Knee and Hip Questions

Hany S. Bedair, MD, Surgeon, is board certified by the American Board of Orthopaedic Surgery and received his medical degree from Yale University School of Medicine. He completed his general surgical internship and residency in orthopaedic surgery at the University of Pittsburgh Medical Center. Dr. Bedair completed an orthopaedic adult reconstruction fellowship at Rush University Medical Center in Chicago. He also served as Clinical Instructor of Orthopaedic Surgery at the University of Pittsburgh Medical Center. Dr. Bedair answers your questions about knee pain.

How common is knee pain?
Knee pain is one of the most common conditions that cause people to seek medical care and has many different causes. Frequently, knee pain may be related to conditions such as overuse injuries like tendonitis, traumatic injuries like tears of the cartilage, arthritis or even pain referred from other areas of the body like the back or the hip.

What are some common overuse injuries of the knee?
Common overuse injuries of the knee include conditions like tendonitis and bursitis. Tendons and ligaments usually glide freely over and around the bones of the knee. Sometimes, however, these tissues don’t move smoothly resulting in friction. This increased rubbing results in inflammation and swelling, which frequently causes pain.

My knee pain has become worse with age. Could arthritis be causing my pain?
Yes. Arthritis is a term used to describe a specific group of diseases that can affect any joint in the body. In general, it refers to the erosion of the smooth and almost friction free cap on the ends of bones called articular cartilage. This cartilage allows the ends of bones to rub against one another in a smooth and pain-free manner.  

According to the Arthritis Foundation, 46 million Americans (nearly one out of every five adults) suffer from arthritis. There are many different types of arthritis, but by far the two most common are osteoarthritis and rheumatoid arthritis, and these two conditions can afflict almost any joint in the body. Osteoarthritis, the most common type, refers to a condition where cartilage wears out over time (commonly referred to as ‘wear and tear’ arthritis) due to forces across the joint over many years and may get worse with age.

Rheumatoid arthritis is a specific condition where the body’s own immune system causes it to slowly destroy articular cartilage. Unfortunately, the final result of most types of arthritis is a slow and irreversible process whereby the articular cartilage in a specific joint disappears. This then causes the two exposed ends of the bones to rub together which causes pain, stiffness, swelling and deformity. The two most common joints in the body affected by arthritis are the hip and the knee.

Knee pain is interfering with my everyday activities. What are my options to relieve my pain?
Most knee pain will resolve with time and rest. Avoiding activities that make the pain worse is extremely important in order to allow any injuries to heal. Oftentimes simple remedies like ice, elastic bandages, wraps and elevation of the leg are very effective treatments. Sometimes common over-the-counter medications like ibuprofen or naproxen can help as well, but checking with a physician before taking these medications is always wise. There are times, however, when none of these remedies work such as in the case of advanced arthritis of the knee.

I think I should make an appointment to get to the bottom of my knee pain. What is involved in a physical examination?
The physicians at the Jim & Ellen Kaplan Joint Center are extremely skilled in treating conditions of the knee. The visit generally starts with our doctors trying to understand when, why and how knee pain may be affecting your life. An examination usually involves gently moving the knee back and forth to test the ligaments, tendons and overall structure of the knee. Often, your physician may want to obtain an X-ray of your knee to better understand the cause of the pain. Based upon your doctor’s findings and your desires, an individually designed treatment plan is made to best serve your goals. Whether the best plan for you involves simple treatments or are more intricate, like surgery, the physicians at the Joint Center will work with you until your pain is resolved.

What treatment options are available at the Joint Center to treat my knee pain?
There are many ways to treat knee pain due to arthritis and the Joint Center offers all of these options. Non-surgical treatments for arthritis of the knee include physical therapy, weight loss, exercise, changing one’s activities, using assistive devices such as a cane, and taking anti-inflammatory medicines. Weight loss may have a substantial impact on preserving and prolonging the function of the knee. Activity modifications include reducing high-impact and repetitive activities that place increased stresses on the knee joint. Also, avoiding activities that require the knee to bend excessively may help with the symptoms of arthritis. Anti-inflammatory medicines, such as ibuprofen and naproxen, can reduce the inflammation around the knee caused by the arthritis and provide significant pain relief.  

If these treatments are not effective, you may be a candidate for knee injections with either viscosupplementation (gels) or cortisone (steroid injections).If these treatments fail to resolve knee pain and there is still significant pain, this disease may best be treated with a knee replacement surgery. Knee replacement surgery consists of resurfacing the diseased ends of the bone with metal and plastic. This procedure removes the arthritis from the knee and allows the knee to return to pain-free function.  

Knee replacements are either partial knee replacements or full (total) knee replacements. In a partial knee replacement, only the part of the knee with arthritis is replaced. This can be either the medial (inside of the knee), lateral (outside of the knee) or patellofemoral (under the kneecap) compartments. This procedure only treats the portion of the knee that is replaced, and so if there is arthritis in other parts of the knee, these areas will continue hurt. Because only a small percentage of people with knee arthritis have arthritis confined to only one part of the knee, most people are not candidates for partial knee replacement (this decision should be made in consultation with your physician). Most patients with advanced knee arthritis are best treated with a total knee replacement where the entire end of the femur and tibia are resurfaced with metal and plastic.
 

