Do You Have Knee or Hip Pain?

Your joints are involved in almost every activity you do. Simple movements such as walking, bending, and turning require the use of your hip and knee joints. Normally, all parts of these joints work together and the joint moves easily and without pain. But when the joint becomes diseased or injured, the resulting pain can severely limit your ability to move or work. Use the following links to learn more about joint pain's causes and treatments. Gaining as much knowledge as possible will help you choose the best course of treatment to help relieve your joint pain - and get you "up and running" again.

How a Healthy Joint Works
Common Causes of Joint Pain
Obtaining a Quality Diagnosis
Treatment Options
Total Joint Replacement

How a Healthy Joint Works

A joint is formed by the ends of 2 or more bones that are connected by thick bands of tissue called ligaments. For example, the knee joint is formed by the lower leg bone, called the tibia or shinbone, and the thighbone, called the femur. The hip joint is a ball-and-socket joint, formed by the ball, or femoral head, at the upper end of the thighbone, and the rounded socket, or acetabulum, in the pelvis.

The ends of the bone in a joint are covered with a smooth, soft material called cartilage. Normal cartilage allows nearly frictionless movement. The rest of the surfaces of the joint are covered by a thin, smooth tissue lining called the synovium. The synovium produces fluid that acts as a lubricant to reduce friction and wear in the joint.

Common Causes of Joint Pain

One of the most common causes of joint pain is arthritis. The most common types of arthritis are:

• Osteoarthritis (OA) - sometimes called degenerative arthritis because it is a "wearing out" condition involving the breakdown of cartilage in the joints. When cartilage wears away, the bones rub against each other, causing pain and stiffness. OA usually occurs in people aged 50 years and older, and frequently in individuals with a family history of osteoarthritis.
• Rheumatoid Arthritis (RA) - produces chemical changes in the synovium that cause it to become thickened and inflamed. In turn, the synovial fluid destroys cartilage. The end result is cartilage loss, pain, and stiffness. RA affects women about 3 times more often than men, and may affect other organs of the body.
• Post-traumatic Arthritis - may develop after an injury to the joint in which the bone and cartilage do not heal properly. The joint is no longer smooth, and these irregularities lead to more wear on the joint surfaces.
• Avascular Necrosis - can result when bone is deprived of its normal blood supply. Without proper nutrition from the blood, the bone's structure weakens and may collapse and damage the cartilage. The condition often occurs after long-term treatment with cortisone or after organ transplantation.

Joint pain can also be caused by deformity or direct injury to the joint. In some cases, joint pain is made worse by the fact that a person will avoid using a painful joint, weakening the muscles and making the joint even more difficult to move.

Obtaining a Quality Diagnosis

The medical management of arthritis and joint degeneration may be handled by a family doctor, an internist, or a rheumatologist. However, when medical management is not effective, an orthopedic surgeon should be consulted to determine if surgery is an option. In some cases, the orthopedic surgeon may be the first physician to see a patient and make the diagnosis of arthritis.

The Orthopedic Evaluation

While every orthopedic evaluation is different, there are many commonly used tests that an orthopedic surgeon may consider in evaluating a patient's condition.

In general, the orthopedic evaluation usually consists of:

• A thorough medical history
• A physical examination
• X-rays
• Additional tests, as needed

A medical history is taken to assist the orthopedic surgeon in evaluating your overall health and the possible causes of your joint pain. In addition, it will help him or her determine to what degree your joint pain is interfering with your ability to perform everyday activities.

What the physician sees during the physical examination, which includes standing posture, gait analysis (watching how you walk), sitting down, and lying down, helps confirm (or rule out) the possible diagnosis. The physical exam will also enable the orthopedic surgeon to evaluate other important aspects of your hip and legs, including:

• Size and length
• Strength
• Range of motion
• Swelling
• Reflexes
• Skin condition

If you are experiencing pain in your hip joint, your back may be examined because hip pain may actually be the result of problems in the lower spine.

After the physical examination, x-ray evaluation is usually the next step in making the diagnosis. The x-rays help show how much joint damage or deformity exists. An abnormal x-ray may reveal:

• Narrowing of the joint space
• Cysts in the bone
• Spurs on the edge of the bone
• Areas of bony thickening called sclerosis
• Deformity or incorrect alignment

Occasionally, additional tests may be needed to confirm the diagnosis. Laboratory testing of your blood, urine, or joint fluid can be helpful in identifying specific types of arthritis and in ruling out certain diseases. Specialized x-rays of the back can help confirm that hip pain isn't being caused by a back problem. Magnetic Resonance Imaging (MRI) or a bone scan may be needed to determine the condition of the bone and soft tissues of the affected joint.

