Podcast 004: Knee Osteoarthritis and Recovery from Knee Replacement Surgery

In this podcast, Dr Brendan Joss, Senior Exercise Physiologist and one of the owners of HFRC, talks about Knee Osteoarthritis and Recovery from Knee Replacement Surgery.

Did you know there are over 100 different types of arthritis?

Osteoarthritis is one form of arthritis that is the most common in the weight-bearing joints, like the hips and the knees.

In osteoarthritis we are seeing a degeneration of the articular cartilage that ordinarily works to provide smooth movement and a shock-absorbing affect between bones in our joints.

Osteoarthritis typically occurs through wear and tear or from an injury that disrupts the articular cartilage. It is more common in older adults and slightly more common again in women due to the different shape of the female pelvis.

Knee osteoarthritis limits people’s capacity to walk and do activities of daily living. People with the condition commonly experience pain during weight-bearing activities.

This pain is not from the osteoarthritis degeneration (as the cartilage doesn’t have nerves or a blood supply), but from the pressure that is applied to the underlying bone that is less protected as the cartilage reduces and weakens.

Patients with knee osteoarthritis also experience inflammation, stiffness when they first get up, pain during weight-bearing movement and lingering pain after activity.

The impact of pain

Pain that is experienced in the knee can affect the patient’s whole system. Once a patient gets pain, their natural response is to avoid the activity associated with causing the pain. This inhibits muscle use and then patients don’t want to walk as far, it is difficult to get out of a chair, the other leg and joints are overloaded etc. This leads to reduction in muscle function and strength. But if the muscles aren’t being used they become weaker due to inactivity and reduced range of motion – then muscular support to the joint is lost and the stress on the joint increases. And the vicious cycle of pain and inactivity goes on and on.

This inactivity can lead to weight gain, then a patient may change the way they walk which can lead to pain in the hip and back. Then the patient feels a bit down, restricted from what they normally do and depression can set in.

HFRC Pain Inactivity Cycle
HFRC Pain Inactivity Cycle

Alleviating knee pain

Ways to alleviate knee pain include medications, exercise and surgery. Surgery is the final stage of management and this involves total knee replacement surgery. It is wise to exhaust all other measures before having surgery.

The aim should be to restore the strength of the muscles supporting the joint. This can be done by engaging in tailored exercises that reduce the inflammatory process without impacting on the knee or increasing the load placed on the knee. Then the muscle becomes stronger and the patient can walk further without pain and return to more life function.

Traditional forms of exercise can aggravate the knee. However the right types of exercise will be more beneficial and relatively pain-free. These exercises are weight-supported and alleviate knee pressure while exercising the muscles around the knee joint. Walking for example, aggravates pain and swelling, however cycling takes the majority of the patient’s body weight through the seat allowing the knee to move with reduced or no pain.

Hydrotherapy or water-based exercises are another way to reduce the load on your joints. In chest-high water, there is 12 times more resistance compared with walking through air but with only half the body weight’s pressure. This can be an ideal way to exercise without pain.

Exercise can delay or prevent the need for full knee reconstruction surgery. HFRC has conducted a research project with patients considering knee reconstruction surgery. Results showed 20% increase in muscular strength, increased walking ability and 25 to 40% in self-reported pain and function. 40% of the group were able to delay their knee reconstruction surgery.

There are significant benefits to be gained from doing exercise. If you are considering knee replacement surgery – try some exercise beforehand. You will get an improvement in function and this may delay your surgery; or if you go through surgery you’ll be in the best physical shape to assist your recovery.

If you would like to get in touch with Brendan Joss, you can email him via brendan@hfrc.com.au or phone 08 9386 9961.

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