newer plastics have increased the lifespan of artificial joints to more than 20 years, making surgery a more acceptable option for younger patients.

​Partial knee replacement surgery

During partial knee replacement surgery, your surgeon replaces only the specific damaged part of your knee rather than your entire joint.

​Partial knee replacement surgery is best for treating localized arthritis. This type of arthritis affects just one of the knee's three compartments.

Partial knee replacement surgery preserves healthy parts of the knee. Surgeons can perform this surgery using minimally invasive approaches, which may result in less pain and quicker recovery.

Complete knee replacement surgery

If you have severe knee pain and a partial knee replacement isn't an option, you may need a complete knee replacement.

During this surgery, your surgeon removes damaged cartilage and a small amount of bone at the base of your thigh bone (femur) and the top of your shin bone (tibia). Then, they implant metal parts to recreate the joint surfaces. Your surgeon then shaves off the underside of your kneecap (patella) and fits that area with a plastic component. Finally, they insert a spacer within the artificial joint.

​While knee replacement components aren't made specifically for you, your surgeon will customize each part for your knee.

“I have roughly 6,000 different combinations of implants on a shelf in the operating room," Dr. Kelley says. “We'll find the combination that matches your body and bone."

What to expect after knee replacement surgery

Recovery after knee replacement surgery involves immediate postsurgical care followed by a structured rehabilitation program.

While people often feel discomfort initially, within the first few months after surgery, you will likely see significant improvements in your ability to move and bend your knee.

Below is a timeline of what you can expect after knee replacement surgery:

• Immediately after surgery—You will likely go home the same day of your surgery. Your doctor will tell you what medications to take for pain, inflammation and swelling. You may notice bruising. Many people feel good after surgery, but you shouldn't overdo it. Follow your doctor's suggestions regarding activities.
• First month after surgery—You will start physical therapy a few days after surgery. Your physical therapist will focus on helping you reduce pain and swelling and improve your range of motion. Recovery during this first month may feel challenging. You may experience pain, swelling and stiffness. This discomfort can make daily activities difficult and may leave you questioning your decision to have surgery.
• Second month after surgery—Physical therapy during the second month will emphasize strengthening the muscles that help you move. You will notice you're better able to move without assistance. You may also be able to climb stairs with support. Many people report they sleep better, and daily activities become easier during this time, and now understand why they had surgery. Depending on the physical demands of your job, you may be ready to return to work. 
• Third month after surgery—After three months, you will likely notice significant improvements in your quality of life. Physical therapy during the third month focuses on improving balance and preventing falls. Your doctor may allow you to resume activities like golf or pickleball. This is the stage most patients wonder why they didn't have surgery sooner.

Don't suffer through knee pain

Don't let knee pain hold you back from doing the things you love. You have many options to reduce your pain or help you live pain-free.

Click to learn more about our joint and spine services or to find relief for your knee or other joint pain. ​