In order to assist the orthopedic surgeon in making a diagnosis, it may be helpful to write down your answers to the following questions before the appointment:

• Where and when do I have pain?
• How long have I had this pain?
• Do I have any redness or swelling around my joints?
• What daily tasks are hard to do now?
• Did I ever the hurt the joint or overuse it?
• Does anyone in my family have similar problems?

Treatment Options

Following the orthopedic evaluation, the orthopedic surgeon will review and discuss the results with you. Based on his or her diagnosis, your treatment options may include:

• Medication
• Physical therapy
• Joint fluid supplements
• Joint replacement

Medication

Many different medications are used to treat the pain and stiffness of arthritis. One of the most commonly prescribed types of drugs are the non-steroidal anti-inflammatory agents, or NSAIDs, which can be taken long-term to reduce both the pain and swelling caused by arthritis.

Another type of medication prescribed to reduce severe pain and swelling are corticosteroids. Corticosteroid injections offer quick, effective pain relief. However, they can be used only a few times a year because they weaken bone and cartilage. Also, corticosteroids can cause other potentially serious side effects; their use must be monitored by a physician.

Physical Therapy

Physical Therapy can be helpful in the management of OA and RA. For example, a physical therapist may recommend:

• Isometric ("pushing") exercises to help build muscle strength without subjecting inflamed joints to excessive wear
• Isotonic ("pulling") exercises to further increase muscle strength and help preserve function
• Daily walking, using a cane or other assistive device as needed

Joint Fluid Supplements

For patients whose knee joint pain does not improve with medication or physical therapy, "joint grease" injections may provide temporary relief. The knee is injected with a joint fluid supplement that acts as a lubricant for the damaged joint. Joint injection schedules and duration of relief vary according to the treatment chosen and the individual patient. However, these injections do not cure the diseased knee, and joint replacement may be needed as the joint worsens with time.

Total Joint Replacement

Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip or knee joint, are removed and replaced with a plastic or metal device called a prosthesis. The prosthesis is designed to enable the artificial joint to move just like a normal, healthy joint. To learn more, read Joint Replacement Facts.

Total Joint Replacement

Total joint replacement is usually reserved for patients who have severe arthritic conditions. Most patients who have artificial hip or knee joints are over 55 years of age, but the operation is being performed in greater numbers on younger patients thanks to new advances in artificial joint technology.

Circumstances vary, but generally patients are considered for total joint replacement if:

• Functional limitations restrict not only work and recreation, but also the ordinary activities of daily living
• Pain is not relieved by more conservative methods or treatment, such as those described above, by the use of a cane, and by restricting activities
• Stiffness in the joint is significant
• X-rays show advanced arthritis or other problems

What Is Total Joint Replacement?

Total joint replacement is a surgical procedure in which certain parts of an arthritic or damaged joint, such as a hip or knee joint, are removed and replaced with a plastic or metal device called a prosthesis. The prosthesis is designed to enable the artificial joint to move just like a normal, healthy joint.

Hip replacement involves replacing the femur (head of the thighbone) and the acetabulum (hip socket). Typically, the artificial ball with its stem is made of a strong metal, and the artificial socket is made of polyethylene (a durable, wear-resistant plastic). In total knee replacement, the artificial joint is composed of metal and polyethylene to replace the diseased joint. The prosthesis is anchored into place with bone cement or is covered with an advanced material that allows bone tissue to grow into it.

Total joint replacements of the hip and knee have been performed since the 1960s. Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients. While the expected life of conventional joint replacements is difficult to estimate, it is not unlimited. Today's patients can look forward to potentially benefiting from new advances that may increase the lifetime of hip and knee prostheses.

Recent Advances in Total Joint Replacement

Nearly half a million hip and knee replacements are performed each year in the U.S. using conventional metal/plastic prostheses. As successful as most of these procedures are, over the years, the artificial joints can become loose and unstable, requiring a revision (repeat) surgery.

These issues - together with the fact that increasing numbers of younger and more active patients are receiving total joint replacements, and older patients are living longer - have challenged the orthopedic industry to try to extend the life cycle of total joint replacements.

Recent improvements in surgical techniques and instrumentation will help to further the success of your treatment. The availability of advanced materials, such as titanium and ceramic prostheses and new plastic joint liners, provide orthopedic surgeons with options that may help to increase the longevity of the prosthesis.

To learn more, contact your treating physician or orthopedic surgeon.

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