William Healy, MD, Surgeon, attended Amherst College and SUNY – Downstate and served as orthopaedic surgical resident at Johns Hopkins Hospital.

He is a professor of orthopaedic surgery at Boston University. Dr. Healy answers your questions about hip pain.

What could be causing my hip pain?
Hip pain can be caused by disorders in the spine, hip or knee. Orthopaedic surgeons at the Kaplan Joint Center use a history, physical examination and X-rays to diagnose the causes of hip pain and create individualized treatment plans.

The hip joint is a ball-and-socket joint, which is designed to allow a wide range of motion and withstand considerable wear and tear. The joint has a cushion of cartilage that helps prevent friction as the hip bone moves in its socket. With age and injury, the cartilage can wear down or become damaged. The hip bones can be fractured during a fall or other injury and muscles around the hip can be injured and overused. Any of these factors can lead to hip pain. Hip pain can be caused by several conditions:

  • Arthritis - Osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults. Arthritis leads to inflammation of the hip joint and breakdown of cartilage. Hip pain gradually gets worse as arthritis progresses and patients may report stiffness and reduced range of motion in the hip.
  • Hip Fractures - Fractures of the hip can occur at all ages, but they are more common in elderly people. With age, the bones can become weak and brittle and are more likely to fracture during a fall
  • Bursitis - Inflammation near the hip joint can be due to repetitive activities that overwork or irritate the joint.
  • Tendinitis - Tendons are thick bands of tissue that attach muscles to bones. Tendinitis is inflammation or irritation of the tendons and is caused by repetitive stress or overuse.
  • Fractures Muscle or tendon strain - Repeated activities can put strain on the muscles, tendons and ligaments that support the hips. When these structures become inflamed from overuse, they can cause pain and prevent the hip from functioning normally. 

What can I do to help relieve my hip pain?
Treatment of hip pain depends on the specific cause. An accurate diagnosis is key in selecting a treatment. Hip pain caused by a muscle or tendon strain, osteoarthritis or tendinitis, can frequently be relieved with an over-the-counter pain or anti-inflammatory medication. Ice and rest can also help with hip pain. If a patient has arthritis, exercising the hip joint with low-impact exercises, stretching and resistance training can reduce pain and improve joint mobility. Swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase range of motion. When osteoarthritis of the hip creates intolerable pain or limited function, a total hip replacement may be a treatment option.

What techniques will you use to diagnose my pain?
Diagnosing the cause of hip pain begins with talking to the patient to understand his or her pain and listening to the medical history. A physical examination allows the doctor to correlate the history of hip pain with the function of the hip joint.  

The physical examination for hip pain focuses on the hip, leg and back. The hip is examined at rest, while standing and while walking. The joint is tested for range of motion and strength and checked for sensation and pulses.  

X-rays of the hip are used to look at the bones and the joint spaces. Narrowed joint spaces and arthritis can be seen on X-rays and confirm the diagnosis of osteoarthritis.  

Advanced imaging such as computerized tomography (CT) or magnetic resonance (MRI) imaging may be considered to gain more information to make a diagnosis.

What are my surgical options for treating hip pain?
If non-operative treatments fail to relieve hip pain, surgical options include hip arthroscopy, osteotomy, surgical dislocation and joint re-contouring and total hip replacement. 

  • Hip Arthroscopy - Arthroscopic surgery is a minimally invasive procedure that allows surgeons to treat joint damage through small incisions. Unlike open joint surgery, arthroscopic joint surgery does not require the joint to be completely opened, resulting in shorter recovery times.
  • Hip Osteotomy - Osteotomy surgery is performed to re-align, shorten or lengthen a bone to correct uneven joint damage, straighten a bone following a fracture or change the way joints bear weight in order to relieve the pain from conditions such as arthritis.
  • Hip Replacement - Total hip replacement is a procedure where the joint is replaced with a joint implant. We routinely perform hip replacement and revision hip replacement at the Joint Center.

What common activities or sports could be affecting my hip pain?
At the Joint Center, we see many patients with hip pain who are involved in sports such as hiking, bicycling, yoga, pilates or karate. We work with these individuals so that they can continue to enjoy their favorite activities and live pain free. Some simple activities that can cause hip pain include: hip flexion, sitting for long periods of time, squatting, getting in and out of the car and putting on shoes and socks.

How can I keep my hip joints healthy as I age?
It is important to care for our bodies as we age. Pain can be avoided or minimized by maintaining a normal weight, avoiding obesity, eating a balanced diet and exercising routinely to preserve range of motion of the hip.  

Women should consult with their primary care physicians regarding preservation of bones and avoidance of osteoporosis with medications and other treatments.  

For older individuals, it is important to minimize the risk of falling and breaking a hip or sustaining other injuries related to a fall. Preventive measures include wearing shoes with a good tread, using a cane or walker for stability if needed and creating safe walking areas in the home that are free of clutter such as scatter rugs.  

It is important for patients of all ages to stay active, eat a balanced diet, avoid smoking and maintain good strength, flexibility and posture throughout life to allow the hip to move and function normally.

For more information about the Jim & Ellen Kaplan Joint Center at Newton-Wellesley Hospital, call us at 1-855-KNEE-HIP (563-3447) or visit nwh.org/jointcenter.