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Sports Medicine

Knee and Leg Pain

04/02/2010

Question:

I am 61 years old. About 5 years ago, I fractured the tibial plateau and had surgery by a respected surgeon, and excellent physical therapy. I was assured I would be jogging, skiing and bicycling again.

Some time ago I started hearing a "thunk" as I walk. The evaluation revealed the upper "ball" of the knee was falling in and out of a depression that had been worn.

Surgery was open to me as an option, but I was warned about the high incidence of complications and failure for knee replacement following tibial plateau fractuare. I decided I could live with it.

Now, however, as few as 50 steps causes me pain that can be on the knee itself, or above or below it. Taking a walk is no longer possible. My leg feels wooden below the knee, and I sometimes have pain like sciatic up the back. It is painful to put weight on, and to take weight off the knee. It won`t bend. then, just moments later, it will seem to be all right and walking is smooth. But I can`t walk a school or hospital hallway.

when I stand after some sitting, I have to hold on to something -- I look like a polio patient taking her first steps! I have tender muscle places which have hurt since the injury. Extensive standing is awful.

What is going on and do I have options other than surgery? Am I unnecessarily afraid of surgery? (I`m going to be on crutches pretty soon.) What should my next steps be?

Answer:

Knee replacement surgery is typically considered if, despite undergoing a comprehensive course of nonsurgical treatment, symptoms and function continue to worsen. The basis for your symptoms would be clarified by a physical examination and imaging studies, which would then determine appropriate treatment interventions. This information is of course available from a consultation with your physician.


If there is a "loose body" (composed of a fragment of cartilage, and possibly also bone, broken off from the joint surface) in your knee, it's possible arthroscopic surgery can be performed rather than knee replacement at this time. This possibility would be evaluated by imaging studies (at least knee X-rays, if not also a knee MRI scan).


Nonsurgical treatment options for knee pain - which may or may not pertain to your case - include the following:

1.      oral anti-inflammatory medications

2.      oral non-anti-inflammatory pain medications

3.      topical anti-inflammatory medications

4.      topical non-anti-inflammatory pain medications

5.      such "dietary supplements" as Glucosamine and Chondroitin

6.      knee injection(s) with steroids (cortisone) or "viscosupplements"

7.      knee braces of various types, including "unloading" designs

8.      such hand-held gait aids as a cane or crutch (or rollator walker)

9.      leg strengthening exercises, often provided by a Physical Therapist

10.  reconditioning exercises, particularly using a warm water pool

11.  well-cushioned footwear, and/or shock-absorbing insoles

12.  a sole wedge - if just one side of the knee (medial or lateral) is involved

13.  weight loss if appropriate

14.  acupuncture

15.  TNS (transcutaneous nerve stimulation).

For more information:

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University