What is Osteoarthritis?
Another common complaint from patients, and a close second to back pain is knee pain. Knee pain can stem from a series of different issues. The leading source being osteoarthritis.
Osteoarthritis (OA) is a degenerative joint condition that affects as many as 27 million Americans, according to the Centers for Disease Control and Prevention (CDC). It occurs when the cartilage that cushions the joints wears away.
Osteoarthritis typically has been viewed as an inevitable consequence of aging or injury, about which little could be done. Earlier on when patients first notice knee pain they do not always see a doctor.
- Patients will often try and rest their joints by avoiding exercise.
- For pain relief, patients will often take aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Which simply mask the patient’s symptoms without correcting the degeneration.
As the pain and degeneration advances, total knee replacements are often thought of as the only solution by the general public. Knee replacements have become more and more popular as the only solution to handling severe osteoarthritis in the knee.
How is Osteoarthritis Treated?
Again, here is where different healing disciplines differ widely on treatment.
An Orthopedic Surgeon will evaluate, and inasmuch as it probably will be a structural problem, have X-Rays, CT or MRI scans done to spot the exact area of concern, and will recommend, more times than not, surgery, which could range from a simple arthroscopic procedure of just repairing a meniscal tear, removing a tab of torn cartilage through arthroscopy (keyhole surgery), or using totally non-invasive laser, to arthroplasty (complete or partial knee replacement.)
An MD will examine the patient and evaluate the extent of injury and locate the area of pain, identifying the source as near as possible on the initial exam. Depending on the state of health of the patient, there can be a variety of diagnostic procedures indicated, such as a blood panel, X-Rays, CT or MRI scans, as the patient may have pre-disposing systemic or orthopedic problems that could affect the new problem of the knee (such as a back problem throwing undue stress onto the knee). The MD may prescribe pain killers, such as oxycodone which will temporarily kill the pain but is short lasting and again, possibly addictive.
A Physical Therapist will recommend exercise and various forms of massage without the use of drugs. Invariably a series of work-outs, isometrics and exercises and regimen that energize and rebuild structures that will assist healing will be given to the patient to do at home.
A Chiropractor will diagnose the area and try every possibility of repair and cure, as well as means of reducing pain for the patient, before sending the patient for surgery or other more invasive and serious treatment. Some of the recommended conservative actions may be:
- Lower limb muscle strengthening and aerobic fitness.
- Strengthening quadriceps and hamstring muscles, focusing on hip abductors---gluteus medius and minimus.
- Ambulatory aids-canes and crutches, weight reduction, physical therapy and exercise.
- Glucosamine and chondroitin sulfate taken together.
- Hyaluronic acid injections, which can be a natural, temporary solution.
- Stem Cell Treatment.
- Nutritional advice.
Total Knee Replacements
According to the Agency of Research and Quality (AHRQ), over 600,000 procedures were performed in 2009. That number is expected to grow into the millions by the year 2030.
Studies show that upward of 85 percent of people who undergo this surgery still have a functioning artificial joint 10-20 years after receiving it. However, wear and tear on the joint can adversely affect its performance and lifespan. Most Knee replacements have an actual average lifespan of 12-14 years.
A study presented at the 2014 American Academy of Orthopedic Surgeons (AAOS) meeting highlighted the rising numbers of knee replacement surgeries. When researchers reviewed hospital discharge data for more than 2 million people undergoing this procedure, they found the rate of knee replacements jumped 120% over a 10-year period.
The overall increase was steep, but it was even more pronounced in younger age groups. While the number of surgeries increased by 89% among those ages 65 to 84, they increased by 188% among those 45 to 64-years-old.
A person can only receive up to two knee replacements within their lifetime. If a patient undergoes a knee replacement surgery at age 45, they will likely need to undergo the surgery again by age 57-59. After that when the replacement wears out by age 80, the patient will not be eligible to undergo a third surgery and will at that point be very limited in their options, and most likely confined to a wheel chair.
Certain complications with a knee surgery may require a patient to undergo a second surgery within only a few years of getting the replacement, or sometimes within a few months. Vigorous exercise may loosen the implant, or infection may prompt a second surgery to be performed. At that point, a 45-year-old undergoing two surgeries within a 3-4 year span may find themselves confined to a wheelchair by age 64, after their second replacement wears out.
Aside from the above risk, most patients also do not realize that a knee replacement is more painful than they would expect. “People compare it to hip replacement, but knee replacement is a lot more painful early on," says licensed physical therapist Robert Fay, clinical director at Armonk Physical Therapy and Sports Training in New York. "It really can be difficult, especially the first few weeks, and it’s definitely something people don’t expect,” he says.
Another point patients do not usually account for when getting a total or partial knee replacement is the medications involved with this type of procedure. Patients are likely to be given morphine while they are in the hospital and then spend another 4 to 8 weeks or more on a prescription pain medication, usually an opioid like Percocet. Like all opioids, these are highly addictive and can make people feel depressed or constipated. Some patients on this medication have reported it causing them to feel nauseated and some even report the medication giving them psychotic symptoms. One patient when interviewed stated "I was hallucinating, I felt really weird and not myself."
Many patients often have to wean themselves off the medications over time, which is not always easy given the addictive quality of these types of pills. As many as one-fourth of people prescribed opioid painkillers get hooked, according to a study published in Mayo Clinic Proceedings.
The Use of Bracing in Conjunction with Treatment
There is a specific knee brace that can be used for osteoarthritis in the knee. This type of brace is referred to as an Unloading, or Offloading Knee brace. Also, some times it may be called an Osteoarthritis brace.
While this type of brace does not cure osteoarthritis or degeneration in the knee, it does several things that can be of great benefit to a patient with osteoarthritis.
An unloader knee brace is designed to lessen the pain of osteoarthritis. It unloads stress from the affected area. It puts pressure at three different points on the thigh bone. This action forces the knee to bend away from the painful area. The brace supports the side of the joint showing degeneration (either the medial or lateral compartment) by adjustment of the braces unloading hinge. By “unloading” the joint, the brace is opening up the space where the cartilage has been worn down, halting further degeneration while the brace is being worn.
While this is not a permanent fix, much like a back brace, this type of knee brace will give your patient an alternative form of pain relief to medication. This type of brace will also buy them time before having to resort to a knee replacement or give them time to find an alternative long-term solution.
There are 4 reasons for medical necessity for these types of knee braces which are:
- Knee Instability
- Knee Pain
- After Knee Surgery
If your patient meets a minimum of one of these requirements, they may be a candidate for and Unloading, or Osteoarthritis (OA) Knee Brace.
“Here's a little background for you: I live in a small suburb about 45 miles northwest of the City of Chicago, but I commute to Chicago by train four days a week to work.
The train station has two flights of stairs up and down to get to the trains. Once in Chicago I have a mile walk to work (currently I take the bus), so when I had to have knee surgery in March of 2017 it was a difficult task. At one point I had to have a Doctor repair my meniscus, shave bone to avoid bone on bone, clean up the arthritis and even drill holes in my bone to promote blood flow. Everyone told me I would be better after the surgery, well I wasn't, I was worse!
I went into Active Medical Center in West Dundee, IL and met with Dr. Mike and the team. They fitted me for a knee brace and explained to me how and when to be wearing it. Less than 3 weeks after working with Active Medical Center and using this brace, I was able to walk half a mile with the brace on and no pain!!
This is the first time since surgery that I have little to no pain, what used to be an 8 every day on the pain scale is now a 4 sometimes. Every day my knee is better and better. I had to take steps one at a time, I can now take steps like everyone else up and down! My goal is to get off the bus and walk to work by summer with no brace. If this keeps up that goal will be my reality!”
So why don’t more doctors turn to bracing as an option?
Orthopedic surgeons are the top prescribers for LSO back braces and offloading knee braces. Patients undergoing back, or knee surgery are prescribed an LSO back brace or OA Knee brace by their surgeon to wear post-surgery. Orthopedic surgeons are meeting the fourth reason for medical necessity for an LSO back brace “To facilitate healing following a surgical procedure on the spine or related soft tissue.” And they are meeting the fourth reason for medical necessity for an OA Knee brace “After Knee Surgery.”
So, we will need to rephrase the above question. The real question is, why don’t more doctors turn to bracing as a preventative measure, before resorting to back or knee surgery, or as an alternative to pain medications?
Let’s take a look at a Doctor of Osteopath and Doctor of Chiropractic. Both these types of doctors are considered doctors of the spine, and the majority of the patients seeking out a Chiropractor or DO have a back problem and are suffering from back pain to some degree. Often if a patient is suffering from back pain, it can be found they also are experiencing some sort of knee pain (often from Osteoarthritis in varying degrees.)
It also can be noted that a large majority of Chiropractors seek alternative solutions for handling pain other than opioids or pain medications. So why don’t these types doctor’s turn to LSO and OA braces as a short-term solution for handling their patient’s pain?
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